Part 34

In the case of 1,000 adult women examined by Eggel with regard to the colour of the pubic hair, the colour of the eyes, and the colour of the hair of the head, there were 239 with dark eyes, 333 with dark hair on the head, and 329 with dark pubic hair; contrariwise, 761 had light eyes, 667 light hair on the head, and 679 light pubic hair. Obviously, then, a considerable number of women with light-coloured eyes must have had dark pubic hair. Roth, in 1,000 North German women examined by him, found the pubic hair blonde, but a rather dark blonde, in a large majority of the cases; in red-haired women, the pubic hair was in all cases bright red, in black-haired women the pubic hair was black in two-thirds only of the cases, in nearly a third it was brown, in two cases dark blonde; in Jewesses, in a large majority of instances, the pubic hair is brown. The arrangement of the pubic hair is described by Roth as very variable. “Sometimes it is short and frizzly, sometimes a luxuriant bushy growth; sometimes the hairs are scanty and thinly set; sometimes they are irregularly distributed; sometimes we see only a narrow strip of long hairs down the middle of the mons Veneris, which is bare at the sides. In some the lateral boundaries of the pubic hair are sharply defined, in others the hairy covering spreads beyond the usual limits.”

Among the ancient Greeks and Romans, it was customary for women to remove the pubic hair, a custom even now observed by all oriental races; for this reason in ancient art the nude female body is depicted without pubic hair. According to Stratz, in the Chansons de Bilitis it is said of the priestesses of Astarte: “They never draw their hairs out, in order that the dark triangle of the goddess shall represent on their bodies the form of a temple.”

The physiological purpose of the pubic hair is to prevent irritation of the genital organs by the sweat that would otherwise run down upon them, and to protect the skin from direct friction during the act of copulation.

The labia majora in women during the menacme are usually strongly developed, their outer surface is hairy; in parous women we almost invariably observe small or even large lacerations of the frænulum pudendi or fourchette, in front of the posterior commissure of the vulva. On the inner surface also of the labia majora, the general characters of which are those of mucous membrane rather than of skin, fine hairs are also to be found. In multiparæ, and even in women who have frequently had sexual intercourse, these inner surfaces of the labia majora are not usually any longer in mutual contact, so that the rima urogenitalis or vulval cleft gapes more or less. In well-nourished women who have led the “sheltered life,” the dense and fat-containing connective tissue of the labia majora (continuous with and similar to that of the mons Veneris) gives these structures a certain firmness and elasticity, and the labia minora or nymphæ do not project beyond them. But when the genital organs are not well preserved, projection of the nymphæ occurs. In women whose genital organs are beautifully formed, the nymphæ are of a soft, delicate consistency, and their mucous membrane is of a pink color; but when the reproductive organs have been subjected to excessive stimulation, the nymphæ are dry, hard, brown in color, and they project from the vulval cleft. In women of the Hottentot and Bosjesman races, the nymphæ attain, as is well known, an excessive length, forming the so-called “Hottentot-apron;” and in certain other indigenous races of Africa, the enormous size of these organs renders resection necessary.

During this sexual epoch, in women with strong sexual passion and having frequent sexual intercourse, the clitoris is largely developed, and sometimes the dorsum of the organ protrudes from between the anterior extremities of the labia majora.

The vaginal orifice gapes a little, so that the irregular carunculæ myrtiformes are visible. In parous women, the vaginal orifice is enlarged in such a manner that the wall of the vagina passes directly and without limitation into the wall of the vestibule, and the external orifice (meatus) of the urethra is situate immediately in front of the anterior vaginal column, and thus lies within the vaginal orifice.

The breasts of a strong, healthy woman who has attained complete sexual maturity are more or less firm in consistency, and considerable in size, exceeding now Ovid’s demand concerning these organs, ut sit quod capiat nostra tegatque manus. The normal hemispherical form and the somewhat soft texture are subject to many variations, these being dependent upon race, climate, and sexual activity and also upon the kind of clothing worn. The nipple and its encircling areola are usually of a brownish colour; but in beautiful women they sometimes retain the pink colour characteristic of these structures in the virgin. In parous women who have suckled their children, the breasts are usually pendent, and often the left breast will be found to be somewhat larger than the other; generally also in such women the nipples are longer and thicker than normal. Not infrequently the nipples are withdrawn into a furrow of the skin, and become prominent only on local stimulation or as a result of sexual excitement. Sometimes in the region of the areola, especially in brunettes, we see a circle of small glands, which produce eminences beneath the skin.

It is easy to understand that the breasts of such women in general no longer have the virginal form of small hemispheres, but have matured to a greater fulness and size. This, however, does not diminish their beauty, for the ideal of beauty must take into account the natural development of the body. Whereas at the present time, under the influence of the modern negation or at any rate undervaluation of maternity as the goal of woman’s life, it is the tendency of a certain school of art to misprize the influence of that state on the form of the breast, and to esteem the “flat bosom,” at an earlier day under the influence of Rousseau’s Emile, a book in which mothers are strongly urged to suckle their own children, the full bosom as a beauty was the fashion in art.

Only a perverted taste can find a woman beautiful without bosom—without “that golden chalice, from which men quaff love, and children life” (Mantegazza),—an angular, flat being, without a rounded form. Nothing but a morbid desire for equality with man can induce woman herself to endeavor to conceal also the external manifestation of her sexual characteristics, and by her clothing to disguise, like a nun, the sexual curves of her figure.

Great deposit of fat, such as occurs from liberal feeding in conjunction with a sedentary mode of life, or as a result of several pregnancies, destroys the beautiful form of the breasts, which attain an immoderate size, thus disturbing the grace and symmetry of the feminine figure, a fact recognized already by the Romans. Hyrtl condemns, from the point of view of anatomical beauty, the nude female figures in the pictures of Rubens, remarking that “the goddesses and angels of this painter are as luxuriant in their development as a Flemish dairy-maid;” and the buxom “goat’s-udder breast” prized by the Arabs does not represent any nobler ideal of beauty. Sometimes these excessively large and fat breasts hang down in a conical form, or, as more or less flattened hemispheres, reach right down over the gastric region; moreover, the interspace between the two breasts seems to disappear, and they touch or rub against one another.

According to Ploss and Bartels, the various forms of breast occurring in different races may be classified as follows: A. According to size: 1, very large; 2, large; 3, medium; 4, small. B. According to consistency and firmness: 1, high; 2, semi-pendent; 3, pendent. C. According to shape: 1, shell-shaped (disc-shaped); 2, hemispherical; 3, conical. The nipples also, according to these authors, exhibit variations dependent upon race, being in some cases small and flat, like a little knob, in some cases large and conical in shape, with a broad base and a rounded extremity, and in some cases large and cylindrical, having almost the shape of a finger-joint. The areola, finally, is in some women quite pale in color, in some dark pink, in some brown and even almost black from excess of pigment.

The uterus of a woman who has attained complete sexual maturity, has undergone such alterations in its proportions that the cervix and the body are of almost the same length. The constriction, visible externally, indicating the separation between these two segments of the organ, is depressed somewhat toward the external os. In sexually active women, a widening and an increased curvature of the region of the fundus occur, the uterine extremities of the Fallopian tubes becoming more widely separated; at the same time the posterior wall becomes more and more convex. The more frequently the uterus has functioned as a reproductive organ, the more strongly marked is the convexity of the body of that organ. The relative lengths of the corporal and cervical portions of the uterine cavity are now the reverse of those that obtain in the uterus of the child; the transverse and antero-posterior diameters have greatly increased. Transverse diameter at the fundus; virgin, 4 centimetres (1.575″), multipara, 5.5–6.5 centimetres (2.165–2.559″): sagittal (antero-posterior) diameter; virgin, 2 centimetres (0.787″); multipara, 3–3.5 centimetres (1.181–1.378″). (Chrobak and von Rosthorn.)

During the menacme, in consequence of the act of reproduction, the uterus undergoes important changes in form. In a nulliparous married woman, the uterus differs little from that of a virgin; the cavity is somewhat more extensive, the convexity of the outer surface a little greater, there is some increase in width in the neighborhood of the fundus, the plicæ palmatæ (arbor vitæ uterinum) are confined to the cervical canal; further, under the influence of copulation the appearance of the vagina changes, it becomes larger, and its walls become smoother, sometimes quite smooth, from the disappearance of the rugæ of the mucous membrane and especially of those attached to the posterior vaginal column. Much more extensive are the alterations in the uterus of a multipara. According to Toldt, “the parts of the cavity representing the cornua, which are pointed on either side as they pass toward the Fallopian tubes, become completely included in the lower undivided portion of the cavity, this change being effected chiefly by means of the increasing outward curvature of the walls, so that the cavity comes to assume an amygdaloid form; the cervical canal is also enlarged, especially the lower part, where also the plicæ palmatæ (arbor vitæ uterinum) becomes less distinct; the vaginal portion of the cervix is shortened, the os uteri externum gapes, the lips of the cervix are tumid, nearly equal in length, and usually beset with scarred depressions.” In nulliparae, the vaginal portion of the cervix is, as in a virgin, of a rather tough consistency, smooth on the surface, while the external os is small, like a dimple, or transversely oval; the color of the vaginal portion of the cervix is identical with that of the vaginal mucous membrane in general. Through frequent copulation, however, the form of the vaginal portion of the cervix is so far altered inasmuch as it is more freely supplied with blood, and, therefore, changes slightly, in consistency. In multiparæ, in consequence of lacerations of the cervix, the os uteri externum changes to a wide transverse fissure with tumid margins, justifying the old designation of this orifice as os tincæ;, carp’s mouth. A large size of the external and internal os, moderate enlargement of the cavity, rounding of the upper angles adjacent to the uterine orifices of the Fallopian tubes, increased convexity of the walls, and partial or complete effacement of the plicæ palmatæ (arbor vitæ uterinum), are the characteristics of the uterus of a multipara (Chrobak and von Rosthorn). According to Hennig, the vaginal portion of the cervix is longest in women who have undergone defloration, and in nulliparae; widest in prostitutes; narrowest in childless wives; thickest in young widows. This author gives the following measurements of the external os, showing its variations in accordance with age and sexual activity:

In childhood, transversely oval 0.46–0.56 cm. (0.18–0.22″) In the virgin, rounded 0.20–0.50 cm. (0.08–0.20″) In prostitutes, transversely, oval 0.60–2.50 cm. (0.24–0.98″) In sterile married women, round 0.16 cm. (0.06″) In parous married women, transverse fissure 1.10 cm. (0.43″) After the menopause 0.81 cm. (0.32″)

In the fully-developed woman, the ovaries undergo changes in size, shape, and consistency, these changes being dependent upon the age, the sexual functional activity, and the constitutional predispositions of the individual. The average length of the ovary is 3–4 centimetres (1.18–1.58″); the average width, 2–3 centimetres (0.79–1.18″); and the average thickness 1 centimetre (0.39″). The surface of this organ gradually assumes a ragged appearance, from the scarred depressions caused by the great number of successive menstruations (ovulations)—sometimes the appearance produced resembles that of a mulberry.

In the vagina at this sexual epoch, the surface of the anterior and posterior vaginal walls is rendered uneven and rugose by well-developed vaginal columns (columnæ rugarum), which feel almost as hard as cartilage, and project considerably above the general level of the wall; the transverse ridges (rugæ) run horizontally outward from the columns. By frequent copulation, the rugæ are partially effaced, and the columns themselves become flatter and softer; still, except in cases in which the genital functions are exercised to great excess, the vagina remains tense and rugose until after several children have been born, when it becomes soft, flaccid, and smooth. Even in women who have been accustomed to frequent intercourse, the narrowest portion of the vagina is still the orifice and the part of the passage lying immediately within the orifice, which can be constricted by the levator ani muscle; childbirth, however, brings about great and permanent distension of these parts also. The widest and most distensible portion of the vagina is the uppermost segment, the region of the fornices.

A special significance must be attached to the glands of the cervix uteri, which, according to my own observations, have the function of providing a secretion that increases the mobility of the spermatozoa, and this enables them more readily to find their way into the uterus. I have endeavored, by a series of histological observations, to determine the properties of these glands and the changes they undergo in the different phases of sexual life. The most important results of these researches may be stated as follows. These glands, which are lined with columnar ciliated epithelium, are but slightly developed before puberty, being then simple excavations; at the time of the menarche, they become tubular; later, during the menacme, they become long, dendriform, blind-ending glands, which during menstruation and under the influence of sexual excitement, furnish a secretion, variable in quantity, and in quality distinguished especially by its alkaline reaction; further, in connection with a number of pathological disorders of the female genital organs, these glands undergo various changes both in their anatomical structure and in their secretory activity. At the time of the menopause and after the climacteric age, these glands, which have hitherto consisted of branched tubules, tend to undergo cystic degeneration, leading to the formation of the vesicles known as ovula Nabothi. After the climacteric, the existence of these cysts may be regarded as a normal occurrence; and, sometimes arranged in grape-like clusters, they often project so as to occupy the greater part of the lumen of the cervical canal.

FIG. 52.—Sagittal section through the cervix uteri of a woman 26 years of age, dendriform branched glands. ]

FIG. 53.—Cervix of a woman 72 years of age, with glands that have undergone cystic degeneration. ]

FIG. 54.—Sagittal section through the cervix uteri of a woman 65 years of age. The glands have undergone cystic degeneration. ]

Diseases of the uterine mucous membrane during the period of sexual maturity often induce various pathological changes in these cervical glands. In consequence of obstruction of their excretory ducts, they may undergo cystic degeneration, forming follicles filled with mucus and epithelium, or cavities containing blood, which pass through the substance of the cervix in every direction; or they may give rise to the formation of slowly-growing glandular polypi and other glandular new formations—changes the general result of all of which is to interfere with the secretory function of the glands.

PATHOLOGY OF THE MENACME.

The full evolution of the sexual life brings in its train many dangers to a woman’s life. This appears at first sight from a comparison of the mortality of married women during the period of greatest sexual activity with that of single women of similar age. Between the ages of 20 and 25 years, the mortality of married women is in all races higher than that of unmarried women; and the same is true between the ages of 25 and 30 years, except in France, in which country from artificial causes maternity ceases at a very early age. In Prussia, in the year 1880, of every 10,000 married women, between the ages named, 21 died, of every 10,000 unmarried women, only 2. In Holland, Belgium, and Bavaria, this excess in the mortality of married women continues up to the age of 40 years; whilst in Prussia, from the age of 30 upward, the mortality of married women and unmarried is practically the same. In many countries, the mortality of married women at many ages exceeds even that of unmarried men.

This greater comparative mortality of married women is ascribed by Hegar to the satisfaction of the sexual impulse, and this authority believes that the dangers attendant on this function would be manifested yet more clearly if the contrast were made, not between married women and single, but between those habituated to sexual indulgence and those who are continent. We, however, are of opinion, that the satisfaction of the sexual impulse is only harmful to this extent, that it exposes women to the consequences of venereal infection, and also to the risk of numerous puerperal and other diseases of the genital organs. This is proved also by the statistical results of the investigations concerning mortality during pregnancy, parturition, and the puerperium. According to Hegar, adding deaths resulting from premature delivery to deaths resulting from delivery at full term, we find the mortality of childbirth in Germany to be about 0.6 per cent.

Whilst Bertillon and Simpson believe that the lower mortality of married women above forty years of age as compared with unmarried women at the same period of life is dependent upon the advantage to the former of the fulfilment of sexual functions, Hegar, on the contrary, gives another explanation. He writes: “At the age of 40, the less powerful married women have already been weeded out. At first, owing to the selection exercised by marriage, the quality of the unmarried women was inferior to that of the married women; the former, however, have not been exposed to the dangers attendant on the reproductive process, and so have passed through the time during which the body possesses the greatest elasticity; but in the years in which a decline in the vital powers naturally sets in, the originally inferior quality of the unmarried women is manifested by a comparatively higher mortality. Also we have to take into account among the unmarried, the consequences of extra-marital sexual intercourse and of prostitution, and further the lack of a family, of the support furnished by husband and children.”

In addition to the far-reaching disturbances of health dependent on sexual activity at this period of life, there are the minor domestic troubles by which woman is depressed and by which her powers are exhausted. The influence of these latter is admirably described by G. von Amyntor: “How many millions of brave house-wives boil and scrub away their vital energy, their rosy cheeks, their merry dimples, in the performance of their household duties, until they become wrinkled, worn-out, dried-up mummies. The ever-renewed question, ‘what must be cooked for dinner to-day,’ the perpetually recurring necessity for scouring and sweeping and dusting and washing-up—these are the continual dropping which slowly but surely wears away soul and body. * * * On the flaming altar on which the sauce-pan simmers, youth and simplicity, beauty and good temper, are offered up; and who can recognize in the old, hollow-eyed cook whose back is bent with toil and trouble, the once blooming, energetic, chastely coquettish bride adorned with her myrtle crown?”

A great number of the diseases of the female genital organs occurring at the epoch of the menacme need only a passing mention. Even coitus, in cases in which there is great disproportion in size between the penis and the vaginal orifice, or when the organ is very rapidly introduced or the act is very roughly performed, may lead to injury to the vulva or the vagina, a fact to which a very large number of recorded cases bears witness.

During the acme of the sexual life of woman, disturbances of the menstrual function are also frequent. Menstruation may cease in consequence of intercurrent diseases or constitutional anomalies; amenorrhœa may occur during the convalescence from acute diseases, in obese women, in those suffering from tuberculosis, diabetes, alcoholism, or psychoses. On the other hand, severe menorrhagia or atypical metrorrhagia may occur, the bleeding either being due to diseases of the uterus, such as endometritis, retroflexion of the uterus, or uterine myomata, or resulting from infectious diseases, disease of the heart or kidney, or from general disturbance of the health by chill or over-exertion. Or, again, dysmenorrhœa may arise, either as a symptom of some local uterine disease or in consequence of external noxious influences or weakness of the nervous system.