Part 12

FIG. 16.—Ripening follicles. ]

The vagina during virgin girlhood is narrow, and its mucous surface is beset with numerous rugæ, which may be plainly felt as well as seen. The calibre of the vagina is proportionately less the younger the girl. The examining finger is gripped by the vaginal wall as by an india-rubber tube (Maschka). The vaginal portion of the cervix is felt in the form of a truncated cone, with a smooth surface, rather dense in consistence; the external os opens at the bottom of a small depression on its surface, in the form of a short oval, the long axis of which is transversely directed. Shortly before the menarche, Bartholin’s glands become noticeable on either side of the lower end of the vagina between the sphincter muscles.

The clitoris in many cases attains a very large size, and this is apt to lead to sexual malpractices. According to Hyrtl, in southern countries the clitoris is larger than in temperate and cold climates. In the women of Abyssinia and among the Mandingoes and the Ibboes, the size is portentous, and amongst the first-named, circumcision of females is a customary operation. It is said that female slaves belonging to these races are greatly esteemed by the ladies of the harem, and are eagerly sought for. In the anatomicopathological museum at Prague there is a preparation of the female genital organs with a clitoris as large as the penis of a full-grown man.

FIG. 17.—Graafian follicles. ]

Sonini describes “as peculiar to women of Egyptian or Koptic descent, the presence of a thick, fleshy, but soft and pendent outgrowth in the pubic region, completely covered with hair,” which he compares to the hanging caruncle on the bill of the male turkey. This appendage becomes thicker and longer with advancing years. Sonini found such an appendage one-half inch in length in a girl of eight years, one of more than four inches in a woman of twenty to twenty-five years. Circumcision in girls consists in the removal of this outgrowth, which hinders copulation; in that part of the world the operation is usually effected in the seventh or eighth year, just before puberty.

The circumcision of girls as practiced by Mahommedan peoples in Africa is said by Ploss and Bartels to consist in abscission of the labia minora, the clitoris, and the præputium clitoridis. Brehm is of opinion that the object of the operation is to diminish the intensity of the sexual impulse, so overpowering among these races; but others believe that the great enlargement of the clitoris and the labia minora usual in those countries is regarded as a serious defect in beauty, a defect removed by the operation; whilst others again hold that the circumcision is required for the removal of the hindrance to copulation presented by the abnormally large clitoris. Closely related to the operation of circumcision in females, according to Ploss and Bartels, is the custom peculiar to Africa of infibulation, wherein, after a preliminary cutting operation like that for circumcision, the fresh wound surfaces are brought into accurate opposition, either by sutures or by appropriate bandages, so that when cicatrization occurs the vulval cleft is closed except for a very small aperture. The object of infibulation is to enforce on girls complete abstinence from sexual intercourse. (Before marriage, the vulval cleft is reopened to an extent corresponding with the size of the genital organs of the future husband; and when pregnancy occurs, the opening is still further enlarged before parturition; but after that event, the wound surfaces are refreshed, and the whole opening is once more closed). On the other hand, in many savage tribes, elongation of the labia minora and the clitoris is artificially undertaken from the earliest years of girlhood, this elongation being regarded as a beauty.

The parts of the external reproductive organs of the female concerned in sexual sensation, first described as such by Kobelt, are already fully developed at the time of the menarche. Of these parts a small portion only, the glans clitoridis, is visible externally, surrounded by the præputium clitoridis, a prolongation of the labia minora, which passes round the front of the clitoris, and sends from each side a fine process behind the glans to become attached to its under surface, forming the frænum of the clitoris. The erectile apparatus of the external genitals is formed by the corpora cavernosa clitoridis. As two delicately constructed trabecular masses of erectile tissue, the crura of the clitoris, these are attached on either side to the inferior or descending rami of the pubic bones; at first passing upwards parallel to the bones, they subsequently curve downward as they converge and unite to form the body of the clitoris; these masses of erectile tissue embrace the sides and the front of the lower extremity of the vagina. This erectile apparatus, when the supply of arterial blood is greatly accelerated and at the same time the outflow of venous blood is diminished, becomes distended with blood, enlarged and stiffened; the process of erection plays an important part, as we shall explain more fully later, in the production of sexual excitement and sexual pleasure during the act of copulation.

In the virgin and in the earlier phases of the sexual life, the hymen is so characteristic an organ that its more minute description would seem desirable.

The hymen, a fold of mucous membrane, springing from the periphery of the vaginal orifice, separates as a perforated diaphragm the vagina from the vulva. Between the two epithelial layers of which, as a fold of mucous membrane, the hymen consists, is a supporting layer of connective tissue of variable strength; in other respects the mucous membrane of the hymen has the same structure as the mucous membrane of the vagina. On its inner surface the rugæ and folds of the vaginal mucous membrane are prolonged. The shape of the hymen is very variable; most commonly its aperture is more or less central, so that the hymen has a ringed or semilunar shape.

FIG. 18.—Annular Hymen. ]

FIG. 19.—Annular Hymen. ]

In the new-born female infant, the hymen has the appearance of a tubular stopper closing the lower end of the vagina; according to Dohrn it exhibits as a rule one of three typical forms: Hymen annularis, denticulatus, et linguiformis; the annular, the denticulate, and the linguiform (or linguliform) hymen. The transverse ridges on the inner surface of the hymen, prolongations of the rugose columns of the vagina, are strongly developed. During the girl’s further growth, in association with the enlargement of the vagina, the hymen undergoes important changes in form and structure. Its border becomes thinner and more tense; and in the virgin at the time of the menarche, the annular hymen is the fundamental type, subject, however, to extensive variations. In most cases, at any rate, the aperture in the hymen is more or less centrally situated; very commonly, however, this opening is crescentic, when we have a semilunar hymen, the height of the border posteriorly being much greater than anteriorly. The consistency of the hymen, its extensibility, and its thickness, are as variable as its shape.

FIG. 20.—Semilunar Hymen. ]

FIG. 21.—Annular Hymen with congenital Symmetrical Indentations. ]

FIG. 22.—Fimbriate Hymen. ]

FIG. 23.—Deflorated Fimbriate Hymen. ]

In the normal position of the reproductive organs the hymen has very rarely the appearance of a tense membrane; as a rule it is folded up, and becomes plainly manifest only when the genital organs are stretched. The margin of the hymeneal aperture, as a close examination shows, is sometimes sharp and regular, sometimes lobulated, with small congenital notches. These congenital notches are to be distinguished from the lacerations resulting from defloration by the fact that the former have a smooth border, which is of the same consistency as the general substance of the hymen. In some instances the border of the aperture in the hymen is beset with small, fine villi (villous hymen).

The common varieties of the hymen are thus classified by Maschka:

1. The annular hymen, in which the membrane when stretched is seen to have a rounded aperture, which may be central or eccentric; very often, indeed, the aperture is more toward the upper half of the hymen, in which case it is not always circular, but frequently rather ovoid in shape.

2. The semilunar or crescentic hymen, in which the aperture is eccentrically placed in the upper half of the membrane, in such a manner that the hymen exhibits a wide surface below the aperture, which surface narrows at either side as it passes upwards until it disappears, the two sides failing to reunite above the aperture.

3. The heart-shaped or cordiform hymen, the general shape of which may be circular, ovoid, or even semilunar, but in which from the middle of the upper or lower margin a three-cornered tongue projects across the aperture, which is thus given the form of the conventional heart of a pack of cards.

4. The infundibuliform hymen has the form of a small projecting funnel resembling in appearance the invaginated end of the finger of a glove.

Maschka refers also to the rare condition in which the hymen is sometimes said to be absent. As a matter of fact, however, in such cases, it is represented by a very narrow annular eminence, the genitals being in other respects normal. The smooth character of the eminence will serve to differentiate it from the remains of a destroyed hymen. Other rare forms are:

1. The imperforate hymen, an occlusive membrane, entirely blocking the vaginal orifice. In some cases, however, the hymen is not absolutely imperforate, a very small, punctiform aperture being present.

2. The cribriform hymen, a hymen which is “imperforate” in the sense that there is no opening of a size approaching the normal, but in which several minute apertures are present.

3. The septate, bridged or divided hymen (hymen bifenestratus, etc.), exhibits a strip of mucous membrane, most commonly running directly from before backward, occasionally, however, somewhat obliquely, across the aperture in the membrane, which is thus divided into two equal or unequal parts. In some instances the process that bridges the aperture of the hymen is expanded in the vertical plane to form a septum which projects for some distance into the vagina.

FIG. 24.—Septate Annular Hymen. ]

FIG. 25.—Septate Semilunar Hymen. ]