Coitus

COITUS (Latin), coition, sexual intercourse, sexual act. Observations of the process of coitus in mammals reveal significant differences among various species in the degree of penile erection, method of insertion into the vagina, position during coitus, movements during coitus, ejaculation, and separation of animals after coitus. In some animals (horses, monkeys), the penis reaches its highest degree of tension just before insertion; in others (bulls), the penis protrudes only slightly beyond the prepuce before coitus. In horses, the glans maintains the same volume before insertion into the vagina and after withdrawal; in dogs, however, the glans reaches its greatest size only inside the vagina. Insertion of the penis presents considerable difficulties in some animals. The tapir mounts the female from behind when the penis has not yet reached full tension but has merely emerged from the prepuce; upon contact with the female's external genitalia, the accessory glands of the penis secrete much fluid, the male performs a series of thrusting movements, and finally with great effort inserts the entire penis to the root into the vagina. In cats, due to the short length of the penis and its vertical position during erection, the male approaches the female from behind while she is lying on her abdomen and inserts the penis obliquely from behind into the vagina, with the female retracting her sacrum and thereby assisting in the upward rotation of the vulva. Many animal species (horses, tapirs, mice, monkeys) require movements (frictions) of the penis inserted into the vagina for ejaculation to occur. These movements are always performed uniformly. In some mammals (pigs, rabbits, cats, ruminants), no movements of the penis are observed. Ejaculation occurs at different intervals in different animals. Coitus lasts longest in kangaroos and bears (about 1/2 hour), during which time several ejaculations apparently occur; the participants remain in the same position throughout this time. In contrast, in ruminants the entire act lasts only a moment. After insertion of the penis, a single thrust is sufficient to cause ejaculation; this thrust in antelopes and deer can be so strong that the female may be simply thrown out from under the male. These peculiar differences in the duration of coitus, according to Disselhorst, are explained by the varying degrees of development of ampullary expansions at the distal end of the vas deferens. The position during coitus depends on the location of the genital organs in a given species, as well as on other physical characteristics. In porcupines, the male cannot immediately approach the female from behind due to the spines covering the posterior part of her body; she first raises the spines on her back and tail, the male approaches in a vertical position and inserts the penis, which stands at a right angle to his abdomen, into the vagina. In many animals (marsupials, rodents, most carnivores, monkeys), the male, during coitus, grasps with his forelimbs the posterior part of the female, behind which he stands on his hind limbs. In hedgehogs and beavers, the abdomens touch each other during coitus. Separation of animals after coitus generally occurs easily. Difficulties may arise only when excessive swelling of the glans occurs, for example in horses, which in young mares sometimes causes damage to the genital organs during coitus. Sometimes the swollen glans forces the animals to remain connected for a prolonged period (dogs).

During coitus in humans, the man is always active, while the woman can participate actively, but can also not participate actively, and merely play the passive role of a semen receiver. During coitus in humans, the erect penis spreads the walls of the vagina, which under normal conditions are closely apposed to each other; and with full insertion, it "fills it to a certain extent." The upward concave shape of the erect penis corresponds to the same shape of the vagina; insertion is facilitated by the ability of the vagina to stretch significantly. The circumstance that the woman's vagina usually corresponds to the average size of the male penis of a given race is also of considerable importance. Due to the onset of sexual excitement before insertion of the penis into the vagina, a sticky secretion is poured outward from the Cooper's and Littré's glands in the man, lubricating the glans and making it slippery; the preputial lubricant secreted by the Tyson's glands makes the glans fatty and also facilitates its insertion into the vagina. Before insertion of the penis into the vagina, a liquid secretion is excreted from the Bartholin's glands, the minor vestibular glands, and the cervical glands in the woman. This secretion in turn facilitates insertion of the penis and makes friction painless. The woman also participates in the friction; due to the abundance of muscles and veins in its walls, the vagina completely adapts to the volume of the penis during its movements inside the vagina; during this, involuntary rhythmic contractions of the vaginal walls occur due to the activity of the vaginal sphincter. These contractions are especially noticeable shortly before detumescence, i.e., before the moment of cessation of the swelling of the sexual organs, accompanied by ejaculation and orgasm. In some women, trembling of the vulva sometimes occurs at this time. During friction in both participants of coitus, a feeling of voluptuousness appears due to the excitation of nerve endings located in the man in the skin of the penis and especially in the glans, in the woman-in the glans of the clitoris, in the vulva, at the entrance to the vagina, and in the vagina itself. The state of excitation increases due to the summation of irritations. The latter are transmitted to the cerebral cortex, already excited by psychic irritants (olfactory, tactile and other impressions coming from the partner), and cause a series of reflexes in the genital-spinal center, the final link of which is the expulsion of semen in the man (ejaculation), secretion of the cervical glands and Bartholin's glands in the woman. Ejaculation is accompanied by the highest voluptuous sensation-orgasm; this is a special, specific sensation, which in its essence is no different from the feeling of tickling on the palms and soles; voluptuous sensation is therefore a special kind of tactile sensation. The origin of orgasm has not yet been clarified. It is possible that it is caused in men by the pushing of semen into the urethra through the narrow openings of the ejaculatory ducts; it is also possible that orgasm is caused by the contractions of the smooth muscle involved in ejaculation; but at the same time it is known that orgasm can occur without ejaculation (sometimes in aspermia) and may not appear even with ejaculation (sometimes in severe neurasthenia, further in chronic prostatitis or spermatocystitis, etc.). Orgasm apparently does not appear at all in the presence of psychic obstacles (indifference, aversion, fear of infection, etc.) or is significantly weakened at this time. According to Moll, orgasm occurs only when the act adequate to the sexual sensation is performed. Sometimes orgasm may be absent despite the performance of an adequate act, and for reasons that are not always known. Electivity plays a certain role here, due to which orgasm is experienced during coitus with one partner, but not with another. Electivity is less developed in men; in women, it is often a decisive factor for the appearance of sexual desire and especially orgasm. Orgasm is therefore dependent on both peripheral and central factors. In women, for the appearance of orgasm during coitus, the fulfillment of the following five conditions is necessary: 1) sufficient irritation of her erogenous zones, 2) sufficient excitability of the erection center, 3) sufficient excitability of the ejaculation center, 4) receiving sufficient irritation by both centers during coitus, 5) a proper state of the psychosexual sphere, i.e., psycho-erotic readiness for coitus. Failure to fulfill at least one of these conditions leads to the absence of orgasm in the woman. The constant absence of orgasm in the woman during coitus, i.e., her not receiving sexual satisfaction, can have a depressing effect on the woman's psyche, and also cause her a series of nervous sufferings, which proceed under a changeable picture of hysteria or have the character of neurasthenia; further, chronic inflammatory processes sometimes occur in the internal sexual organs. The woman's not receiving sexual satisfaction often depresses the psyche of her partner and can harm his sexual ability. The intensity of orgasm in a man, as in a woman, varies greatly depending on temperament and constitution; it ranges from a pleasant sensation to unbridled passion. Orgasm represents a nervous discharge, equal to which there is none in the body. The average duration of coitus is 2-6 minutes; some men manage to prolong the act to 10 minutes, rarely longer. The positions during coitus in humans can be very diverse; Vorberg describes 48 positions during coitus ("figurae Veneris"). Among cultured peoples, coitus is usually performed in the lying position face to face, with the woman (more rarely-the man) lying on her back; however, among a number of less cultured peoples (among the natives of Sudan and New Caledonia, New Guinea, some Eskimo tribes, southern Slavic peoples, especially in Dalmatia), coitus a posteriori is practiced, in which the man is behind the woman; among the mentioned peoples, the vulva is located more posteriorly in women. Among the natives in Australia (Miklukho-Maklai), the man squats between the thighs of the woman lying on her back, etc. The influence of coitus on the body. Sexual excitement is not limited to the sexual organs and their centers, but encompasses the entire organism. Sexual excitement depends on the irritation of sympathetic fibers going to the penis with the fibers of the 1st, 2nd, and 3rd sacral nerves; the state of irritation caused in this department of the autonomic nervous system is transmitted to the entire vasomotor nerve apparatus. The irritation of the autonomic nervous system is indicated by the injection of the conjunctiva, protrusion of the eyeballs, dilation of the pupils, accelerated heartbeat, hyperemia of the heart muscle, more intense excitation of the cardiac nodes during coitus. Due to the intensified cardiac activity, the tension of the arteries sharply increases, and blood pressure greatly increases. The pulse quickens and may become irregular. After a single coitus, the pulse very soon returns to normal; after multiple coitus, the pulse rate increases to 150 per minute, dicrotism of the pulse wave appears, and blood pressure falls. Some people breathe heavily during coitus, in others breathing is interrupted due to contraction of the laryngeal muscles; as a result, the air compressed for some time can be expelled outward with inarticulate sounds. In the limbs, convulsive twitching may be noticed, or on the contrary, they straighten out like iron rods; due to the compression of the jaws, the teeth grind; some subjects may go so far in their erotic excitement that they bite their partner to the point of bleeding. Sweat and tears often appear during coitus. The emotion at the highest moment of intense sexual satisfaction is so strong that a brief loss of consciousness may occur. The state described above, despite its short duration, causes a feeling of fatigue and drowsiness, weakly expressed in strong people and, conversely, extremely sharply expressed in weak people and sometimes in neurasthenics. Violently performed coitus makes considerable demands on the nervous mechanism of the cardiovascular system. In this connection, this mechanism is sometimes so shaken that even the thought of an impending coitus can cause palpitations, a feeling of tightness in the chest, and other distressing sensations, which are manifestations of cardiovascular neurosis. No physiological act, continuing for such a short period of time, causes such a strong reaction in the body and has such a relaxing effect as coitus. It is therefore clear that the most suitable time for it is going to sleep. For some people, coitus is a kind of sleeping pill. Some authors recommend as an exception to postpone coitus to the morning for those who do not have good excitement in the evenings, in order to use the erection that occurs in such persons in the morning upon awakening from sleep. Coitus performed in the morning often leads to a state of lethargy and fatigue for at least several hours. The relaxing effect of morning coitus is sometimes especially strongly manifested in neurasthenics. There are neurasthenics who are generally unable to tolerate the consequences of the sexual act; coitus apparently completely upsets their nervous system.

On the other hand, moderate indulgence in sexual functions sometimes produces a feeling of satisfaction and has a calming effect on the nervous system, and under its influence, distressing feelings of melancholy and vague anxiety sometimes disappear. Pathology of C. The pathology of C. should include primarily deviations from the conventional position of the participants in the sexual act. Such deviations include the standing position, which (if used systematically) can often cause painful sensations in the back after a relatively short time, and the sitting position, which facilitates injuries during C. (see below). Prolonged C. (prolongatus, protractus), which consists of repeatedly interrupting frictions to prolong physical pleasure, and incomplete C. (incompletus), which refers to cases where the man, due to fear of conception, does not carry the act to ejaculation and prolongs the C. itself, are also considered perversions. This perversion leads to stagnant phenomena in the prostate gland and seminal vesicles, as well as to the appearance of various nervous symptoms (fears, increased irritability, headaches, etc.). Furthermore, interrupted coitus (C. interruptus, reservatus, sterilis, congressus interruptus), which consists of the man withdrawing the penis from the vagina just before ejaculation, so that ejaculation occurs outside it, is considered a perversion. This requires extreme attention until the moment of ejaculation; the latter occurs less energetically than in natural C due to the change in the course of the excitation mechanism; the orgasm is weaker; hyperemia of the sexual organs persists for an indefinite time and disappears slowly. Since interrupted C. does not leave a feeling of satisfaction, there often arises a desire to repeat the act, to manipulate the female sexual parts, etc. Frequent interrupted C., practiced over a long time, can lead to various diseases of the sexual organs and a decrease in sexual ability; it often causes various neurotic conditions (especially the fear neurosis). In women, the effect of interrupted C. on health depends on the phase in which the interruption of the act occurs. The worst situation for her occurs if the interruption of C. happens when she is already considerably excited and approaching orgasm. Frequent interruption of C. can lead in women to stagnant phenomena in the sexual organs and to neurasthenia. Vestibular coitus (C. vestibularis, perinaealis) consists of the penis remaining at the entrance to the vagina with the intact hymen, and ejaculation occurs here. Paranymphal C. (C. paranymphalis) consists of introducing the penis not into the vagina but into other body openings [mouth (see Sexual perversions), anus (see Pederasty)]. Some authors see harm in C. performed with a prophylactic (C. condomatus). One cannot deny that using a condom can dull the sensitivity of the penis during C. and thereby prolong the act and consequently cause greater fatigue. According to observations by some authors, C. condomatus, practiced for several years, does not cause noticeable harm. However, in some cases, especially with an insufficiently thin condom, even numerous frictions are unable to bring C. to ejaculation. Excesses in C. (abusus sexualis, excessus in coitu, excessus in Venere). These should include everything that exceeds sexual need. However, it is difficult to determine where between the maximum and minimum of sexual activity lies its optimum. In each individual case, this depends on the degree of excitability, the strength of the sexual drive, and the power of inhibitory influences. If we consider average people who do not represent physiological deviations in sexual capacity, then it can be considered that under normal conditions, one sexual act every 3-4 days corresponds to the norm. The condition after excesses in C. sharply differs from the condition after normal C. Even 100 years ago, Lallemand described it as 'a feeling of sadness, fatigue, satiety, heaviness in the head, sleepiness, lethargy, slowness of thought, reluctance to move, uncertainty in desires.' A feeling of weakness in the legs, numbness in them, dull pains in the back, frequent pollutions, decreased sexual ability, and less frequently-headaches, dizziness, sometimes digestive disorders; in other words, a picture of so-called sexual neurasthenia develops. Sakharov suggests that the depression after sexual excesses is caused by auto-intoxication with intermediate, and possibly unusual, metabolic products. However, one should not overestimate the harm of excesses in C.; they are often only one link in a chain of factors harmful to the body.-- Obstacles to C. in men: sexual impotence (see Impotence) regardless of the cause; mechanical obstacles to C: very large hydrocele of the testicle, elephantiasis of the scrotum, large scrotal hernia, very large abdomen in general obesity, which covers the penis. In women: vaginismus, infantile condition of the sexual organs or far-advanced shriveling of them (in old women), further malformations of the external sexual parts, hymen or vagina, tumors (new growths, inflammatory tumors), absence of the vagina. Injuries during C. occur in men and women; minor injuries are more frequently observed, such as collision of heads, bites ('exaggerated' kisses), bruises against a hard bed. In men, mild injuries include tears of the prepuce and frenulum. Compression of one or both testicles often occurs in pendulous scrotum in elderly people, mainly in the knee-elbow position of the man, because the scrotum gets between the bodies of the C. participants. Bruises of the testicles also occur when they are kneaded during C., sometimes practiced by women to enhance the man's sexual ability. Ruptures of the urethra during C. have been described. Hemorrhages into the seminal vesicles are observed, recognized by the bloody color of the ejaculated semen. A rare injury is fracture of the penis (fractura penis), more precisely-a subcutaneous rupture of the tunica albuginea of the cavernous bodies of the penis; the sheath usually ruptures transversely due to external mechanical impact (a push in the direction of the longitudinal axis of the penis, excessive bending, twisting); this usually happens in an abnormal position of the C. participants, when the woman sits on the lying man, or when C. occurs in the sitting position, especially during riding (in a carriage or in an automobile), or when the C. participants touch their abdomens, but the head of each is at the feet of the other. Simultaneously with the rupture of the tunica albuginea, the integrity of the cavernous bodies is violated with significant hemorrhage into them. Dislocations of the penis have been described, which occur due to the detachment of the prepuce in the coronal sulcus; the skin is then pulled back from the penis and it disappears under the skin of the scrotum or pubis. Sometimes during C. in a woman, there occurs a spastic contraction of m. levator ani; as a result of this, such a strong strangulation of the penis occurs that the part of it located in front, especially the glans, becomes greatly swollen and the penis cannot be withdrawn from the vagina. A state of penis captivus ('captured penis') results, which requires the woman to be anesthetized or both participants to be placed in a warm bath to relieve it. In women during defloration, injuries to the entrance to the vagina and the vagina itself often occur, leading to severe diseases of the pelvic organs or to bleeding; the latter can take a threatening character. Neugebauer collected 157 cases of severe injuries to the woman's sexual organs during defloration from the literature; Lotmar added 12 more. Nathan described defloration pyelitis, caused by infection originating from tears in the hymen. These injuries to the sexual organs in connection with C., particularly with a very large penis, are observed mainly in children and in infantile individuals; if they occur in normal and deflowered women, it is usually in cases of abnormal position (standing, knee-elbow), with pathological changes in the tissues, or with C. shortly after childbirth. Death in connection with C. ('mort douce') occurs during C. or shortly after it. The sharp fluctuations in blood pressure described above, which occur during C., sufficiently explain the possibility of such death, which is preceded by some disease, such as arteriosclerosis or endocarditis. Death is most often observed in elderly men with sclerosis of the cerebral and coronary arteries, especially if preceded by a heavy meal and consumption of a significant dose of alcohol. Death occurs from apoplexy or embolism, sometimes from paralysis of the heart; in tuberculous patients-from severe hemorrhage. Mendel described a case of death during C. from hemorrhage into the spinal cord. History knows a number of cases of death during C. (the famous artist Raphael, surgeon Gunther, French president Faure, etc.).

Death during coitus occurs significantly less frequently in women; it was known in classical antiquity (the death of Lais, described by Ovid in the 1st century A.D.). Of course, this does not include cases where a raped woman dies from shock or from the consequences of injuries received during the rape. The causes of death during coitus in women are, in general, the same as in men. Cases of death in women related to coitus were described by Gumprecht, Flesch, and others.

L. Yakobson. From a forensic medical point of view, the question of former coitus arises: 1) in cases of rape and seduction, when the sexual act is performed under unlawful conditions, and the existing damage to the genital organs, inflammatory processes, and other consequences of coitus are evaluated in terms of severity according to the legislation of the USSR; 2) in cases of infection with venereal diseases, which may be connected with rape and seduction or may be observed as an independent crime (Article 150 of the Criminal Code, ed. 1929). - Bodies of persons who died during or shortly after coitus are subjected to forensic medical examination to determine the cause of death. There are indications that in persons who died during coitus (as in other cases of sudden death during severe physical exertion or convulsions), rigor mortis can develop very quickly and be very intense.