In 1983, I first gave a lecture on ‘Sex and the Nose’ in the Practical Rhinoplasty Course (an instructional course for surgeons operating on the nose) at the Royal National Throat, Nose and Ear Hospital in Gray’s Inn Road, London, (which was, until the NHS Management ([affectionately known to hospital doctors as ‘Stasi’) closed it in 2019, part of University College Hospital). I had been asked by the organisers to talk about problems when doing rhinoplasty in a District General Hospital, but I didn’t have much to say about this. I spoke mainly about the sexual aspects of the nose, (a topic which I had always considered is neglected by Ear, Nose and Throat Surgeons). I thought some of the insights my talk contained would be of use to surgeons working on the cosmetic and functional aspects of the nose. To my utter surprise, I was not only invited back the following year, but every year for the next twenty years. I was put on the regular annual payroll of the University of London and every February, I found myself on an annual pilgrimage to give a similar lecture. After the first year, I made no pretence about talking about doing rhinoplasties ‘out in the sticks’ (which as far as I could see, is not any different to doing them in a teaching hospital anyway!)

Over those next twenty years, I came to realise just how wide a subject it is. I did more research and kept up with any developments in this niche part of otolaryngology. Long before surgeons working in their specialty started to profess an interest in sub-specialties, I had begun to state my ‘special interest’ in the sexual aspects of the nose and this was how I was listed by the General Medical Council on the Medical Register from 1985 until I retired from practice in 2013. As one of the few remaining single-handed consultants (without a consultant partner), it was inappropriate to develop a sub-specialty anyway. In fact I was the last remaining solo consultant, (merely because I was the last man standing!)

Since most of the current UK rhinologists had been on the Rhinoplasty course and attended my lecture, most colleagues knew of my interest and indeed a few of them contacted me to discuss cases of interest. Over the years I even had a few patients referred! Because everybody in general appears to be interested in sexual matters, I was asked to give talks to post-graduate meetings up and down the country, and indeed also in France, Germany and the Netherlands. When lectures and lecturers were becoming somewhat of a rarity, ‘Sex and the Nose’ appeared to be an attractive title.

Shortly after my retirement, I was asked to give the Watson-Williams triennial lecture in Bristol. Of course I chose as the subject of my address, ‘The Physiological and Pathological Associations Between the Nose and the Sexual Apparatus of Man.’ I thought that this would be the last time I would ever talk about the subject, but even now I get asked to talk about it.

More than one dear friend and colleague have pointed out that I have never written anything on this matter. I was eventually cajoled, during my enforced isolation during the first Covid Lockdown, to put pen to paper at long last, (whilst I am still spared!) I always used to tell friends that the reason why I never wrote any of it down was because once it had been published, I would no longer be asked to talk and I would be destroying a good meal ticket.

It was not until I started writing about it, that I realised how important the illustrations had been. They are of course an integral part of the subject. The impact of Barbara Millett’s surrealist painting, ‘Head,’ which was always the first picture I showed, was universal. It’s probably the only thing most people remembered about the lecture!

Table of Contents

Introduction

Preface

Prolegomenon

Chapter I. The Surreality
The importance of art and illustration (particularly surrealism) cannot be overemphasised. Certain paintings epitomise the essential allegorical harmony of the naso-genital link. Millet’s Head, Magritte’s Le Viol. Goya’s Caricatura Alegre. Testa di Cazzi. Abbé Mauri.

Chapter II. Classical Naso-Genital Link
The so-called ‘Naso-Genital link’ in folklore is a timeless myth that the size of a person’s nose is an indication of the size of their genitalia. This is examined from Classical times to the present. Lascaux Caves. pre-Viking petroglyphs. Ovid. Astrology. Heliogabalus and Nasuti. Queen Giovanna. Cyrano de Bergerac. Michael Scot. Massinger. Kama Sutra.

Chapter III. Eros, Nose and Throat
The sexual physiology of the throat and even the ears. Sexual aspects of voice and throat. Infibulation, Castrati. Antonio Moreschi. Male Infibulation. Contemporary Romanian rituals. Chapter IV. Physiognomy 27 Giambattista della Porta; Charles Darwin and the Captain of the Beagle. Desmond Morris and genital mimicry in African baboons. Scrotal mimicry and pubic/moustache resonance.

Chapter V. Nasal Gestures
Cocking a snook. Fullocking vs.Churchillian V-sign. Obscene Iraqi palm back insult. Nasal Greeting around the world: Eskimo kiss (kunik); Maori hongi; Thai sniff-kiss; Arabs in Gulf nasal tip-to-tip. viii Chapter VI. Nasal Erectile Tissue 39 Victorian descriptions of erectile nasal tissue. Mackenzie’s seminal article. Discussion of physiological evidence. Sneezing and sex. Ayurvédic medicine.

Chapter VII. Sex and the Nose in Japanese Art
Shunga. Hokusai. Utagawa Kuniyoshi. Manga and Anime. Hanaji, the epistaxis trope in manga.

Chapter VIII. Kallman’s Syndrome
Heschel of Vienna. Aureliano Maestre de San Juan. Kallmann and Rüdin. Little Jimmy Scott. Genetics.

Chapter IX. Masturbation and the Nose
Victorian preoccupation with evils of masturbation and its connection to nasal disease. Louis Tussaud’s waxworks. Sigmund Freud, Wilhelm Fliess and the tragedy of Emma Eckstein. Nasal Neurosis. Biorhythmicity. Male 23 day menstrual period based on nose. Fliess’s Flow of Life book.

Chapter X. Nasal Dysmenorrhoea
Nasal treatments for painful periods.

Chapter XI. The Pregnant Nose
Pregnancy rhinitis. Life-threatening epistaxis during pregnancy. King Lear.

Chapter XII. Hormonal Rhinitis
Varieties of hormonally related nasal diseases. Old man’s drip. Honeymoon rhinitis. Kraurosis nasi. Weber-Rendu-Osler’s Disease (Hereditary Haemorrhagic Telangiectasia)

Chapter XIII. The Nose in the Human Sexual Response
Coital epistaxis. Amatus Lusitanus. Native American Sioux. Theophilus Bonet. King Louis XIV. Psychiatric Nose. Masters and Johnson’s groundbreaking research and personal involvement. Viagra.

Chapter XIV. The Nose at Puberty (Menarchal Rhinitis)
Puberty epistaxis. World Sneezing Records in adolescent girls. Guinness Book of Records. Treatment.

Chapter XV. Vicarious Menstruation
Hippocrates and Celsus. Nose bleeds in place of menstruation as index of pregnancy. Collop’s On Phlebotomy. Martin Schurig. Mary Murphy’s menstrual earbleeds. Male menstruation: Sambia tribal induced menstrual epistaxis. Dr Carrere and the French miller.

Chapter XVI. Jacobsen’s Organ
Ruysch and his Cabinet. Von Sömmering. Ludwig Jacobsen and his Military career.The circuitous history of the vomero-nasal organ: Gratiolet, Dursy, von Kölliker, Potiquet. Nomenclature.

Chapter XVII. Robert Broom and the Vomeronasal System
Broom’s discovery of the function of the VNO in the animal world.

Chapter XVIII. Butenandt and Bombykol
Adolf Butenandt and his discovery of pheromomes. Hitler and the lost Nobel Prize.

Chapter XIX. Animal Pheromones
Hagfish and lampreys. Magic of Pheromones. Lee-Boot effect. Whitten effect. Vanderbergh effect. Coolidge effect. Urinary pheromones. The pig with the prolapse. Boar Mate. Perigord Truffles.

Chapter XX. Human Pheromones
Copulin and Rhesus Monkeys. Menstrual synchrony in girls’ boarding school dormitories. Humarone. BBC and Tomorrow’s World. Monti-Bloch and the electrovomeronasogram (EVG). Routine contemporary nasal surgery and its effect on libido. Nitric oxide. Conscious breathing tapes.

Chapter XXI. Smell and Pheromones
Axel and Buck’s Nobel Prize for physiology of olfaction.

Chapter XXII. Major Histocompatibility Complex
The genetic and Darwinian importance of pheromonal attraction.

Chapter XXIII. Death of the Human Vomeronasal System
How two venture capitalists and their perfume company misled scientists for sixteen years. Didier Trotier’s proof of the non-functioning VNO.

Chapter XXIV. The Terminal Nerve
How a ‘new’ cranial nerve (of which even now many physicians are not aware) was discovered. Its rôle in the reception of pheromones.

Chapter XXV. Post Script: Smell and Memory
Rousseau and the scent of his mistress’s nightgown. Schopenauer and the sense of memory. Rudyard Kipling and smell cracking the heartstrings. Proustian moments.

Conclusion and Postlegomenon
Nietzsche and the sixth sense – of veracity.

General Index

 Reference Index

Acknowledgements

In print , April 2023, HNO-Nachrichten, Springer Med
By Dr. med. W. Lübbers

Hätten Sie gewusst, was das Kallmann Syndrom ist oder der Calvin Coolidge-Effekt oder was es mit den langen Nasen der Kasperle Figuren oder den japanischen Tengu Masken auf sich hat? Dank des Corona Lock Downs hat sich der englischen HNO-Arzt John Reddington Young an die Arbeit gemacht und all sein Wissen über die seit Jahrtausenden von Jahren vermuteten bzw. bewiesenen sinnlichen naso-genitalen Verbindungen aufzuschreiben. Schon seit 1983 hat Young regelmäßig auf englischen Rhinologen-Kongressen als „Bonbon“ über das pikante Thema „Sex and the Nose“ referiert. Allein der Titel des Buches setzt bewusst oder im verdrängten Unterbewusstsein eine sicher zu hinterfragende Korrelation voraus, die aber Neugier erweckt. Denn irgendwo hat man ja schon als Vorurteil abgespeichert, dass die Größe und Länge der Nase etwas mit den männlichen Genitalien zu tun hat. Auch die Schwellkörper in den Nasenmuscheln werden anatomisch und histologisch korrekt mit anderen Körperteilen in Verbindung gebracht. Young eröffnet dem Leser in seiner fast als „Wimmelbuch“ zu bezeichnenden Veröffentlichung seine abgründige Sammlung von surrealen Abbildungen, Karikaturen und oft erotisch „unzüchtigem“ Material. Anatomie, Physiologie, Pathologie, Kultur, Anthropologie und Astrologie der Nase werden bis in die tiefsten Abgründe der menschlichen Natur und seine dunkelsten sexuellen Assoziationen dargelegt. All das wird an zahlreichen Darstellungen der bildenden Kunst von Goya über Magritte bis Dali erläutert und interpretiert. Die Bedeutung des Geruchsinns wird von den „betörenden“ Pheromonabsonderungen der Achselschweißdrüsen bis zu der Verfilmung von Patrick Süskinds Roman “DAS PARFUM“ dargestellt. Ja, manche Bilder und besonders die Comics lassen den Leser vor Scham erröten. Aber der im Buch oft zitierte Sigmund Freud hätte seine Freude an dem Buch und besonders an den Schlussfolgerungen gehabt.

Nicht nur das Buch ist etwas skurril. Der 1947 in Yorkshire geborene Autor ist ein im Ruhestand lebender Militär HNO-Arzt (Colonel !) mit der besonderen Vorliebe für Angeln, britische Bulldoggen und der Anfertigung von Buntglasmosaiken, er ist ebenfalls ein Preisträger für die Züchtung von süßen grünen Erbsen. Eine regionale Zeitung führt ihn in der Liste der „50 Coolest People in Devon“. Ein typischer Engländer mit Zwirbel-Bart, scherzhaftem Lachen und einer großen Portion Humor, eben englischem Humor, der nichts lieber tut, als die verwunderlichen Launen des menschlichen Verhaltens aufzudecken. So trägt ein weiteres Buch von ihm den Titel Poetry,Physik,Pestilence and Pox.

Also lesen und lächeln!

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Journal of Laryngology and Otology
By Edward W Fisher

This book has 25 chapters with introductory sections and a summary and is very well indexed. The book is a synthesis of knowledge from the worlds of the practising adult and paediatric otolaryngologist (rhinology in particular), endocrinology, comparative anatomy and physiology, literature, poetry, medical history, social history and art – to list but a few. There are therefore many groups of readers that would find something of interest in this book, and I have not found any similar publication that is as well set out and referenced. The author is a multi-talented retired otolaryngologist who worked in North Devon during his career and has many interests, including poetry and history. He gave a lecture on this topic for many years as part of the rhinoplasty course at the Royal National, Throat, Nose and Ear Hospital, London. This course was organised by Mr Tony Bull and Mr Ian Mackay, and the book is dedicated to Mr Tony Bull, who died in 2016.

‘Sex’ is used in its widest sense, with much of the most useful material for the jobbing otolaryngologist being in relation to the effects of hormones on everyday clinical conditions such as rhinitis, epistaxis and olfactory function. My own experience of teaching trainees is that the more practically relevant subject matter is not well enough known (to the detriment of their patients) and this book covers the ground comprehensively. Topics such as Jacobsen’s organ (the vomeronasal organ), the terminal nerve (cranial nerve XIII) and pheromones in animals and humans are covered comprehensively with wide-ranging references.

The quality of the artwork, photographs and diagrams is high and there are some that might be considered ‘erotic’ but are always relevant and make the point well in the way that words alone could not. Art work goes well beyond Western Europe and includes relevant Japanese artwork. The text is liberally sprinkled with the author’s trademark humour. Professor Nick Jones, in his preface, suggests that some readers may find themselves blushing at some of the content. This is fair comment, but the content never crosses the line of acceptability. This is primarily an academic treatise and the author never loses sight of that. The author’s use of the English language is carefully tailored to be intelligible to the layman as well as a medical or scientific reader. The cost of the hardback book is high, which is a great pity as the book could achieve better sales from the wider reading public, rather than languish in specialist libraries or the library of an ENT specialist with an interest in rhinology. The publishers may wish to consider the feasibility of a low cost paperback version which would fall within the budget of the general reader. The book is much too useful to be restricted to a narrow readership.

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US American Journals
A. Mudry

ChatGPT (Generative Pretrained Transformer) is an artificial intelligence program freely accessible through a ‘chatbot webportal. When it became generally available to the public in November 2022, it very quickly became a cultural sensation.¹ Not only does it claim to offer rapid and in-depth understanding of complex matters; it also generates tailored responses ‘in a conversational manner’ to the exact question posed.² It can respond to queries and requests with prose of such surprisingly high quality, that they are said to be almost indistinguishable from that of a human.³ Other researchers have suggested that this excitement should be tempered with some caution. Although ChatGPT might be a tool which could transform science and society, we must not lose sight of the boundaries between promise and peril with respect to artificial intelligence.⁴

A recent paper examined the question: “can sex improve nasal function?” Its conclusion was that: “sexual intercourse with climax can improve nasal breathing by the same amount as the application of a nasal decongestant for up to 60 minutes in patients with nasal obstruction”.⁵ In a further discussion of this paper, it was concluded that “controversy continues to exist in relation to nasal symptoms and sexual arousal”.⁶ There is nothing new about the ‘naso-genital link’. The physio-logical connection between the nose and sex was proposed, along with the ‘reflex nasal neurosis’ at the end of the 19^th century. Another aspect of this relationship, which also led to controversy,⁷ is that the nose is a symbol of the sex organ, a kind of representation of the phallus. This idea dates as far back as the mythology of the ancient Greeks and the folklore of the American Indians.

These controversies, together with others, suggested an opportunity to test ChatGPT on this subject. When posed with the question, “Sex and the nose?”, ChatGPT answered (https://chat.openai.com/chat, 06.03.2023): “I am sorry, but I’m not sure what you’re asking. Could you please provide more context or clarify your question?” The question was then modified to: “What is the relationship between the sex and the nose?” ChatGPT replied that: “there is no direct or established relationship between sex and the nose. However, there are some differences in the appearance of male and female noses that may be associated with gender. . . There are also cultural differences in how noses are perceived, with some cultures valuing a particular size, shape, or feature of the nose as a marker of beauty or attractiveness. . . Ultimately, the appearance of one’s nose does not determine one’s gender or sexual identity”. To the complementary question: “correspondence between sex and the nose,” ChatGPT concluded by saying: “It’s also important to recognise that physical characteristics do not necessarily define a person’s gender identity or expression. Some individuals may identify as male or female but have a nose that does not fit typical gender expectations, and this is completely valid”.

In other words, this is a controversial and complicated topic which needs more research than ChatGPT is able to bring to light! A pioneering step in this direction came very recently with the publication by John Riddington Young, of a 170-page book entitled ‘Sex and the Nose,⁸ An examination of the physiological, pathological, cultural, anthropological, artistic and historical relationships between the nasal organ and the genitalia in man, with a few observations on the throat and the ear’. It presents an ‘amazing’ new approach. The book is packed full not only of medicine, but also with poetry, obscure beliefs and stories of human behaviour.

Right at the beginning, we are told simply that the lining membrane of the nose does contain identifiable erectile tissue. We go onto learn about the relevance of sex in olfaction, pheromones, sexual activity and human attraction. Throughout the 25 chapters, all aspects and interrelationships of the ‘naso-genital link’ are scrutinised with elegance, pertinence and humour. The lavish collection of over a hundred images illuminates the quality of the text and allows the reader to visually travel in their own imagination, from traditional Japanese masks (replacing the nose with a penis), to the bronze Roman faun with an ‘equal’ sized nose and penis. Other chapters discuss masturbation and sexual excesses “conducing to chronic rhinitis”, Kallmann’s syndrome, nasal dysmenorrhoea, the pregnant nose, menarchal rhinitis and Jacobsen’s organ.

In conclusion, the nose can certainly be considered as ‘a secondary sexual characteristic.’ Any reader unfamiliar with this affirmation can simply delve into the pages of Sex and the Nose to be totally convinced that this is definitely a subject which merits much more attention. ChatGPT still has a lot to learn.

1. Thorp HH. ChatGPT is fun, but not an author. Science 2023;379:313.
2. Patel SB, Lam K. ChatGPT: the future of discharge summaries? Lancet Digit Health2023;5:e107–8.
3. Looi MK. Sixty seconds on. . . ChatGPT. BMJ 2023;380:205.
4. Stokel-Walker C, Van Noorden R. The promise and peril of generative AI. Nature2023;614:214–6.
5. Bult OC, Oladokun D, Lippert BM, Hohenberger R. Can sex improve nasal function? – An exploration of the link between sex and nasal function. Ear NoseThroat J 2023;102:40–5.
6. Mayo-Yanez M, Herranz-Larraneta J, Calvo-Henriquez C. Commentary on cansex improve nasal function – an exploration of the link between sex and nasalfunction. Ear Nose Throat J 2022;14 [1455613221077601].
7. Book HE. Sexual implications of the nose. Compr Psychiatry 1971;12:450–5.
8. Young JR. Sex and the Nose. Amsterdam: Wayenborgh; 2023.