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[undated; envelope of June 6, 1894, may belong to it]
With an unerring hand you have raised the question at the point I feel is the weak one. All I know about it is this: It quickly became clear to me that the anxiety of my neurotic patients had a great deal to do with sexuality; and in particular it struck me with what certainty coitus interruptus practiced on a woman leads to anxiety neurosis. Now, at first I followed various false tracks. I thought that the anxiety from which the patients suffer should be looked on as a continuation of the anxiety felt during the sexual act — that is to say, that it actually was a hysterical symptom. Indeed, the connections between anxiety neurosis and hysteria are obvious enough. Two things might give rise to the feeling of anxiety in coitus interruptus: in the woman, a fear of becoming pregnant; in the man, worry that his [preventive] device might fail. I then convinced myself from various cases that anxiety neurosis also appeared where there was no question of these two factors, where it was basically of no importance to these people whether they had a baby. Thus the anxiety of anxiety neurosis was not a continued, recollected, hysterical one.
A second extremely important point became established for me from the following observation: anxiety neurosis affects women who are anesthetic in coitus just as much as sensitive ones. This is most peculiar, but it can only mean that the source of the anxiety is not to be looked for in the psychic sphere. It must accordingly lie in the physical sphere: it is a physical factor in sexual life that produces anxiety. But what factor?