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J R Soc Med. 2007 November; 100(11): 489–490.
PMCID: PMC2099406

The nose and sex: the nasogenital reflex revisited

Bhutta (JRSM 2007;100:268-274) reminds readers of the pre-eminent position of the nose in evolution and describes evidence linking olfaction and perhaps pheromones to human reproduction.1 The significance of the nose, he notes, is under-appreciated in the medical literature. This was not always the case.

Over one hundred years ago, neurological reflexes emanating from the nose—termed the nasal reflex neurosis—were considered to be the cause of many symptoms, including symptoms related to the genitalia. In 1883 McKenzie, an otolaryngologist from Johns Hopkins Hospital, proposed a nasogenital reflex responsible for symptoms such as dysmenorrhea, pelvic pain, etc. and described improvements following nasal treatments.2 In 1901 Fliess, an otolaryngologist and personal physician of Freud, described genital areas in the nose responsible for activating the proposed neurological pathways.3,4

The significance of a protuberant midline structure with paired erectile tissue was not lost on Freud, who collaborated with Fliess on such theories as inherent bisexuality. Freud's support of Fliess and his theories weakened after Fliess' negligent surgical care of Emma Eckstein and her later recanting of any relationship of nose bleeds to psychological stress.5 Reports of the nasogenital relationship diminished in the early 20th century and espousal of the theory faded as medical knowledge advanced.

Recent quality-of-life research, however, documents the profound effect of chronic rhinosinusitis on general health and the substantial improvements noted after nasal surgery.6 Ironically, it would not be surprising if diminished libido and sexual performance were noted in chronic rhinosinusitis and improvement documented after nasal surgery—the nasogenital reflex redux.


Competing interests None declared.


1. Bhutta MF. Sex and the nose: human pheromonal responses. J R Soc Med 2007;100: 268-74 [PMC free article] [PubMed]
2. Mackenzie J. Irritation of the sexual apparatus as an etiological factor in the production of nasal disease. Am J Med Sci 1884;88: 360-5
3. Fleiss W. Die Nasale Reflexneurose. Wiesbaden, Germany: JF Bergman, 1893
4. Zucker A, Wiegand D. Freud, Fliess, and the nasogenital reflex: did a look into the nose let us see the mind? Otolaryngol Head Neck Surg 1988;98: 319-22 [PubMed]
5. Freud S. The Complete Letters of Sigmund Freud to Wilhelm Fliess 1887-1904. Mason JM (ed and trans) Cambridge, Mass: The Belknap Press of Harvard University Press, 1985
6. Bhattacharyya N. Clinical outcomes after revision endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 2004;130: 975-8 [PubMed]

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