“He kept this up a couple of years. Suddenly the whole thing lost its charm for him. His phantasy cooled down. Finally he gave up the game altogether. At 18, the patient attempted for the second time normal coitus. He had an erection but premature ejaculation _ante portas_. A third attempt failed on account of drunkenness. Again he reverted to his masturbation habit, his thoughts during the act once more centered on the hips of a young boy; this was a fetich to him. Masochistic fancies he entertained no longer; but he dwelt profusely on homosexual phantasies. Later the patient thought of _coitus inter femora_ with boys. He became very friendly with a 14-year-old boy, kissed him, and allowed the boy to touch his own genitals. But when he found that the boy had hairy hips his passion for the boy cooled off at once. During that time the patient (20 years old) entertained thoughts of suicide because he felt that his life was a failure. An attempt at analysis only excited him worse instead of quieting him. Again the patient linked himself in intimate friendship with a 14-year-old boy; as that boy resented any physical display of affection, his attachment remained purely platonic. Every now and then patient masturbated fancying he was carrying out _coitus inter femora_ with his friend. His sadistic fancies again broke to the surface. He became more and more restless, enticed a boy (under a slight pretext) to visit him and devised most refined ways of abusing him; for instance, hanging over the boy’s back with the hands clasped around his neck, or beating him over hips and buttocks with a reed cane; for every stroke the boy was to receive a sum of money. As a consequence of this action the patient was brought to the clinic.”[27] _Fleischmann_, in his psychologic examination of this case, lays stress particularly on the significance of trauma and ascribes to the masturbation a predominant rôle in the psychogenesis of the paraphilia: “This case proves clearly that the various sexual anomalies differ only in their sexual objective and aim,—their developmental interrelationship—but that the mechanism of their development must be looked upon as identical.” But of particular significance in this case is the constant association of sadism and masochism, a condition with which but few sexologists thus far have been impressed as a bipolar expression of the same underlying tendency; next, the tremendous sense of guilt which no masochist lacks; further, the defense reaction against the homosexual tendencies: disgust of the _immissio penis in anum_, and the unpleasant feelings roused by the sight of the boy’s hairy thighs.