Among women, especially young girls, hypochondriasis is not common and cases of sexual hypochondriacs who accuse themselves of masturbating are rare among them. Women who masturbate generally keep their secret and are apparently very little affected by it. However, onanism does them nearly as much harm as men; it is true they have no loss of semen, but the repetition and intensity of the nervous irritation are greater than in man, and it is this which causes most exhaustion. In spite of this, it is curious to observe that women who masturbate are generally less ashamed than men, and are apparently less depressed by it. We must bear in mind that the loss of semen by masturbation has in man a peculiarly depressing effect, for it lacks its object and represents an absolutely abnormal satisfaction of the sexual appetite. It may be objected that this difference is due to another cause, that women who masturbate have less moral tone and are especially depraved individuals. I agree that this is often the case, but far from always. The intensity of the sexual excitability in women has nothing in common with their character; it may be associated with high intelligence, with high moral and æsthetic qualities, and even with a strong will. On the other hand, deficiency in moral sense and will may occur with sexual frigidity, and, as we have already seen, may lead to sexual excess without any voluptuous sensation, in accordance with the peculiarities of feminine sentiment. These facts show how complex are the causes of a given effect in the sexual domain. PERVERSIONS OF THE SEXUAL APPETITE OR PARÆSTHESIA OF THE SEXUAL SENSATION We are here concerned with sexual appetite provoked by inadequate objects. Krafft-Ebing having made a profound study of this question we shall follow his subdivisions in the main. =Perverted Sexual Appetite Directed Toward the Opposite Sex.=--(A.) _Sadism_ (association of sexual desire with cruelty and violence). History shows us a number of celebrated persons who satisfied their sexual desire by making martyrs of their victims, up to complete butchery. The most atrocious types of this kind are perhaps assassins such as "Jack the Ripper," who lie in wait for their victims like cats, pounce on them, revel in their terror, assassinate them by inches, and wallow voluptuously in their blood.