Why was masturbation such a medical concern in the 19th century? 

Before the 1700s, masturbation had been condemned on specifically religious grounds. It was considered sinful because it ‘denied the “natural” function of sexuality’, i.e. procreation. As A. N. Gilbert writes, ‘[a]s a sexual act, it meshed easily with the traditional Christian distrust of sensuality and bodily pleasure.’ But by the nineteenth century onwards, doctors had become concerned by the act as a medical and a social issue. Often referred to at the time as ‘self-abuse’, ‘self-pollution’ and the ‘solitary vice’, masturbation was said to cause impotence, effeminacy, insanity, disease, and even death.
This essay will examine the various debates on why such anxiety with regard to masturbation arose within the medical profession in regards to masturbation. Ultimately, it will be argued masturbation was viewed with so much concern for two main reasons. Firstly, due to the changing status of the medical profession as a result of scientific and medical advances, which led to pressure to find answers to previously unsolved questions, or questions previously explained through religion. Secondly, because towards the end of the nineteenth century, doctors were reflecting the societal anxieties over masculinity, degeneration, and class due to the growth of capitalism and an expanding British Empire. 

Beginnings of Medicalisation

The publication of the anonymously authored Onania; or, The Heinous Sin of Self-Pollution in 1710, followed in 1758 by Tissot’s Onanism; or a Treatise upon the Disorder Produced by Masturbation is often viewed as the keystone in the change in the conception of masturbation from simply a sin into a medical worry. The former insisted that onanism would cause a wide range of illnesses and disorders, but was still ‘more concerned with the sin than the harm of masturbation’, and E. H. Hare asserts that there is ‘reason to think that this anonymous author was a clergyman turned quack. Certainly he is not a physician.’ 

Tissot, however, actually was a doctor. He would most notably write that the loss of an ounce of semen ‘would weaken more than that of forty ounces of blood’. He claimed that the loss of this ‘seminal liquor’ would cause general debility, and thus open ‘the way to consumption, deterioration of eyesight, disorders of digestion, impotence, and so on’. He also suggested that, as masturbation causes increased blood flow to the brain, it would have detrimental effects on the nervous system and could result in insanity.

These ‘quasi-medical text[s]’ would be a cited authoritatively up until the end of the nineteenth century. Many of of the most well-regarded medical authorities insisted that the ‘solitary vice’ could make an individual––especially children and adolescents––‘impotent, cause consumption, and drive him insane.’ And, as Gilbert writes, if he was to somehow avoid these outcomes, ‘there was a long list of equally unpleasant diseases waiting to strike him down for his masturbatory sins.’ In fact, ‘one nineteenth century doctor claimed that fully two-thirds of all diseases’ could be attributed to masturbation, and it was commonly claimed that masturbation led to the grave. Though physical debilitation and disease was the main concern of the eighteenth and early nineteenth centuries, so-called ‘masturbatory insanity’ would become the main concern around the middle of the nineteenth century. Doctors traced this category of insanity to ‘the exhaustion of the brain and nervous system by the unnatural demands of masturbation.’

To cure this masturbatory illness, both doctors and parents would use various chemical therapies, corrective surgery, and mechanical devices; treatments described by Lesley Hall as ‘brutal to the extreme’. ‘In 1854 the Lancet published a series by John Laws Milton … who recommended the use of strategically-placed spiked rings’, and in 1857, doctor and author William Acton published The Functions and Disorders of the Reproductive Organs, in which he recommended ‘lots of physical exercise to discourage the practice – or failing that, tying-up the hands of a boy at night to stop it’. The mere rhetoric of anti-onanist writers was intended to ‘terrify patients into abstinence’. For example, the nineteenth century American phrenologist Orson Fowler would once remark: 

It not only poisons your body, destroys your rosy cheeks, breaks down your nerves, impairs your digestion, and paralyzes your whole system; but it also corrupts your morals, creates thoughts and feelings the vilest and worse possible, and endangers your very soul’d salvation! No words can describe the miseries it inflicts throughout your whole life down to death. … You can never fully rid yourself of those terrible evils it inflicts.

Religious Hangovers and the Limits of Medicine

Some believe that doctors during this time were simply sadists, who took pleasure in ‘painful operations and … purveying psychological harm.’ Thomas Szasz, for example, believed the anti-masturbation movement to be another example ‘of the great chain of oppression by “manufacturers of madness” who used their power to control deviant behaviour.’ He adds that, ‘like witch hunters in the past, and institutional psychiatrists in the present, the medical profession in the nineteenth century … was dedicated to persecuting the heretic, in this case the sexual heretic.’ Alex Comfort also saw the anti-masturbation campaign as ‘men in authority using their power to cripple those unfortunates under their control’. 

There is similarity between Szasz and Comfort’s arguments with Foucault’s theory that the anti-masturbation campaign was ‘not only a matter of power, or authority, or ethics’, but also ‘a pleasure’; that there was ‘enjoyment in intervening’. However, while some doctors may well have been sadists who exploited their position of power, and indeed the anti-onanist movement caused great harm––physically and psychologically––to many, this is a psychological explanation which fails to take into account the wider historical, social and cultural explanations. It must also be recognised that, for some doctors, their intervention was justified because as far as they believed, onanism was deadly.

Importantly, the 19th century was the period when doctors were trying to establish themselves and gain a more respected reputation as a “profession”, on the same basis as lawyers and solicitors. In previous centuries, doctors had been regarded little more than the local butcher or witchdoctor, and anybody could call themselves a doctor whether qualified or not. The British Medical Association was not established until 1856, and this would help to bring about the Medical Act 1858 and establish the General Medical Council, introducing professional regulation and setting a standard for qualified doctors. The medical profession was attempting to assert control and legitimise itself, but this perhaps made doctors liable to medicalise social issues.

Meanwhile, the role of religion was being questioned in society, and ideas that sin, evil spirits, and witches caused illness, disease, insanity and death were in decline as a result. Yet doctors had not yet been able to formulate an adequate hypothesis to substitute these beliefs. Thus, it could be said that there was something of a religious hangover in the medical profession. H. Tristram Englehardt has noted that, ‘If one examines the world with a tacit presupposition of a parallelism between what is good for one’s soul and what is good for one’s health, then one would expect to find disease correlates for immoral sexual behaviour.’ Essentially, as R. P. Neuman argues, doctors ‘were becoming the arbiters of sexual morality in an era where the religious basis for morality was being challenged. Behaviour condemned as sinful and immoral was now diagnosed … as unhealthy and even insane.’

Tissot’s assertion of the debilitating effects of loss of seminal fluid in Onanism played a significant role the earlier medical understandings of the consequences of masturbation. Gilbert highlights how there were already ‘certain presuppositions about the body and sexual intercourse’. Whether through intercourse or masturbation, ‘the fatigue that set in immediately after “spilling seed,” seemed to confirm the hypothesis that this was indeed a dangerous activity,’ especially if performed by an ‘immature youth’. Overall, the ‘undeniable aftereffects of intercourse and masturbation, a powerful Christian tradition that condemned onanism, and an understandable confusion between morality and health, gave credibility to the claims about masturbational diseases.’

Moreover, Victorian concerns about the welfare of children meant that doctors were facing increasing pressure to account for the deaths of young children. This rising ‘concern about the role of the child in the family and society as a whole’ was in contrast to a ‘certain callousness’ towards children in previous centuries. With the rise in the role of science in society and the medical advances being made as a result, there was a higher expectation placed on the medical profession. ‘While it is impossible to measure the gap between knowledge and prestige,’ writes Gilbert, ‘it seems clear that medical authority greatly outstripped capability in the nineteenth century.’ As masturbation was common amongst the young, it served as an ‘all-purpose culprit for a medical profession that could not provide answers to grieving parents’. Thus, while the doctor was absolved of the ‘burden of accepting and explaining the limitations of his profession’, the idea that onanism ‘was a veritable scourge’ was reinforced.

Furthermore, as Alan Hunt points out, doctors would find themselves in the privileged position of being able to ‘undertake systematic observation of large numbers of patients’ due to the rise in the number of asylums in the late eighteenth and early nineteenth centuries. Discovering that many of those held in asylums would masturbate ‘with little or no inhibition’, doctors drew a false correlation and concluded that masturbation was the cause of their patients’ insanity. Furthermore, the concept of ‘masturbatory insanity’ appeared to explain many of the questions about mental disturbances in adolescents.

Class and Continence
In the middle of the nineteenth century, it was increasingly young people that were becoming the focus of concern over masturbation. As Jeffrey Weeks described, ‘adolescence was now seen as a special stage of life, and one that was, moreover, clearly differentiated on class lines.’ Indeed, Hunt stresses that at this time, ‘the distinctive feature of this antimasturbation panic is that it was directed primarily at middle- and upper-class teenage males who were presumed to be attending residential boarding schools, the English public schools.’ Novels began to be published, such as Tom Brown’s Schooldays in 1857, and, a year later, Frederick W. Farrar’s Eric, or, Little By Little, to explicitly promote certain ideas of social and sexual morality among adolescent boys. However, there was little to no concern about working-class male sexuality. 

Industrial capitalism was changing the nature of the family. Peter Cominos has suggested this these new modes of economic and social relations dictated a new ‘respectable’ middle-class sexual ideology. ‘More than any other social class, the middle classes took pride in being “self-made,” in achieving and preserving itself in society through hard work and personal achievement. Above all, the sublimation of sexual energy into “useful” work was central to the respectable sexual ideology.’ ‘Continence’ supposedly resulted in the accumulation of wealth, whereas ‘incontinence’ would result in poverty and early marriage. Self-discipline equalled conformity ‘to certain coordinated patterns of behavior for gentlemen (e.g. professional men) … in the functioning of new industrial society’. Gilbert suggests that this concept fit in well with the ‘Rousseauian doctrines of self-reliance and the perfectability of man’, and ‘helped to restore a sense of ‘meaning’ to a universe bereft of the concept of God and a sense of worth to the individual adrift in the sea of industrialization and collectivism.’

As such, when children of the middle and upper classes were found masturbating, parents were distressed ‘by any sign that their sons might be unwilling to live by the respectable sexual ideology’. Doctors were thus compelled to blame it on ‘organic problems’ such as irritants leading children to scratch their genitals, or, most commonly, ‘bad habits taught them by others.’ It would be alleged that nurses and servants ‘fondled the infants genitals to quiet it … [causing] sexual precocity and serious problems later in life.’ Hunt summarises that ‘because domestic servants and nurses invariably came from foreign, farm or working-class backgrounds, it seems likely that such suspicions derived from their middle-class employers’ own feeling that as a member of the “lower orders,” servants did not share the respectable sexual ideology.’

As Bertrand Russell remarked, public schools encouraged ‘boys to be constantly occupied so that they will have no time for sexual sin’. Sport once normally associated with ‘rough popular [read: lower class] games’ came to be pushed in public schools and promoted by Church leaders and secular leaders alike by the end of the nineteenth century. It was a masculine, respectable way to release excess sexual energy, as opposed to masturbating.

It must also be noted that while the concern about masturbation was indeed focused on the ‘better classes’, the anti-masturbation propaganda also helped to reinforce ideas of discipline at work, conformity and self-control for the working class. This would of course contribute to keeping workers ‘in their place’ and stem social disorder. Through their own profession, doctors––being middle class themselves––upheld these social and sexual attitudes which were ‘inextricably bound to the bourgeois trinity of work, family and paternal authority’.

Imperial Anxiety

Fear of the influence of the ‘lower orders’ on the sexuality of the upper and middle classes was tied to a growing issue of ‘imperial anxiety’. Alan Hunt writes how there was increasing concern over the ‘problem of population’, which was conveyed through a complex mix of neo-malthusianism, social Darwinism and, by the end of the nineteenth century, eugenicism. As Hunt explains,

This involved a contemporaneous shift from a social Darwinism focusing on competition between individuals, to a nationalist variant of social Darwinism stressing the struggle between nations and races that intensified as the clouds of World War I gathered. A new discourse on population emerged, urging the imperative of population expansion, increased birthrate, and a healthy and numerous population. There were two distinct strands of the population concern. One concerned the state of the lower order and expressed itself in the persistent apprehension about degeneracy. The other concerned the demographic position of the middle and upper classes, one of whose most frequent refrains was that the “better classes” had too few children while the “lower classes” had too many. 

Masturbation, rather than directing sexuality towards procreation and the formation of family, ‘threatened to direct sexual desire and pleasure inward’, away from family. If Britain could not sustain its ‘better classes’, how would it be able to sustain its imperial mission? 

Hunt highlights a ‘common thread’ in this anxiety was ‘an obsessive concern with the fate of great empires that is embodied in the preoccupation with the “decline and fall” of great civilizations and the thesis that empires fall because of the moral degeneration of their people or their leaders’. With the failures of the Crimean War undermining British military confidence, a major economic crash in 1857 and the Indian Rebellion of the same year, ‘questions of military needs, imperial capacity, and economic stability were constructed as signs of an internal–that is, national–debility.’ Fear of the increased militancy of the working class at home and the rebellion abroad was complemented by a concern over the ‘internal weakness’ of the upper and middle classes, and as such, sexual self-restraint and self-discipline came to be seen as the ‘touchstone of national capacity.’ Racial and imperial superiority could only be assured, Hunt writes, ‘when sexual purity took the form of a self-denying and self-controlling chivalry linked to the biological reproduction of the middle and upper classes within marriage’.

This gives an indication of the ideological roots of the rising popularity of ‘muscular Christianity’ in the 19th century. As Tony Collins summarises, ‘In the public and grammar schools, the training of the future leaders of the British Empire, whether at home or abroad, was based on an overtly anti-feminine masculinity.’ There was a widespread, misogynistic fear of feminised men, and masturbation ‘represented a loss of control over [men’s] nature, thereby undermining their masculine status’. Thus, ultimately depriving Britain ‘of “virile young men” who were the primary agents of both economic and military strength.’


The growth of anti-masturbation concern amongst doctors in the middle of the nineteenth century is therefore the result of a complex combination of religious, moral, social and cultural factors. In contrast to the ahistorical approach of Foucault, it was not simply ideas about masturbation that led to the rise of the anti-masturbation campaign of the Victorian era, but broader societal concerns about how to develop a ruling elite at home and abroad. Fears of personal degeneration, defilement and effeminacy reflected wider fears about the strength and vitality of British society and its empire.

While doctors were finding themselves able to draw on increased medical and scientific advances, in turn they faced increasing pressure to explain all the ills of society. Doctors were products of the middle and upper classes and their associated institutions, and by medicalising masturbation they were carrying over the anxieties and sexual attitudes of their class into their diagnoses and practice. Yet the medical profession was not the vanguard of the antimasturbation campaign. Medical science had been somewhat appropriated ‘by groups with interests ranging from the religious to the commercial’. This meant that medicine was used to reinforce a waning religious morality; instead of sending you to hell, masturbation was now going to send you mad and make you weak. Either way, it was still bad.



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