Part 3

The subject with which we are especially concerned is discussed in a work by Boireau-Laffecteur, Essai sur les Maladies Physiques et Morales des femmes, Paris, 1793; and also in Marie-Clement’s Considerations Physiologiques sur les Diverses Epoques de la Vie des Femmes, Paris, 1803. the same connection we must mention von Humboldt’s treatise, Ueber den Geschlechtsunterschied und dessen Einfluss auf die organische Natur. The first comprehensive work in which an exhaustive inquiry was made into the functional disorders of the female genital organs and the relation of these disorders to the female organism as a whole and to the physical and mental peculiarities of woman was Busch’s: Das Geschlechtsleben des Weibes, Leipzig, 1839.

In the second half of the nineteenth century a very large number of monographs were published, investigating and describing the reflex disturbances produced alike in the individual organs and in the nervous system as a whole by changes in the uterus and its annexa. Many of these works will be mentioned more particularly in the course of this treatise.

The sexual life, based upon the purpose, so important to every creature, of the propagation of the species, possesses in the female sex a vital significance enormously greater than sexual activity possesses in the male. From the very beginning of sexuality, when the idea of a bisexual differentiation dawns for the first time in the brain of the little girl, down to the sexual death of the withered matron, who laments the loss of her sexual potency, physical and mental activity, work and thought, function and sensation, arise for the most part, wittingly or unwittingly, from that germinal energy which is the manifestation of the unalterable law that the existing organism endeavors to reproduce its kind.

Every phase of the sexual life of woman, from the threshold of puberty to the extinction of sexual activity, the first appearance of menstruation, the complete development of the sexual organs, the act of copulation, conception, pregnancy, parturition, and the puerperium, finally the involutionary process which accompanies the cessation of menstruation at the climacteric period—every one of these sexual phases entails consecutive physiological processes and pathological changes alike in the individual organs and in the nutritive condition of the entire organism, in the functions of the cardio-vascular apparatus, of the brain and the nerves, of the skin and the sense-organs, in the processes of digestion and general metabolism. Herein we see a striking illustration of the old saying of von Helmont, propter solum uterum mulier est quod est; also of the similar aphorism of Hippocrates, uterus omnium causa morborum qui mulieres infestant; a conception summed up by Goethe in the words of Mephistopheles:

“Es ist ihr ewig Weh und Ach So tausendfach Aus einem Punkte zu kurieren.”

Just as in a tree the process of growth is made manifest to the superficial observer by the pleasure he feels at the sight of the buds and blossoms, by the refreshment he obtains from the fruit, and by the sadness which the withering of the leaves causes him, so in the sexual life of woman there are landmarks which no one can possibly overlook, by means of which three great epochs are distinguished. These are: puberty (the menarche), recognized by the first appearance of menstruation and the awakening of the sexual impulse; sexual maturity (the menacme), in the fully developed woman, characterized by the functions of copulation and reproduction; and sexual involution (the menopause), in which we see the gradual decline and ultimate extinction of sexual power and all its manifestations. In all these three epochs the sexual life of woman not only affects the hidden domain of the genital organs, but controls also all the vegetative, physical, and mental processes of the body, and is clearly and incontestably apparent in all vital manifestations. What Madame de Staël said of love is indeed true of the entire sexual life of woman: l’amour n’est qu’unc épisode de la vie de l’homme; c’est l’histoire tout entière de la femme..

The sexual life of woman is coextensive with the peculiar vital activity of the female sex, for it endures from the moment when individuality first begins to develop out of the indifferent stage of childhood until the decline into the dead-level of senility.

To illustrate this fact, I have drawn up a curve of the sexual life of woman, making use of the statistical data available in central Europe regarding the age at which menstruation first appears, the age at which maidens marry, the age at which the largest number of women give birth to a child, and the age at which menstruation ceases; and reducing the figures to averages. * denotes the fifteenth year of life, as the average age at the menarche; ** denotes the twenty-second year of life as the average age at marriage; *** denotes the thirty-second year of life, in which woman exhibits her maximum fecundity; **** denotes the forty-sixth year of life as the average age at the menopause. (FIG. 1.)

FIG. 1.—Curve of the sexual life of woman from the tenth to the sixtieth year of life. ]

Not in this respect alone, however, is the sexual life of woman of paramount importance; it is, in addition, the mainspring of the well-being and progress of the family, of the nation, of the entire human race. In the evolution of man from the primitive state in which he existed merely for the performance of vegetative functions up to the highest stage of contemporary culture, in the history of all races and of all times, the sexual life has been a most potent determining factor. With that life, religion, philosophy, ethics, natural science, and hygiene, have been most intimately related; for that life, they have furnished precepts and laws. The history of the sexual life is identical with the history of human culture.

In a primitive condition of society, among people living in a state of nature and among the lower races of mankind, the sexual life of woman possesses no great general interest, the female being merely a chattel; the ownership of this chattel, moreover, being often temporary and transient. The investigations of anthropologists have shown that among primitive people this form of property is neither highly esteemed nor carefully safeguarded. In such societies no restraint is imposed on the sexual impulse, which is gratified without shame and without formality. No hindrance is offered to the mutual intercourse of the two sexes. Chastity in the females is not prized by the males, nor do the latter compete for the favors of the former. Procreation is no more than a gregarious impulse of the masses among whom the common ownership of all booty is a matter of tribal custom. The woman has no disposing power over that which every one desires and which every one has the right to demand. Very gradually, however, a change takes place in this respect, so that in every period of social life since the very earliest, the modesty of young girls, the high valuation put upon the preservation of virginity, the ethical approbation of chastity in the wife, respect for the duties and rights of the mother, the reverence felt for the matron—all these, throughout the sexual life of woman, have had a civilizing, ennobling, and elevating effect. Thus, as family life has become developed, and as love and marriage have been more highly esteemed, woman has become the much-prized embodiment of all that is beautiful and good, of all that is summed up in the idea of the “housewife,” and her sexual life has been more completely, more ideally admired. The danger is not remote, however, that the leveling tendencies of the present day, and an inclination to despise the sexual life of woman, far from resulting in a further elevation of the social status of womanhood, will result rather in its abasement.

The Bible, as we may expect from the patriarchal relationships of the women of that time, bears witness to the worth of woman, and, whilst esteeming child-bearing, refers to yet higher duties. Precise religious and social precepts are furnished for all the phases of sexual life.

In classical antiquity, also, we see that woman rose to some extent above the low position she had previously occupied in the family circle and in society at large. Both among the Greeks and among the Romans, there was open to women a more intimate place in social life and a more influential rôle in the life of the family, than would have been their portion regarded merely in relation to their child-bearing activity. Amongst the Germans in the very earliest times, chastity gave rise to purer and more moral sexual relations; whereas among the Slavonic peoples the conception of woman as the childbearer continued to dominate these relations.

In consequence of the diffusion of Christianity, woman became man’s companion and equal, and her life, the sexual life included, acquired a deeper significance, owing to the stress which that religion laid on chastity as a virtue, and as a result of the educational influence of woman in the family circle.

With the progress of civilization the sexual life of woman comes to exhibit its activities only within the bounds of morality and law, which in human society have replaced the crude rule of nature, and have supplied regulations adapted to the changing phases of sexual vital manifestations. The wise adaptation of these regulations requires, however, a full understanding of the mental and physical processes, an exact recognition of the bodily states and intellectual sensibilities, of woman regarded as a sexual being.

Modern culture and the social organization of the present day, in association with the resulting sexual neuropathy of women, have exercised on their sexual life an influence as powerful as it is unfavorable, manifesting itself in the overpowering frequency of the diseases of women. In one of the most thoughtful books ever written on the subject of woman, Michelet’s L’Amour, the author remarks that every century is characterized by the prevalence of certain diseases: thus, in the thirteenth century, leprosy was the dominant disease; the fourteenth century was devastated by bubonic plague, then known as the black death; the sixteenth century witnessed the appearance of syphilis; finally, as regards the nineteenth century, “se siècle sera nommé celui des maladies de la matrice”. It is certain that the education and mode of life of the modern woman belonging to the so-called upper classes are, as far as sexual matters are concerned, in direct opposition to those that are agreeable to nature and those that the laws of health demand.

Even before sexual development begins, before the physical ripening of the reproductive organs to functional activity, the imagination of young girls is often prematurely occupied with sexual ideas in consequence of unsuitable literature, owing to visits to theatres and exhibitions, or on account of social intercourse with young men who are not overscrupulous in the selection of topics for conversation. From the time of puberty up to the time of marriage the growing woman is under the influence of the now awakened sexual impulse, which experiences ever-renewed stimulation. A sedentary mode of life, unsuitable nutriment, and the early enjoyment of alcoholic beverages, exhibit their inevitable result in the frequency with which, in this epoch of the sexual life, chlorotic blood-changes, neurasthenic conditions, and diverse symptoms of irritation of the genital organs, make their appearance. Thus, when marriage, so often unduly postponed in consequence of the condition of modern society, does at length take place, it is apt to find the woman not only fully enlightened as regards sexual matters, but often in a state of nervous weakness from sexual stimulation, one of the type whose characteristics have been happily summed up by the French writer Prévost in the expression demi-vierge. The conjunction of this state of affairs in the bride with the frequent partial impotence of the bridegroom, who has already dissipated the greater part of his virile power before entering upon marriage, leads often to the appearance of vaginismus and other sexual neuroses in young married women. Even more disastrous in its consequences as regards the future sexual life of the wife is the ever-increasing frequency of gonorrhœal infection in the first days of marital intercourse, with all the evil results of that infection. On the other hand, an ever-larger proportion of girls belonging to the “middle and upper classes,” abstaining alike from the good and the evil results of marriage, falls under the yoke of sexual impulses denied satisfaction or gratified by abnormal means, and suffers in consequence both physically and mentally. Further sources of injury arising from the conditions of modern social life are to be found in the neglect by women of the well-to-do classes of the duty of suckling their children, and in the ever-increasing frequency with which the women of these classes, after giving birth to one or two children, resort to the use of measures for the prevention of pregnancy, which result in serious consequences as regards both the nervous system and the genital organs of the women concerned. Thus there comes an accelerated ebb in the sexual life, leading to a premature appearance of the general phenomena of senility, with a cessation of the menstrual flow. The modern wife, who claims the right to lead the life that best pleases her, will be more rapidly overtaken by sexual death.

For the elucidation of the manifold reflex and other processes which are dependent upon or accompany the sexual phases of woman, we must in the first place consider the anatomical changes and physiological functions of the female reproductive organs characteristic of the several periods of sexual life which have already been distinguished. We must not fail also to take into consideration the mental states which accompany and characterize these respective phases.

The anatomical changes which occur in the female genital organs during these different phases of sexual life give rise to a number of manifold local stimuli, increasing and decreasing, varying greatly in intensity and area of distribution, upon which depend the reflex effects and remote manifestations in the sphere of the nervous and circulatory systems.

We must first consider the changes in the ovaries, which play an etiologically important part. At the onset of puberty, the follicular masses of the ovary exhibit a more active growth, the follicles increase in size, with their contained ova they approach the surface, and finally, by the bursting of the follicles, the ova are extruded. Then, in the life-phase in which conception occurs, and under the influence of the hyperæmia of all the pelvic viscera that accompanies this process, a notable development of the corpus luteum takes place, this latter body reaching its maximum size in the eleventh week of pregnancy, subsequently undergoing involution and leading to the formation of a considerable scar. Finally, in the critical period of life in which the menstrual flow ceases, a continually increasing growth and new formation of connective tissue-stroma takes place in the ovaries at the expense of their cellular constituents, and a regressive metamorphosis of the graafian follicles occurs.

In association with these sexual processes there ensues a series of striking changes in the shape and consistency of the ovaries, affecting both the surface and the parenchyma of these organs, and capable of stimulating the nervous ramifications in their tissue. In this connection it is worthy of note that the branches supplying the ovaries from the spermatic plexuses of the sympathetic contain a considerable proportion of sensory fibres.

Quite as significant, moreover, as the changes in the ovaries, are those which, in the course of the sexual life, the uterus undergoes, in shape and size, in its muscular substance and mucous lining, and in its vascular and nervous supply.

FIG. 2.—Portion of the pelvic viscera in the female, and their relation to the muscles of the pelvic outlet (or perineal muscles), shown in the left half of the pelvis, seen from the right side.—The parametrium. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.) ]

At the time of puberty the infantile uterus undergoes changes affecting both its external form and the shape of its interior cavity. The body of the uterus enlarges to the size characteristic of sexual maturity, and its mucous membrane becomes the seat of periodic changes. This waxing and waning growth and transformation of the uterine mucous membrane continues throughout the period of menstrual activity, the most superficial layers of the membrane being shed during menstruation, a process followed by regeneration, which is itself succeeded by the premenstrual thickening. When conception occurs, still more extensive changes ensue, the fertilized ovum becoming imbedded in the uterine mucous membrane, and the pregnant uterus, in shape and structure and in the respective relations of the body and neck of the organ, in the increasing distension of its veins and the increasing size of its nerves, becoming adapted to the important functions it has now to fulfil. When these have been fulfilled, and, parturition having taken place, the uterus is empty once more, the organ again adapts itself to altered circumstances by the process of involution. Later, in the climacteric period, a slow regressive process occurs, the outward manifestation of which is the cessation of the menstrual flow, characterized anatomically by atrophy of the muscular tissue of the uterus and of its vascular apparatus, by the dessication of its mucous membrane, by obliteration of the lumen of the uterine cavity, and ultimately by senile degeneration and atrophy of the now entirely functionless organ, so that it becomes an insignificant, cicatrized, solid body.

Next to the ovaries and the uterus, it is the pelvic fascia which in its entire architectonic structure as well as in its individual parts undergoes the most notable changes in consequence of the processes of generation.

A short account of the nerves and blood vessels of the female genital organs appears indispensable, to facilitate the comprehension of the manner in which sexual processes are influenced by the nervous system, and to demonstrate the intimate connection between the blood-supply of the genital apparatus and the general circulation.

The complex nervous network of the female sexual organs is supplied by spinal as well as by sympathetic fibres, the fibres from the two systems anastomosing in a very intimate manner.

FIG. 3.—The distribution of the pudic nerve, n. pudendus, in the female perineal and pubic regions. The trunk of the pubic nerve, n. pudendus, is covered by the gluteus maximus muscle. On the right side of the body the branches of the inferior pudendal nerve, rami perineales, nervi cutanei fermoris posterioris have been dissected out; but the branches of this nerve to the labium majus have been cut short. The formation of the anococcygeal or subcaudal nerves, nn. anococcygei, out of the posterior primary division of the coccygeal nerve and out of the perforating branches which arise from the anterior primary divisions of the fourth and fifth sacral nerves and the coccygeal nerve. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.) ]