BRITISH MEDICAL JOURNAL 20 OCTOBER 1979 977

Occasional Review

Penis captivus-did it occur?

British MedicalJournal, 1979, 2, 977-978 cated by a quotation from, or at least a reference to, the news-
paper sources.
The relevant textbooks of the early part of this century
mentioned the symptom of penis captivus, but only in a
Summary and conclusions hearsay manner and without authentication. In Bloch's The
The symptom of penis captivus during sexual inter- Sexual Life Of Our Time,4 there is the following footnote: "A
course has had a largely hearsay existence in medical few years ago a remarkable case of this kind occurred in Bremen.
history, and rumour has embellished the drama of its One of the dock labourers was having sexual intercourse in an
occurrence. It is not entirely mythical, however. It seems out-of-the-way corner of the docks, when the woman became
to have been a symptom of great rarity in former times affected with this involuntary spasm, and the man was unable to
and to have vanished perhaps completely in this century. free himself from his imprisonment. A great crowd assembled,
from the midst of which the unfortunate couple were removed
in a closed carriage, and taken to the hospital, and not until
The story of a couple locked inseparably in sexual intercourse chloroform had been administered to the girl did the spasm pass
through penis captivus until their cries of anguish led to their off and free the man."
mortifying detection has been doing the rounds for a very long Kisch, in his Sexual Life of Women,- speaks of "more or less
time and still occasionally raises qualms in the minds of some credible instances of penis captivus" being on record. He
sexually inexperienced girls. Ricci' mentions that the symptom mentions an account by a medical man called Davis, not
was first described by Martin Schurig in 1729. Rolleston,' otherwise identified, who was one day called to a couple found
however, unearthed much earlier reports. He began his biblio- in this "most compromising position. All the endeavours of the
graphical searches after "personal inquiries of many eminent pair thus surprised to separate proved ineffectual, and their
London gynaecologists, urologists, venereologists, sexologists, attempts to draw apart caused them intense pain. Davis . . .
general surgeons, and medical antiquarians revealed the fact ordered an iced douche, which, however, failed to liberate the
that they had not only never seen any cases of the kind but knew imprisoned penis. Release was impossible until the woman had
little or nothing of the literature of the subject which most of been placed under chloroform. The swollen and livid penis
them seemed to regard as unworthy of serious consideration." exhibited two strangulation-furrows."
Rolleston delved into mediaeval sources and found passages In his influential Lehrbuch der Gyndkologie6 Stoeckel had this
that described the symptom of penis captivus in sinners who to say: "Just as in animals (dogs), there are also cases of so-called
had indulged in clandestine intercourse in churches and were 'penis captivus' in human beings.... The [coital] contractions
discovered only the following day, when prayers or a splash of [of vaginal and pelvic muscles] can suddenly turn into spasms
cold water brought liberation. One gets the impression that which imprison the penis and cause it to swell up excessively.
these reports were largely based on hearsay and probably had The cases encountered all concerned illicit coitus, performed
only a tenuous connection with the actual facts. In particular furtively (behind bushes or standing in doorways). Fear of
the long duration of the symptom is suspect. detection was obviously an important aetiological factor.... The
The latest report of the symptom, found by Rolleston, was event evokes ridicule, sneers, and scorn in bystanders and
published by Piltz.3 It ran: "We remember a case of vaginismus naturally puts those affected into a shocking position from which
with penis captivus which occurred in 1923 at Warsaw and they can often be released only by a narcosis of the woman. Even
ended by double suicide. It was in the spring, a couple of young then it is frequently still difficult to free the thickly swollen and
students stayed behind in the garden after closing time. In the dark-purple penis from its imprisonment, a task which is
midst of their amorous sport a violent spasm occurred im- occasionally only possible through the forceful introduction of
prisoning the penis. The keeper alarmed by the desperate cries a finger" (personal translation). This account by Stoeckel has an
of the young man ran up. The doctor of the municipal ambulance authoritative ring, though he is wrong, as we shall see, in
after giving an anaesthetic to the woman separated the couple. asserting that only illicit intercourse gives rise to the symptom.
The matter might have been forgotten, but the journalists in Moreover, he probably only repeats hearsay information; he
their greed for sensational facts did not fail to publish the would certainly have mentioned it if he had personally dealt with
adventure. The next day two revolver shots put an end to the patients.
mental sufferings of the two lovers." Again, the validity of this In the nineteenth century, two papers were published by
report comes under suspicion through its aura of dramatic German gynaecologists who had had personal experiences of such
elaboration and its reliance on memory which is not authenti- patients. Scanzoni remarked, almost as an aside, in a paper on
female sterility: ''At the moment of orgastic excitation, there
usually are quite obvious fast and strong [vaginal] contractions.
London NW3 7RG Several observations have shown that, in certain clearly known
F KRAUPL TAYLOR, MD, FRCPSYCH, consultant physician circumstances, these may become so intense as to be painful for
both man and woman. They may end in a spasm of the
978 BRITISH MEDICAL JOURNAL 20 OCTOBER 1979
constrictor cunni which occasionally lasts rather long and makes vaginismus it occurs before the introduction of the penis (or of
the withdrawal of the penis impossible.... Apart from several some gynaecological instrument) into the vagina and thus
other cases which have come to my knowledge [?through prevents normal sexual intercourse. In penis captivus, the spasm
hearsay], I should like to mention that of a completely healthy occurs during normal sexual intercourse and prevents the
young woman, married for six months and at present being termination of the coital connection of the partners. Vaginismus
treated by me. Her husband has had to refrain from intercourse is a relatively common symptom, but penis captivus is obviously
for some time, because it always caused his wife to have spastic rare. It is so rare that it is often regarded nowadays as no more
vaginal contractions. They are most painful to him and . .. did than a prurient myth. Indeed almost all the cases mentioned in
on several occasions end in a spasm of the constrictor cunni medical publications and in textbooks are based on hearsay and
which sometimes lasted more than ten minutes and made it rumour, which have tended to aggravate the drama and trauma
impossible for the couple to separate" (personal translation). of the event. Yet the descriptions published by Scanzoni and
The second and most complete account of the symptom of more especially by Hildebrandt leave no doubt about the
penis captivus in a personally treated patient came from reality of this unusual symptom. At the same time one is struck
Hildebrandt.8 He remarked that he had occasionally heard of by the fact that these descriptions lack the spectacular character-
the symptom but had been doubtful about the possibility of its istics of the hearsay reports. The spasms lasted only minutes
actually occurring. Yet the observation of a typical example and not hours; and they relaxed spontaneously without the need
convinced him that "there is a form of tonic cramp among the of admission to hospital or an anaesthetic.
muscles of the female genitalia which occurs during coitus, or One might argue, however, that the symptoms in the patients
more exactly just before the end of coitus, in such a way that the of Scanzoni and Hildebrandt were so mild because they occurred
erect penis is forcibly held back in the vagina, gripped in a tight during the legitimate intercourse of spouses in the privacy of
muscular cramp, unable to move forward or backward until, their bedrooms. The symptom of penis captivus might be more
after a few minutes of agitation and fear, the cramp relaxes and severe when illicit intercourse takes place in a hidden public
the shrunken penis can be removed." The patient observed was location. In these cases, sexual impetuosity tends to be at a high
a woman who had been married for a year. She was "very pitch and mingled with the fear of the forbidden and hazardous.
excitable and apparently also of a very erotic nature. She had This could conceivably increase and prolong the muscular
suffered from uterine symptoms already as a girl and these got spasms and thus make detection and humiliation more likely.
worse during marriage, though they did not prevent intercourse Such a reaction cannot be dismissed offhand as impossible. It is
which was always painless. Because of these symptoms, treat- theoretically quite possible. Yet it does not seem to have
ment was started [elsewhere] in the spring which involved the occurred in the past 100 years or so. If there had been, during
application of a probe, speculum, compressive sponge, glycerine that time, a case of penis captivus that needed medical inter-
tampons etc which I believe had been used carelessly, too often, vention or admission to hospital it would have been eagerly
and perhaps not with the skill required, since this young and reported in a medical journal with as much detail and evidence
chronically neurotic woman grew every week more agitated as possible. It is the absence of any such reports which suggests
and excitable so that she eventually responded to the smallest that penis captivus is not only a rare but also a relatively
aggravation with compulsive crying fits." transient symptom with consequences that are less sensational
"During the course of this treatment and despite her severe than those fabricated by rumour.
nervous irritability, she had intercourse on one occasion. [The
husband] described his experience on that evening, when,
incidentally, his wife had appeared less ill than usual, though References
she felt very agitated. He reported that just at the moment, when
he thought intercourse, which had been quite normal till then, Ricci, J V, One Hundred Years of Gynaecology. Philadelphia, Blakiston,
had come to an end, he suddenly felt that he, or rather his glans, 1945.
2 Rolleston, J D, Janus, 1935, 39, 196.
was held back deep in the vagina, tightly gripped and imprisoned, 3 Piltz, A, These de Paris, 1931, No 376. (Quoted from Rolleston2).
while his whole penis was in the vagina. All attempts at with- 4 Bloch, I, The Sexual Life of Our Time. In Its Relation to Modern Civiliza-
drawal failed. When he forced the attempts, he caused severe tion (transl by M E Paul). London, Rebman, 1908.
5 Kisch, E H, The Sexual Life of Women in its Physiological, Pathological
pain to himself and his wife. Bathed in perspiration through and Hygienic As'pects. London, Rebman, 1910.
agitation, alarm, and his failure to free himself, he was finally 6 Stoeckel, W, Lehrbuch der Gynakologie, 4th edn. Leipzig, S Hirzel, 1933.
forced to resign himself to waiting in patience. He could not say 7 Scanzoni, F W, Beitrage zur Geburtskunde und Gyndkologie, 1870, 7, 109.

how many minutes this lasted, his imprisonment seemed 8 Hildebrandt, Archiv fur Gynakologie, 1872, 3, 221.
9 Jeffcoate, N, Principles of Gynaecology, 4th edn. London and Boston,
endless. Then-the hindrance vanished on its own; he was free" Butterworths, 1975.
(personal translation).
Hildebrandt disagreed with Scanzoni's opinion that the (Accepted 14 August 1979)
constrictor cunni muscles were responsible for the symptom of
penis captivus; those muscles at the entrance to the vagina were
not strong enough to prevent movements of the penis. He argued
that the culprits were the levator ani muscles, which could A pregnant patient has not developed her usual bout of hay fever this
powerfully compress the lower part of the vagina. This con- year, as has occurred during previous pregnancies. Is there a simple
formed with the husband's report that his penis had been held explanation for this phenomenon ?
fast at the glans deep within the vagina, and not at its base. It has been known for many years that a wide variety of immuno-
Moreover, in patients with vaginismus, Hildebrandt had logical reactions may be altered during pregnancy or indeed during
observed spastic contractions of the levator ani muscles which menstruation-for example, transient depression of delayed hyper-
were strong enough to prevent the passage of even a thin probe. sensitivity skin-test responses to such agents as tuberculin can occur
This observation has been confirmed by modern authors. during pregnancy. It is also well known that both asthma and rhinitis
Jeffcoate,9 for instance, remarks that vaginismus "is a condition may either improve or indeed get worse when a woman becomes
of spasm affecting the sphincter vaginae and levatores ani pregnant. In one study of asthmatic patients who became pregnant
muscles, especially the latter. The spasm may be so great that 40( experienced dramatic remission of symptoms while 350,,
the lower vagina is practically closed and both husband and wife showed no change. In 25 ",,, however, the asthma became much
worse. Occasionally the first episode of rhinitis or asthma occurs
have the impression that there is an organic obstruction." during pregnancy. It is not known how the physiological changes
* * *
occurring during pregnancy have this variable effect on the symptoms
of asthma and rhinitis. At present there is little information on the
In both vaginismus and penis captivus muscular spasms occur effects of pregnancy on immediate type I allergic reactions, which
that affect the levatores ani. The timing of the spasm differs. In are so important in the pathogenesis of allergic rhinitis and asthma.