Other causes of impotence of libido in women are excesses in alcohol, bromides, cocaine, morphine and other narcotics and stimulants. Sometimes impotence of libido is the result of a hard confinement. During such confinements extensive lesions in the erectile tissues of the bulbs and in the sphincter cunni muscles are apt to occur. Now, the integrity of the vaginal bulbs, of the sphincter cunni, of the intermediary net of vessels, and of the clitoris is necessary for the normal experiencing of libido. If a serious lesion occurs, the blood current is interrupted, and the blood is prevented from leaving the bulbs and from entering the corpora cavernosa of the clitoris. The following case will serve as an illustration: The patient, twenty years of age, married twenty months, has a baby ten months old. She states that since her confinement she has no libido during coition. Before this event she always found perfect gratification. The examination shows a first-degree laceration of the perineum. Absence or smallness of the clitoris and an adherent prepuce may also often diminish the feeling of libido. _Pathology of male impotence._—The minute penetration into the different causes of sexual anaesthesia in the preceding pages was of particular importance, in order to fully understand the pathology of the different kinds of impotence. The accomplishment of the physiological act of copulation and impregnation requires from the man the possession, first of the desire to associate with the other sex, or of the instinct of voluptas,[AW] secondly the power of effecting intromission or the potency of erection, thirdly the potency of ejaculating a healthy sperma for impregnation, and finally it requires that libido or pleasure accompanies the emission to assure the repetition of the act. From these requirements it follows that the individual must command over four potencies, the potency of voluptas, which compels the individual to seek the society of the other sex, the potentia coeundi, which depends upon strong normal erections, the potentia generandi, depending upon normal secreting testicles, and upon the perviousness of the entire seminal canal, from the testicle to the meatus of the urethra, and finally over the potency of libido, which depends upon the intact centripetal nerves and normal centres of generation in the brain. If any of these potencies are missing, the individual will be impotent. Hence four kinds of impotencies may be distinguished in both sexes: (1) The impotence of voluptas, or the absence of sexual desire. (2) The impotence of immission, or absence of the power of erection in men and the anomalies at the entrance into the vagina in women. (3) The impotence of impregnation, or the absence of spermatozoa in men and of ova in women. (4) The impotence of libido, or absence of the ability to experience pleasure at the moment of emission.