Translated from the seventh enlarged and revised German edition. Krafft-Ebing identifies a difference between congenital and acquired homosexuality. The latter is cause by homosocial environments, masturbation, fear of sexual disease or pregnancy from heterosexual intercourse (188-189), and may be reverted only if the person is untainted by other poor health conditions (190). Congenital homosexuality is always a degenerate trait to Krafft-Ebing, and any physical intersex trait is a sign of extreme degeneration (304). He describes the trans experience with several labels, including "Metamorphosis Sexualis," "effemination," and "viraginity" (202, 222-223) and says that the bisexual condition, termed psycho-sexual hermaphroditism, is predominately homosexual (222). Finally, he observes that people experiencing anaesthesia sexualis (asexuality) commonly have other traits of degeneration (42).