nanistic[80] purposes.
In the case of boys we shall seldom, comparatively speaking, be able to
do this; although, even in boys, operation is sometimes needed for the
removal of articles used for onanistic purposes, which have found their
way into the urethra or the bladder. In girls, such operations are more
frequently required. Hairpins, pencils, and various other articles used
for onanistic purposes, are from time to time removed from the vagina or
the female bladder. Other signs that are supposed to indicate the
habitual practice of masturbation are of little diagnostic value. It is
traditionally held that masturbation in girls leads to elongation of the
clitoris, but there appears to be no warrant in fact for this opinion.
As I have previously pointed out, laceration of the hymen does not in
general result from masturbation. Other signs, such as local irritation
or swelling, are hardly ever seen in boys, and in girls are seen only in
cases in which they masturbate to excess. _In girls, moderate reddening
of the external genital organs has no significance whatever; and I take
this opportunity of giving a special warning against inferring from the
existence of such reddening that masturbation is practised, and also
against attaching any importance to this symptom in a case in which a
sexual assault is supposed to have been committed on a little girl._

Certain other signs which have been believed to support a diagnosis of
masturbation, do not even justify suspicion. Among these reputed signs
may be mentioned: black lines under the eyes, pallor of the cheeks,
inflammation of the eyes, &c. Generally speaking, it must be said that
in sexually immature children nothing but direct observation will
justify a definite diagnosis of masturbation, except in cases in which
the child itself makes confession to someone in its confidence. For the
diagnosis of auto-erotism, however, it is not necessary to establish
the occurrence in the child of the voluptuous acme; it suffices for this
diagnosis if there occur signs of those general voluptuous sensations
which were described on page 58. In many cases in which the practice of
masturbation is diagnosed, and in cases in which children themselves
confess to masturbating thirty times a day or more, we can hardly
suppose that the voluptuous acme or orgasm is attained.

It is sometimes maintained that the early appearance of the physical
manifestations of puberty is an indication that psy