For there is really no complete analogy between sexual desire and hunger, between abstinence from sexual relations and abstinence from food.  When we put them both on the basis of abstinence we put them on a basis which covers the impulse for food but only half covers the impulse for sexual love.  We confer no pleasure and no service on our food when we eat it.  But the half of sexual love, perhaps the most important and ennobling half, lies in what we give and not in what we take.  To reduce this question to the low level of abstinence, is not only to centre it in a merely negative denial but to make it a solely self-regarding question.  Instead of asking:  How can I bring joy and strength to another? we only ask:  How can I preserve my empty virtue?

Therefore it is that from whatever aspect we consider the question,—­whether in view of the flagrant contradiction between the authorities who have discussed this question, or of the illegitimate mingling here of moral and physiological considerations, or of the merely negative and indeed unnatural character of the “virtue” thus set up, or of the failure involved to grasp the ennoblingly altruistic and mutual side of sexual love,—­from whatever aspect we approach the problem of “sexual abstinence” we ought only to agree to do so under protest.

If we thus decide to approach it, and if we have reached the conviction—­which, in view of all the evidence we can scarcely escape—­that, while sexual abstinence in so far as it may be recognized as possible is not incompatible with health, there are yet many adults for whom it is harmful, and a very much larger number for whom when prolonged it is undesirable, we encounter a serious problem.  It is a problem which confronts any person, and especially the physician, who may be called upon to give professional advice to his fellows on this matter.  If sexual relationships are sometimes desirable for unmarried persons, or for married persons who, for any reason, are debarred from conjugal union, is a physician justified in recommending such sexual relationships to his patient?  This is a question that has frequently been debated and decided in opposing senses.

Various distinguished physicians, especially in Germany, have proclaimed the duty of the doctor to recommend sexual intercourse to his patient whenever he considers it desirable.  Gyurkovechky, for instance, has fully discussed this question, and answered it in the affirmative.  Nystroem (Sexual-Probleme, July, 1908, p. 413) states that it is the physician’s duty, in some cases of sexual weakness, when all other methods of treatment have failed, to recommend sexual intercourse as the best remedy.  Dr. Max Marcuse stands out as a conspicuous advocate of the unconditional duty of the physician to advocate sexual intercourse in some cases, both to men and to women, and has on many occasions argued in this sense (e.g., Darf der Arzt zum Ausserehelichen Geschlechtsverkehr