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The dynamic concept of instinctual drives and its extension in the libido theory forms one of the fundamental contributions of freudian psychology. This theory has been repeatedly challenged. Libidinal drives characteristically become attached to a number of prominent areas referred to as 'erotogenic zones'. The areas cathected depend upon a multitude of individual determinants as well as upon sociological and cultural factors and are customarily at mucocutaneous junctions.
Small discusses two cases of ulcerative colitis that terminated respectively in ileostomy and appendicostomy, in which the surgical openings were subsequently used as displaced genital organs for masturbatory satisfaction. In both cases there was a fear of genital masturbation. In the second case, the appendicostomy began to close when the patient resumed genital masturbation. The author believes that the character structure of the ulcerative colitis patient played an important role in the phenomenon cited. Patients who have had bowel openings for other reasons, such as carcinoma, do not ordinarily show the same type of erotic interest in their surgical orifices.