By the _sexual life of woman_ we understand the reciprocal action
between the physiological functions and pathological states of the
female genital organs on the one hand and the entire female organism in
its physical and mental relations on the other; and the object of this
book is to give a complete account of the influence exercised by the
reproductive organs, during the time of their development, their
maturity, and their involution, on the life history of woman.
From the earliest days of the medical art this sexual life of woman has
aroused in the leaders of medical thought the highest interest, and for
this reason great attention has been directed, not only to the anatomy
of the genital organs and to the diseases of the reproductive system,
but also to the individual manifestations of sexual activity and to the
influence exercised by these on the female organism as a whole.
Several works by _Hippocrates_ are extant on this subject, among which
may be mentioned: περι Γυναικειης Φυσεος,[1] a treatise on the
physiology and pathology of woman; περι Αφορων,[2] which discusses
sterility in women; περι παρθενιων,[3] a treatise on the pathological
states of virgins. These writings of _Hippocrates_ contain some very
remarkable observations on the influence exercised by disorders of the
reproductive organs on the general health of women.
_Aristotle_ wrote at some length on the functions of the female genital
organs. In the writings of _Aretæus_ and _Galen_ on the diseases of
women we find striking observations, as for instance, in _Galen’s De
Locis Affectis_,[4] which contains a “Statement of the Similarity and
Dissimilarity of Man and Woman.” Another notable work is that of
_Albertus Magnus_, entitled _De Secretis Mulierum_.[5]
The numerous works on the diseases of women published in the sixteenth
century consisted for the most part of a repetition of the observations
of ancient writers. The gynecological treatises of the eighteenth
century, however, bore witness to an increased knowledge of the anatomy
of the female reproductive organs, and were illumined by _Haller’s_
researches on the functions of these organs.
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_,[6] Paris, 1793; and also in _Marie-Clement’s
Considerations Physiologiques sur les Diverses Epoques de la Vie des
Femmes_,[7] Paris, 1803. the same connection we must mention _von
Humboldt’s_ treatise, _Ueber den Geschlechtsunterschied und dessen
Einfluss auf die organische Natur_.[8] 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_,[9] 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_;[10] also of the similar aphorism of _Hippocrates_,
_uterus omnium causa morborum qui mulieres infestant_;[11] 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_.[12].
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.)
[Illustration:
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_,[13] 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_”.[14] 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_.[15] 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.
[Illustration:
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.
[Illustration:
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.)
]
The greater number of the spinal nerves distributed to the genital
organs arise from the lumbar portion of the spinal cord, pass as rami
communicantes to the first four lumbar ganglia of the great sympathetic
cord, whence they proceed to the series of symmetrical (paired) and
asymmetrical (azygos) sympathetic plexuses in front of, and adjacent to
the abdominal aorta, which already contain afferent and efferent spinal
fibres derived from the pneumogastric, phrenic, and splanchnic nerves. A
small number only of coarse nerve-filaments, a larger number of fine
nerve-filaments, derived from the sacral nerves, proceed direct to the
internal genital organs; many of these fibres enter the lower extremity
of the pelvic or inferior hypogastric pleans, some pass to the cervical
ganglia of the uterus. Below the bifurcation of the aorta and in front
of the sacral promontory, a large number of the uterine nerves, both of
spinal and of sympathetic origin, unite to form an azygos plexus which
has been shown by experiment to possess great functional importance.
Anatomically this constitutes the upper undivided portion of the
hypogastric plexus, which is the downward continuation of the abdominal
aortic sympathetic plexus; but inasmuch as it is the principal channel
of nervous impulses to the uterus it is often known at the present day
as the great uterine plexus (_plexus uterinus magnus_). The nerves to
the ovary and Fallopian tube (ovarian nerves) are derived from the
spermatic (ovarian) plexus, an offshoot of the renal plexus; as the
spermatic plexus descends, it is reinforced by branches from the
abdominal aortic plexus, these branches often arising from a small
ganglion (spermatic ganglion). The hypogastric or great uterine plexus,
single and median above, divides below into the paired pelvic or
inferior hypogastric plexuses, which pass downward and forward on either
side of the rectum; these plexuses are reinforced by spinal elements
derived from the sacral nerves. Before the terminal expansions of the
pelvic or inferior hypogastric plexus enter the tissues of the internal
genital organs, the bladder, and the rectum, small masses of ganglionic
matter are interspersed among the nerve fibres.
To the above general sketch, which has been based on the synoptical
description of _Chrobak von Rosthorn_, must be added a more detailed
account of the innervation of the ovaries, this branch of the subject
being of especial importance. The nerves of the ovary are derived from
the sympathetic system, in part from the spermatic ganglion, in part
from the second renal ganglion, and in part from the superior mesenteric
plexus. The nerves of the ovary are for the most part vascular nerves,
which unite before entering the ovary to form the ovarian plexus, and
then pass into the hilum with the vessels, envelop the vessels of the
medullary layer, and thence pass to the follicular region; exceedingly
numerous, they form a close-meshed network, surrounding all the vessels
up to the finest capillary ramifications; those fibres which terminate
in the capillary walls and those also which reach the follicles are
regarded by _Riese_ as sensory. The great trunks of the uterine nerves
are transversely disposed in relation to the great lateral vessels of
the uterus, and passing inward toward the mucous membrane they break up
into pencils of filaments; the uterine nerves proper are distributed for
the most part to the muscular substance. In the Fallopian tubes, the
nerves form arches around the lumen of the tube; some fibres also pass
to the longitudinal folds of the mucous membrane.
This expansion of the nerves of the cerebrospinal and sympathetic
systems in the female reproductive organs manifests the multiple
interconnection of the two systems in this region, and proves beyond
doubt that the sensory nerves of the genital organs have manifold
connections with the motor tracts of the whole organism on the one hand
and with the sensory ganglia of the central nervous system on the other,
and in addition with the vasomotor centres and with efferent motor and
secretory fibres.
As regards the vascular system of the female genital organs, the latter
are supplied by the internal iliac artery. One of the two terminal
branches of the common iliac, the internal iliac artery, descends into
the pelvis over the sacro-iliac synchondrosis. Its branches may be
arranged in four groups: anterior group, the hypogastric, iliolumbar,
and obturator arteries; posterior group, the lateral sacral, gluteal,
and sciatic arteries; internal group, the inferior vesical, uterine, and
middle haemorrhoidal arteries; inferior group, comprising a single
artery only, the internal pudic; the uterine artery supplies the uterus
and the vaginal fornices; the ovarian artery supplies the ovary, the
Fallopian tube, and the broad ligament of the uterus; the vaginal,
cervicovaginal, or vesico-vaginal artery supplies the vagina; the
internal pudic artery supplies the vestibule and the clitoris; the
superior and inferior external pudic arteries (branches of the femoral
artery) supply the labia majora. The veins of the female genital organs
correspond in general to the arteries in their course and nomenclature,
and empty their blood into the internal iliac vein.
[Illustration:
FIG. 4.—The distribution of the lateral sacral arteries, the superior
haemorrhoidal or superior rectal artery, the uterine artery, the
ovarian artery and the distal portion of the internal pudic artery.
(From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.)
]
Attention must also be paid to the extremely rich lymphatic vascular
system of the female genital apparatus. The body of the uterus and the
annexa of that organ, the neck of the uterus and the vaginal fornices,
the middle segment of the vagina, the lower segment of the vagina, the
vestibule and the external genital organs—each of these possesses an
independent set of lymphatic vessels, leading moreover to independent
groups of lymphatic glands. It may be said that the lymph from the vulva
passes to the inguinal glands, that from the vagina and the neck of the
uterus to the internal and the external iliac lympathic glands, that
from the upper part of the uterus and also that from the ovaries and
Fallopian tubes to the median group of lumbar lymphatic glands (also
known, from their position in front of the aorta and the vena cava, as
the aortic lymphatic glands) (_Chrobak von Rosthorn_).
The important influence which the genital processes exercise on the
female organism as a whole is established not only by the anatomical
relations just described but also by a number of physiological
investigations and experiments and by the result of operations on the
female genital organs.
Thermic and mechanical stimulation of the female genitals has, as my own
experiments have shown, a notable influence on the heart and the general
circulation. In these experiments, when uterine douches were given at
temperatures of 4° C. (39° F.) and 45° C. (113° F.), the reflex nervous
impulse which resulted from these manipulations had a two-fold influence
on the circulation, manifesting itself first by an immediate and
considerable augmentation in the functional activity of the heart, the
frequency of which was increased in a degree proportional to the nervous
sensibility of the individual, and secondly by a notable rise in blood
pressure.
With a view to determining the influence of stimulation of the ovary on
blood-pressure, _Röhrig_ carried out some experiments on bitches, from
which it appeared that electrical stimulation of the ovary invariably
produced a remarkable increase in the general blood-pressure, an
increase ranging from twelve to twenty-four millimeters of mercury. It
further appeared in the course of these experiments that toward the end
of the period of stimulation the rise in blood-pressure was always
followed by a decline; to which, however, a renewed rise of
blood-pressure succeeded after the stimulation was discontinued,
provided the duration of this had not been excessive. Only after this
second rise was the normal mean blood-pressure regained. Finally it was
established that the pronounced phenomena of vagus-irritation exhibited
by the curve during and immediately after the stimulation of the ovary
were invariable concomitants of the rise of blood-pressure produced by
such stimulation.
According to the observations of _Federns_, the blood-pressure undergoes
a rhythmical change between one menstrual period and the next, the
pressure curve being normally at its lowest at the time of the
commencement of the flow, and at its highest at some time during the two
days immediately preceding the flow. This rhythmical change of
blood-pressure manifests itself also some time before the first onset of
menstruation, when the approach of puberty is indicated only by the
menstrual molimina.
Observations made by _Kretschy_ in a patient with a gastric fistula have
proved the influence exercised on gastric digestion by the physiological
processes occurring in the female reproductive organs. In this patient,
his attention was especially directed to determining at what period of
digestion the secretion of acid by the stomach attains its maximum, and
how that secretion increases and diminishes. He observed that the
digestion of breakfast was completed in four and one-half hours, the
acid-maximum occurring in the fourth hour, and the reaction of the
gastric contents becoming neutral one and one-half hours later. This
apparently constant acid-curve began, however, to become irregular as
soon as the first symptoms of the approach of menstruation became
apparent. When the flow had actually begun, he found that the reaction
of the gastric contents remained acid throughout the entire day. As soon
as the flow was over, the normal acid-curve was immediately
reëstablished.
These observations have been confirmed by _Fleischer_. This investigator
carried out his researches in menstruating women with normal stomachs,
and found that with the appearance of the catamenia the process of
digestion was almost always notably retarded, but that with the
diminution and cessation of the flow digestion returned to the normal.
By stimulation of the central segment of the divided hypogastric or
great uterine plexus, _Cyon_ was able to provoke vomiting, a
confirmation of the well-known physiological fact that irritative
disturbances of the female reproductive organs have a reflex influence
on the vomiting centre.
It is also clearly established that diverse stimulation of peripheral
nerves, those for instance of the mammary gland, of the internal
genitals, or of the epigastrium, is capable of affecting the motor
centre of the uterus.
Worthy of note also are _Strassmann’s_ experiments, showing that rise of
pressure in the ovary causes swelling and structural changes in the
uterine mucous membrane.
Striking also are _Neusser’s_ discoveries that during menstruation there
is an increase in the eosinophil cells of the blood, and that by the
intermediation of the sympathetic nervous system the ovaries exercise an
influence on the hæmatopoietic function of the red marrow of the bones.
Most noteworthy is the connection between the functional activity of the
ovaries and osteomalacia. In this disease of metabolism we have to do,
according to _Fehling’s_ now generally accepted assumption, with a
trophoneurosis of the bones, a stimulation of the vasodilator nerves of
the osteal vessels, dependent on a reflex impulse from the ovaries. The
connecting path between the ovaries and the bones _Neusser_ finds in
this case also in the sympathetic nervous system.
The reflex influence exercised on the heart and the general circulation
has been shown also by the results of operations on the female genital
organs. In cases in which the ovaries have been removed, or in which
these organs have been roughly handled, _Hegar_ has noticed a great
diminution in the frequency of the pulse, sometimes even cessation of
the heart’s action. In similar circumstances _Champonière_ also observed
as a rule diminished frequency of the pulse, but in some cases increased
frequency. _Mariagalli_ and _Negri_ have described tachycardia following
laparotomy and the extirpation of double pyosalpinx. _Bonvalot_ has
published cases in which, in consequence of vaginal or intra-uterine
injections, in consequence of simple examination, and in consequence of
the performance of version, sudden death has resulted from cardiac
syncope.
The psychical influences which proceed from the female genital organs in
the different periods of sexual life have also great significance for
the organism as a whole. Manifold impulses both stimulating and
depressing arising in the reproductive organs affect the workings of the
mind. The maiden at puberty is affected by the knowledge of sexuality;
the sexually mature woman, by the desire for sexual satisfaction, and by
the yearning for motherhood; the wife, by the processes of pregnancy,
parturition, and suckling, or, on the other hand by the distressing
consciousness of sterility; the woman at the climacteric period, by the
knowledge of the disappearance of her sexual potency. The mind is
further sympathetically influenced by the stimulation of the terminals
of the sensory nerves in the genital organs. Through the increase of
such stimulation, through its spread to adjacent nerves and nerve tracts
and to the entire nervous system, the mind is affected, directly by
irradiation, or indirectly by vasomotor processes and spinal
hyperæsthesia.
Psychical manifestations and the nervous states associated with these
are somewhat frequently, and even actual psychoses occasionally,
encountered in the various phases of the sexual life of woman, sometimes
taking the form of violent sexual storms, which may indeed, as ordinary
menstrual reflexes, accompany every catamenial period.
Of great interest are the facts which have, in recent times especially,
been scientifically established, pointing to a certain periodicity, to
an undulatory movement of the general bodily functions of the female
organism, dependent upon the sexual life. The observations of _Goodman_,
_Jacobi_, _von Ott_, _Rabuteau_, _Reinl_ and _Schichareff_, have shown
that in woman the principal vital processes pursue a cycle made up of
stages of increased and diminished intensity, and that this periodicity
of the chief general processes of vital activity finds expression also
in the functions of the reproductive organs. _Goodman_ has compared this
play of general vital functions to an undulatory movement. According to
this writer, a woman’s life is passed in stages, each of which
corresponds in duration with a single menstrual cycle. Each of these
stages exhibits two distinct halves, in which the vital processes are
respectively ebbing and flowing: in the latter we see an increase of all
vital processes, a larger heat production, a rise in blood-pressure, and
an increased excretion of urea; in the former we see, on the contrary,
that all these vital processes display a diminished intensity. The
moment when the period of increased vital activity is at an end, the
moment when the ebb begins, corresponds, according to _Goodman_, to the
commencement of the catamenial discharge.
_Goodman_ sought for verification of this undulatory theory of the
sexual life of woman in certain data regarding the bodily temperature
and the blood-pressure. A more extensive research was undertaken by
_Jacobi_, who, as the result of her observations, came to the following
conclusions. In eight cases she noticed in the premenstrual epoch a rise
of temperature ranging from 0.05° C. to 0.44° C. (0.09° F.–0.79° F.);
and during the catamenial discharge a gradual fall of 0.039° C.–0.25° C.
(0.072° F.–0.45° F.), never less, that is to say, than a quarter of a
degree Centigrade; but in the majority of cases the temperature did not,
while the catamenia lasted, regain the normal mean. She further observed
in the generality of cases an increased excretion of urea during the
premenstrual epoch; and a notable fall in blood-pressure during
menstruation.
_Reinl’s_ observations on healthy women, in whom menstruation ran a
normal course, showed that in the great majority of cases in the
premenstrual epoch the temperature was elevated as compared with that of
the interval, that in eleven out of twelve cases the temperature
gradually declined during menstruation, to fall in three-fourths of the
cases below the mean temperature of the entire interval, and exhibiting
in the post-menstrual epoch a still further depression, giving place,
however, to a somewhat higher mean temperature during the first half of
the interval. In the second half of the interval a higher mean
temperature was observed than in the first half.
If we make a graphic representation of the mean differences in
temperature commonly observed throughout the various stages of an entire
menstrual cycle, we see that the curve does in fact take the form of a
wave. That drawn by _Reinl_ is shown in the following figure: (FIG. 5.)
[Illustration:
FIG. 5.
]
The rising portion of the wave, the beginning of the tidal flow,
corresponds to the second half of the interval; the height of the tidal
flow, the crest of the wave, corresponds to the premenstrual epoch. As
the flow gives place to the ebb, as the wave begins to decline, we come
to the actual period of the catamenial discharge; later in the ebb is
the post-menstrual epoch, and the lowest portion of the declining wave
corresponds to the first half of the interval. Rhythmic changes
corresponding to those observed in the temperature have been recorded—at
least in isolated stages of the menstrual cycle—affecting the
blood-pressure by _Jacobi_ and by _von Ott_, affecting the excretion of
urea by _Jacobi_ and by _Rabuteau_, and affecting the pulse by _Hennig_.
It is evident that the vital activity of the organism attains its
maximum shortly before menstruation; and that with or immediately before
the appearance of the catamenial discharge, a decline of that activity
commences.
_Schrader_, through his researches on metabolism during menstruation in
relation to the condition of the bodily functions during this process,
has established that immediately before menstruation the elimination of
nitrogen in the fæces and the urine is at its lowest, a fact which
indicates that at this period of the menstrual cycle the disintegration
of albumen in the body is notably diminished.
_Von Ott_ found in thirteen cases out of fourteen that at the beginning
of the catamenial discharge or just before a considerable fall in
blood-pressure occurred, and that throughout the flow the pressure
almost always remained below the mean, no rise taking place till
menstruation was finished; this fall in blood-pressure during
menstruation was more considerable than could be accounted for by the
moderate hæmorrhage. The same author, in conjunction with _Schichareff_,
examined fifty-seven healthy women in respect of heat-radiation,
muscular power, respiratory capacity, expiratory and inspiratory power,
and tendon-reflexes. He found that the energy of the functions of the
female body increased before the beginning of menstruation, but declined
with or immediately before the appearance of the catamenial discharge.
He exhibited this rhythmical variation in the vital processes by means
of the following curve, in which the line _A B_ represents these
physiological variations, whilst on the abscissa line _c e_, the days of
observation are recorded, and the interval _m n_ represents the
menstrual period. The degree of intensity of the united functions is
indicated by the numbers 0–100 on the ordinate.
[Illustration:
FIG. 6.
]
Still another point of view from which the influences affecting the
female organism as a whole may be regarded has very recently become
apparent in consequence of the doctrine of _Brown-Séquard_ relating to
the internal secretions of ductless glands. As regards the female
reproductive glands, which in consequence of their structure must be
referred to the group of ductless glands, and yet owing to their
secretory function must be classed among secreting glands (so that the
nature of the ovary is that of a secreting gland without an excretory
duct), it would appear that these glands are not concerned only with the
specific female reproductive functions of menstruation and ovulation,
but that they also exercise a powerful influence on the nutritive
processes, on metabolism and hæmatopoiesis, and on growth and
development in their mental as well as their physical relations.
It is supposed that these glands under normal conditions enrich the
blood with certain substances, which in part assist in hæmatopoiesis,
and in part by regulating the vascular tone in the various organs are
concerned in the normal processes of assimilation and general
metabolism. According to _Etienne_ and _Demange_, ovariin possesses an
oxidising power similar to that possessed by spermin. Thus it becomes
easy to understand how disturbances in the functions of the ovaries give
rise to disturbances in the processes of general metabolism and of
assimilation. Some go even further, though in doing so they leave the
ground of assured fact, suggesting that the ovary in certain
circumstances produces toxins, or that the normal ovary possesses an
antitoxic function, and speaking of an occasional ovarian
auto-intoxication of the body or of a menstrual intoxication. Thus,
chlorosis is by some regarded as a disturbance of hæmatopoiesis,
dependent on an abnormal condition of the female reproductive organs
during the period of development, and referable to a disturbance of the
internal secretion of the ovaries (_Charrin_, _von Noorden_, _Salmon_,
_Etienne_, and _Demange_). And it is now generally assumed, the
assumption being based on the observations recently made concerning the
organo-therapeutic employment of the chemical constituents of the ovary,
that many of the disorders, and especially those connected with the
vasomotor system, common during the climacteric period, are dependent on
the deficiency of the products of the internal secretion of the ovary
that accompanies the cessation of the menses.
Recent experimental investigations on this subject have shown that the
interconnection between the female genital organs and the organism as a
whole, between the functions of the reproductive organs and the
functions of other organs, does not depend on nervous influences only,
but that in this interconnection the blood vascular system and the
lymphatic vascular system also play their parts. _Goltz_ has proved by
actual experiment that the nervous influence on menstruation and
ovulation is not the only determinant. In a bitch, he divided the spinal
cord at the level of the first lumbar vertebra, and observed, as soon as
the animal had recovered from the operation, the appearance of the usual
signs of heat; the bitch was impregnated, and gave birth to one living
and two dead puppies; lactation and sucking took place as in a normal
animal. When the bitch was killed and the body examined it was found
that no reunion had taken place in the severed spinal cord. The
experiments of _Halban_ gave similar results. He found that in apes, if
the ovaries are removed from their normal situation and successfully
transplanted to some region remote from the genital organs, the animals
remain capable of menstruating. But if the ovaries, which have been
transplanted beneath the skin or beneath the peritoneum, are
subsequently entirely removed, menstruation, which has continued
regularly after the first operation, ceases altogether after the second.
It follows from these experiments that the cessation of the menstrual
process may be considered to be brought about through the intermediation
of the lymphatic or blood-vascular system, by the absence of a kind of
internal secretion.
_Loewy_ and _Richter_ have further proved by experiment that in spayed
bitches the consumption of nitrogen is less by about 20 per cent. and
the entire gaseous interchange less by about 9 per cent., as compared
with what takes place in normal animals, and that this change in
respiratory metabolism lasts for a long time after the oöphorectomy, for
as much as nine to twelve months. If dried ovaries are given to such
animals in their food, the gaseous interchange rises to the former level
and even higher.
The undulatory movement of the vital processes in woman is apparently in
some way dependent on ovulation, though the nature of the connection has
not hitherto been fully elucidated. This view is confirmed by the fact
that no such rhythmic variation in the bodily functions can be detected
either in girls under thirteen years of age, or in women from
fifty-eight to eighty years of age in whom menstrual activity has
entirely disappeared. The menstrual rhythm begins at puberty and ends
when ovulation ceases.
A further contribution to the doctrine of the undulatory movement of the
vital processes in woman is to be found in my own observations that
pathological symptoms which have become manifest before and at the time
of the first onset of menstruation, and have given but little trouble
throughout the period of developed and regular sexual activity, are apt
when menstruation ceases to recrudesce, and to become as prominent as
they were at the commencement of the sexual life. Women who at the time
of puberty suffered from cardiac troubles, from digestive disturbances,
or from various forms of nervous irritation, and in whom as they grew up
these disorders passed more or less into abeyance, are apt at the
climacteric period to exhibit, as I have frequently been able to
observe, a violent return of these symptoms, in the form, as the case
may be, of tachycardia, of dyspeptic troubles, or of psychoneuroses. In
this connection we may mention an observation of _Potain’s_, who
distinguishes a peculiar form of chlorosis, occurring in individuals of
delicate constitution, which, though apparently cured, reappears at the
menopause.
Related to the sexual life of woman is another attribute, one intimately
connected with the idea of the female sex, and one which since the
primeval days of humanity has filled men with delight and poets with
inspiration—the attribute of beauty.
The beauty of woman, a prominent secondary sexual character, makes its
first appearance at puberty, when the girl’s form, hitherto
undifferentiated in its external bodily configuration, begins to assume
a soft and rounded appearance, when the features become regular, the
breasts enlarge, and the pubic hair begins to grow—when, in short, to
the primary sexual characters already existing, the secondary sexual
characters are superadded.
Feminine beauty continues to increase until the attainment of sexual
maturity. In her third decade woman arrives at the acme of her sexual
life and at the same time attains the perfection of her beauty.
The ensuing sexual phases, pregnancy, parturition, and lactation, entail
a decline in beauty, not rapid indeed, but advancing gradually, with the
slow yet sure-footed pace of time. The organic revolutions accompanying
these processes leave traces recorded upon the surface of the body in
conspicuous and indelible characters. The illnesses, also, which so
often accompany the fulfilment of sexual functions, in injuring health
impair also beauty.
A woman who has given birth to and nursed an infant begins to lay on
fat, and this tendency to obesity becomes more pronounced as the
climacteric period approaches. The breasts become inelastic and pendent,
the abdomen becomes ungracefully prominent; the tonicity of the entire
organism gradually declines, and, in consequence of the loss of
elasticity in the subcutaneous cellular tissue, the dreaded wrinkles
make their appearance and the features become wizened. Beauty is a thing
of the past. With the cessation of the sexual life the external
secondary sexual characters disappear, and the old woman is even farther
removed than the old man from our conception of beauty.
As _Mantegazza_ insists, the beauties peculiar to women are one and all
sexual; they depend, that is to say, upon the peculiar functions that
nature has allotted to woman in the great mystery of procreation. One of
the most vivid and poetical descriptions in ancient or modern literature
of these secondary sexual characters on which feminine beauty depends is
to be found in the Song of Solomon.
In the following figure (FIG. 7) the curve of beauty of woman is given
as drawn up by _Stratz_. In one case it may rise very quickly, to
decline with equal quickness—the so-called _beauté du diable_;[16] in
other cases, again, the curve rises very slowly, and declines also very
slowly, the culmination of the curve being in this case attained later,
and when attained being absolutely higher, than in the case of the
steeper curve.
[Illustration:
FIG. 7.
]
The age at which the maximum of beauty is attained is a very variable
one. In the southern races this often occurs as early as the fourteenth
or fifteenth year of life; but in the peoples of the Teutonic stock,
Germans, Dutch, Scandinavians, and English, not as a rule before the
twentieth year, and it may be even later. _Stratz_ has known cases in
which women did not attain the prime of their beauty until the thirtieth
and even the thirty-third year. The same author, a most competent
authority as regards the subject of feminine beauty, affirms that a
beautiful woman is most beautiful when the period of maximum beauty
coincides in her case with the first month of her first pregnancy. With
the commencement of pregnancy the processes of nutrition are
accelerated, all the tissues are tensely filled, the skin is more
delicately and at the same time more brightly tinted owing to the
greater activity of the circulation, the breasts become firmer and more
elastic. Thus the attractive characteristics of beauty at its fullest
maturity become enhanced, but for a short time only, since the
enlargement of the abdomen in the further course of pregnancy impairs
the harmony of the figure. Finally we must point out, before dismissing
this subject, that women of the so-called better classes arrive as a
rule at maturity later, and remain beautiful for a longer period, than
women of the working classes.
The degree to which the female organism as a whole is influenced by the
processes of the sexual life that occur in the genital organ depends
upon many of the characteristics that combine to make up the
individuality. Inherited characteristics, temperament, and race, play a
great part in this connection; and not less important than these are the
social conditions, the environment, in which the women under
consideration pass their life. Thus, among women belonging to the
poorer, labouring classes, the reflex manifestations in other organs
dependent upon the processes of the genital organs are less frequent and
less intense than among women belonging to the well-to-do strata of
society and to the cultured classes; less also in the country than in
large towns. In phlegmatic individuals, such manifestations exhibit less
intensity than in those of an active, ardent temperament; they are less
frequent in persons with a powerful constitution than in those endowed
by inheritance with an unstable nervous system. Finally, they are less
often encountered among families whose upbringing has aimed at hardening
the constitution and at inculcating the control of instinctive impulses,
than among those in whom from early childhood sensibility and
impulsiveness have been given a loose rein.
Extremely variable also are the sympathetic disturbances and morbid
states which depend on the processes of the sexual life of woman. “Le
cri de l’organe souffrant ne vient pas de l’utérus, mais de tout
l’organisme,”[17] says _Courty_. And a large number of isolated
observations has shown how complex are the relations between the healthy
and unhealthy female genital organs and the other organs of the body as
well as the organism as a whole. Precise and incontestable proofs exist
of such relations between the female genital organs and morbid changes
in the eye and ear, the skin, the respiratory organs, and the vascular
and nervous systems.
The influence exercised by the reproductive system on the general vital
processes of woman is indicated also by the general statistics of
mortality and the incidence of disease. Mortality in women, the earliest
years of childhood being left out of consideration, is at its highest
precisely during the great sexual epochs, namely at the time of puberty,
during pregnancy, during the puerperium, and at the climacteric period.
The complete performance of the reproductive functions entails a higher
proportion of illnesses and death; and statistical records show that the
mortality of married women between twenty and forty years of age, during
the period, that is to say, in which in consequence of marriage they
fulfil the duties of sexual intercourse and procreation, and are exposed
to the dangers connected with these sexual acts, is much higher than the
mortality of unmarried women of corresponding ages. Infection with the
gonococcus and with the virus of syphilis, chronic salpingitis,
metritis, and parametritis, the manifold diseases of pregnancy, the
diseases of the puerperium, the various displacements of the uterus,
osteomalacia—all these are pathological states the dependence of which
upon the sexual life of the married or at any rate sexually active woman
is indisputable. But the complete renunciation of sexual activity
appears also to exercise an injurious influence on the health, and to
give rise or at least predispose to morbid manifestations. Hysteria, for
instance, chlorosis, uterine myomata, and various neuroses, have long
been supposed to depend in part upon such renunciation, though the
causal connection cannot be regarded as yet fully established.
Especially true as regards woman, indeed, is that which _Ribbing_ says
concerning the sexual life in general: “Since all human life and being
has its origin in sexual relations, these sexual relations may be
regarded as the heart of humanity. We may work day and night for the
good of humanity, we may sacrifice for that good our time and our blood,
but all this work and all this sacrifice appear to me to remain useless
if we neglect and despise the sexual life, the eternally self-renewing
elementary school of true altruism.”
From the vital phase in which, marked by the visible manifestations of
puberty and by the first appearance of menstruation, ovulation is
assumed to begin, the sexual life of woman continues to the period of
life in which, marked by the climacteric cessation of menstruation,
ovulation also ceases. The total duration of this sexual period in
woman’s life is usually about thirty years; but it is subject to great
variations, from six to forty-six years according to the available
statistics, these variations depending upon climate, race, constitution,
and the sexual activity of the person under consideration.
The duration and the intensity of the sexual life of woman depends upon
a series of external conditions affecting the individual, but especially
upon the inherited predispositions, upon the constitutional conditions,
upon the varying vital power of the individual. My own observations have
led me to formulate, as a general law, that the earlier a woman
(climatic and social conditions being similar in the cases under
comparison) arrives at puberty, the earlier, that is to say, that
menstruation first makes its appearance, the greater will be the
intensity and the longer the duration of sexual activity, the more will
the woman in question be predisposed to bear many children, the more
powerfully will the sexual impulse manifest itself in her, and the later
will the menopause appear. It seems that in such women a more intense
vitality animates the reproductive system, bringing about an earlier
ripening of ova, a more favorable predisposition on the part of these
ova to fertilization by the spermatozoa, a livelier manifestation of
sexual sensibility, and a longer duration of ovarian functional
activity.
My general views on this subject are embodied in the following
propositions:
1. The duration of sexual activity is less in the women belonging to the
countries of southern Europe than in those belonging to the countries of
northern Europe. It would appear that in those climates in which
ovulation begins sooner and menstruation first appears at an earlier
age, the menopause also appears earlier; but that, on the contrary, in
those climates in which puberty is late in its appearance, the decline
of sexual activity is similarly postponed.
2. Women in our mid-European climates, in whom puberty appears at an
early age, the first menstruation occurring between the ages of thirteen
and sixteen, exhibit a more prolonged duration of the sexual life, of
menstrual functional activity, than women in whom menstruation begins
late, between the ages of seventeen and twenty. Extremely early
appearance of the first menstruation—so early as to be altogether
abnormal—has, however, the same significance as abnormally late onset of
menstruation; both indicate that the sexual life will be of short
duration.
3. Women whose reproductive organs have been the seat of a sufficient
amount of functional activity, who have had frequent sexual intercourse,
have given birth to several children, and have themselves suckled their
children, have a sexual life of longer duration, as manifested by the
continuance of menstruation, than women whose circumstances have been
just the opposite of these, unmarried women, for instance, women early
widowed, and barren women. Sexual intercourse at a very early age,
however, accelerates the onset of the climacteric period and the
termination of the sexual life. The same result follows severe or too
frequent confinements.
4. The sexual life has a shorter duration in the women of the laboring
classes and belonging to the lower strata of social life, as compared
with upper class and well-to-do women. Bodily hardships, grief, and
anxiety also hasten the onset of sexual death.
5. Women who are weakly and always ailing have a shorter sexual life
than women who are powerfully built and always in good health. When
irregularities and disorders have appeared in the various sexual phases,
the decline of sexual activity occurs earlier than in women whose
functions have in this respect been normal. Certain constitutional
conditions, such as extreme obesity, certain acute diseases, such as
typhoid fever, malaria, and cholera, and certain diseases of the uterus
and its annexa, chronic inflammatory conditions for instance, bring
about a notable shortening of the duration of the sexual life.
In 500 cases that have come under my own observation, the women
concerned belonging to very various nationalities, the duration of the
sexual life, as witnessed by the continuance of menstruation, was as
follows:
Menstruation continued for:
6 years in 1 woman.
7 years in 1 woman.
9 years in 2 women.
11 years in 4 women.
15 years in 6 women.
16 years in 8 women.
17 years in 12 women.
18 years in 15 women.
19 years in 9 women.
20 years in 6 women.
21 years in 18 women.
22 years in 20 women.
23 years in 24 women.
24 years in 18 women.
25 years in 16 women.
26 years in 25 women.
27 years in 26 women.
28 years in 29 women.
29 years in 36 women.
30 years in 22 women.
31 years in 32 women.
32 years in 49 women.
33 years in 31 women.
34 years in 26 women.
35 years in 12 women.
36 years in 12 women.
37 years in 10 women.
38 years in 8 women.
39 years in 6 women.
40 years in 2 women.
43 years in 2 women.
45 years in 1 woman.
46 years in 1 woman.
Thus we see that the duration of the sexual life varies from 6 to 46
years. The most frequent duration is one of 32 years, next to this one
of 29, next again, 31, 33, and 37 years, respectively. In 6 women only
did the duration of the sexual life exceed 40 years, and in 4 only was
it less than 11 years. In half of all my cases the duration of the
sexual life was between 27 and 34 years, and from these figures we
obtain an average duration of about 30 years.
For North Germany, _Krieger_ gives data from which it appears that in
this region the average duration of the sexual life is 30.49 years. In
more than half of the 722 cases recorded by this writer the duration was
between 31 and 37 years. In isolated cases the duration was very short,
not exceeding 8, 9, or 10 years, or, on the other hand, as long as 47
years; whilst the number of cases increased fairly regularly up to the
duration of 34 years, and thereafter again diminished.
As regards Austria, _Szukits_ has collected information in the case of
269 women, and found, in these, that the duration of the sexual life
varied from 12 to 45 years. The average duration was 29.16 years; in
more than half of the women, the period of sexual activity lasted from
21 to 30 years; the shortest period observed was 12 years, the longest
45 years.
The period of sexual activity lasted:
12 years in 2 women.
14 years in 1 woman.
15 years in 2 women.
17 years in 3 women.
19 years in 3 women.
20 years in 17 women.
21 years in 10 women.
22 years in 7 women.
23 years in 5 women.
24 years in 17 women.
25 years in 7 women.
26 years in 13 women.
27 years in 5 women.
28 years in 26 women.
29 years in 18 women.
30 years in 17 women.
31 years in 8 women.
32 years in 8 women.
33 years in 13 women.
34 years in 8 women.
35 years in 18 women.
36 years in 19 women.
37 years in 14 women.
38 years in 9 women.
39 years in 8 women.
40 years in 1 woman.
42 years in 1 woman.
43 years in 1 woman.
44 years in 2 women.
45 years in 2 women.
In Poland, according to _Raciborski_, the duration of sexual activity is
in Jewesses 23 years, but in women of Slavonic blood 31 years.
In France, according to _Courty_ and _Puech_, the usual duration of the
sexual life is from 28 to 30 years.
According to _Puech_, among 10 women menstrual activity lasted:
33 years in 2 women.
35 years in 1 woman.
36 years in 2 women.
39 years in 2 women.
43 years in 2 women.
44½ years in 1 woman.
_Brierre de Boismont_ gives the following particulars of the duration of
menstrual activity in 178 Frenchwomen:
5 years in 1 woman.
6 years in 1 woman.
8 years in 1 woman.
11 years in 1 woman.
16 years in 4 women.
17 years in 4 women.
18 years in 1 woman.
19 years in 3 women.
20 years in 3 women.
21 years in 4 women.
22 years in 3 women.
23 years in 12 women.
24 years in 8 women.
25 years in 8 women.
26 years in 11 women.
27 years in 7 women.
28 years in 6 women.
29 years in 7 women.
30 years in 13 women.
31 years in 13 women.
32 years in 9 women.
33 years in 9 women.
34 years in 7 women.
35 years in 5 women.
36 years in 10 women.
37 years in 6 women.
38 years in 5 women.
39 years in 2 women.
40 years in 7 women.
41 years in 1 woman.
42 years in 3 women.
44 years in 2 women.
48 years in 1 woman.
For England, _Tilt_ gives the mean duration of menstrual activity, as
observed in 500 women, as 31.21 years; it varies between 11 and 47
years; there are more cases with a period of 34 years than with any
other integral number of years. _Tilt_ found the duration to be:
11 years in 1 woman.
13 years in 1 woman.
15 years in 3 women.
16 years in 1 woman.
17 years in 2 women.
18 years in 4 women.
19 years in 1 woman.
20 years in 3 women.
21 years in 6 women.
22 years in 11 women.
23 years in 11 women.
24 years in 10 women.
25 years in 22 women.
26 years in 11 women.
27 years in 25 women.
28 years in 29 women.
29 years in 35 women.
30 years in 36 women.
31 years in 33 women.
32 years in 38 women.
33 years in 35 women.
34 years in 49 women.
35 years in 33 women.
36 years in 26 women.
37 years in 16 women.
38 years in 15 women.
39 years in 15 women.
40 years in 6 women.
41 years in 4 women.
42 years in 7 women.
43 years in 5 women.
44 years in 3 women.
45 years in 1 woman.
46 years in 1 woman.
47 years in 3 women.
For London the average figure is 34 years; for Paris, 30 years; for
Vienna, 29 years; and for Berlin, 34 years.
From the data of various observers obtained from diverse nationalities,
the following table has been compiled, exhibiting the mean duration of
the sexual life:
_Comparative Table Showing the Duration of the Sexual Life in Various
Nationalities._
┌───────────┬────────┬────────┬─────────┬──────────┬─────────┬───────┬───────┐
│ │Germany.│Austria.│ France. │ England. │Denmark. │Norway.│Russia.│
├───────────┼────────┼────────┼─────────┼──────────┼─────────┼───────┼───────┤
│Number of │ │ │ │ │ │ │ │
│ Cases │ 722 │ 265 │ 178 │ 500 │ 312 │ 391 │ 100 │
├───────────┼────────┼────────┼─────────┼──────────┼─────────┼───────┼───────┤
│Mean │ │ │ │ │ │ │ │
│ duration │ │ │ │ │ │ │ │
│ of │ │ │ │ │ │ │ │
│ menstrual│ │ │ │ │ │ │ │
│ activity,│ │ │ │ │ │ │ │
│ in years │ 30.4 │ 29.1 │ 29.1 │ 31.8 │ 27.9 │ 32 │ 31 │
├───────────┼────────┼────────┼─────────┼──────────┼─────────┼───────┼───────┤
│Observers’ │Krieger,│ │ Brierre │ │ │ │ │
│ names │ L. │ │ de │ │ │Faye & │ │
│ │ Mayer. │Szukits.│Boismont.│Whitehead.│Hannover.│ Vogt. │Lieven.│
└───────────┴────────┴────────┴─────────┴──────────┴─────────┴───────┴───────┘
In the temperate zone the sexual life of woman lasts longer than in the
colder and subarctic regions. Still more favorable is the contrast
between the temperate zone and the countries of the tropics, in which
the duration of the period of menstrual activity is limited to eighteen
or twenty years. According to some isolated observations the duration of
sexual activity in Arabian women in Africa was as little as nine years.
A certain influence on the duration of the sexual life is exercised by
the commencement of menstruation at an earlier or later age than the
average. The total duration of menstrual activity is more variable in
women who begin to menstruate early than in women who begin to
menstruate late, in whom the duration of the sexual life is a more
regular one. In those women who begin to menstruate early the mean
duration of the sexual life is about thirty-three years, in those who
begin to menstruate late it is about twenty-seven years.
The following data, based on the observation of 250 cases, are published
by _W. Guy_, regarding the duration of the sexual life, that is to say
of menstrual activity, in women beginning to menstruate early and those
beginning to menstruate late, respectively:
_Menstruation began._ _Duration of the sexual
life._
In 5 cases in the 8th to the 10th year Averaging 36.60 years.
In 70 cases in the 11th to the 13th year Averaging 33.65 years.
In 110 cases in the 14th to the 16th year Averaging 30.85 years.
In 56 cases in the 17th to the 19th year Averaging 28.35 years.
In 9 cases in the 20th year or later Averaging 20.45 years.
A further analysis of these 250 cases is given by Guy in the following
table:
_First appearance of menstruation._ _Average age at _Duration of
which menstrual
menstruation activity._
ceased, in
years._
In 1 case in the 8th year 42 34 years.
In 2 cases in the 9th year 46 37 years.
In 2 cases in the 10th year 47 37 years.
In 10 cases in the 11th year 47.10 36.10 years.
In 29 cases in the 12th year 45.34 33.34 years.
In 31 cases in the 13th year 46.16 33.16 years.
In 39 cases in the 14th year 45.33 31.33 years.
In 40 cases in the 15th year 46.30 31.30 years.
In 41 cases in the 16th year 46.14 30.14 years.
In 26 cases in the 17th year 45.18 28.18 years.
In 19 cases in the 18th year 46.87 28.87 years.
In 11 cases in the 19th year 46.18 27.18 years.
In 5 cases in the 20th year 40.80 20.80 years.
In 3 cases in the 21st year 41.66 20.66 years.
In 1 case in the 23d year 41 18 years.
_Hannover_ also gives data respecting the relation between the duration
of menstrual activity and the early or late appearance of menstruation.
These data are tabulated as follows:
_First appearance of menstruation._ _Average age at _Duration of
which menstrual
menstruation activity._
ceased, in
years._
In 5 cases in the 12th year 47.80 35.80 years.
In 10 cases in the 13th year 45.89 32.89 years.
In 50 cases in the 14th year 44.98 30.98 years.
In 34 cases in the 15th year 45.56 30.56 years.
In 38 cases in the 16th year 44.13 29.13 years.
In 36 cases in the 17th year 43.00 26.00 years.
In 49 cases in the 18th year 44.96 26.96 years.
In 33 cases in the 19th year 44.79 25.79 years.
In 38 cases in the 20th year 45.36 25.36 years.
In 10 cases in the 21st year 44.10 23.10 years.
In 4 cases in the 22d year 43.50 21.50 years.
In 3 cases in the 23d year 44.33 21.33 years.
In 4 cases in the 24th year 39.50 15.50 years.
Totals: In 412 cases the average age at the menopause was 44.82, and the
average duration of menstrual activity was 27.973 years.
From the tables of _L. Mayer_, _Krieger_ has instituted a comparison
between the duration of menstrual activity in 101 women who began to
menstruate early and 180 women who began to menstruate late, finding in
the case of the former a mean duration of 33.673 years, and in the case
of the latter a mean duration of 27.344 years, showing therefore a
sexual life longer on an average by 6.429 years in those in whom puberty
was early as compared with those in whom puberty was late.
From the tables of _Tilt_, based on the observation of 164 cases, 76
women in whom menstruation appeared early and 88 in whom it appeared
late, we learn that among the former the shortest duration of menstrual
activity was 18 years, among the latter 12 years; among the former the
longest duration was 37 years, among the latter only 33. The majority of
those who began to menstruate early continued to menstruate for 28, 31,
32, 33, 34, 35, 36, 38, or 39 years; those who began to menstruate late,
for 23, 27, 28, 30, or 31 years. The mean duration of the sexual life in
those who began to menstruate early was 33.66 years; in those who began
to menstruate late it was 28.28 years. Since the average duration of the
menstrual function is given by _Tilt_ as 31.33 years, those who began to
menstruate early exceeded this average by 2.33 years, while those who
began to menstruate late exhibited a duration of menstrual activity of
at least three years less than the average.
In addition to climate, nationality, and the age at which menstruation
begins, the sexual activity of women also exercises an influence on the
duration of their sexual life, and of especial importance in this
connection are the number of children born, and exercise or neglect of
the function of lactation. From my own observations on this matter it
appears, that in women who are healthy and of powerful constitution,
whose reproductive organs have been sufficiently exercised, who have
given birth to several children and have suckled these children
themselves, the duration of menstrual activity is in general notably
longer than in women whose circumstances have been just the opposite in
these respects. Among the women in my own series of cases in whom
menstrual activity lasted longest, of the 177 women in whom menstruation
ceased between the forty-fifth and the fiftieth year of life, 1 only was
unmarried, 2 were married but childless, 32 married with 1 or 2 children
only, and 142 married and with more than 2 children; of the 89 women in
whom menstruation ceased between the fiftieth and the fifty-fifth year
of life, none were either unmarried or childless, 19 were married with 1
or 2 children, 17 married and with more than 2 children; of the 17 women
in whom menstruation ceased later than the fifty-fifth year of life,
there were 2 only with less than 2 children, but 10 who had each given
birth to from 6 to 8 children. A similar influence is exercised by the
function of lactation. Among 40 women who had not suckled their
children, the average duration of menstrual activity was 4 years less
than the general mean.
As regards the conditions of life, _L. Mayer_ affirms that the duration
of sexual activity among well-to-do women is on the average a year and a
half longer than among women of the working classes.
_Metschnikoff_ has drawn attention to the remarkable disharmony in the
development of three of the phases of the sexual life of woman, inasmuch
as the sexual impulse, the union of the sexes, and the capacity for
procreation, which, considering their nature and purpose, might have
been expected to be attuned so as to act in harmony, exhibit as a matter
of fact no such relation; the different factors of the sexual function
develop independently and unharmoniously. In a child not yet fitted to
fulfil the function of procreation, the sexual impulse will none the
less make its appearance, and be liable to misuse. In the girl the
pelvis does not attain that complete development which fits it for the
process of parturition until toward the age of twenty, whilst puberty
occurs at the age of sixteen. “A girl of ten is capable of aspiring to
play the part of a woman, but not before the age of sixteen is she
fitted to play that part, nor indeed fitted to become a mother before
the age of twenty.”
In general, we may say, regarding the women of our own part of the
world, that in those who are healthy, who lead a regular life, are well
fed, free from the pressure of anxieties, with their sexual functions
sufficiently exercised, the duration of the sexual life is longer than
in women whose circumstances are the reverse of those just enumerated.
It is a sign of decadence when women of the well-to-do classes, leading
a life of ease, manifest a diminished duration of the sexual life. The
greatest physical power and the highest ethical development are
associated with a lengthening of life in general, and associated also
with a lengthening alike in the sexual life of woman and the sexual
potency of man. A decline in morals and culture entails a diminution of
sexual vital capacity, this being true alike of individuals, of
families, and of nations. Woman is venerated and valued the more, the
longer the duration of her sexual life; a woman in whom the sexual life
is short quickly loses value and significance, both in domestic and in
social circles.
The social significance of the sexual life of woman is
disproportionately greater and farther reaching than the sexuality of
the male, as the former is concerned with the fundamental principles of
human social life, influencing the constitution of the family, and
controlling the good of the coming race. Sexual purity, which to the
youth is a romantic dream, is to the maiden a vital condition of
existence; adultery, in the husband a pardonable transgression, is in
the wife an overwhelming sin committed against family life. To the
freedom of the male in affairs of love is opposed the strict restraint
of the female, based on monogamic marriage. The sexual needs and desires
of the female are transformed in an ideal manner by means of the feeling
of duty of the wife and mother; the violent pressure of the sexual
impulse is restrained by the opposition of ethical forces. When this
restraint fails, the running off the rails that ensues has a far
profounder influence in the case of the female than of the male, an
influence not limited to her own personality, but dragging down the
whole family into the abyss of consequences, into the depths of moral
and physical destruction.
Though in nature everywhere the same, the sexual life of woman exhibits
in the various gradations of social life different outward
manifestations, from the brutal sexual congress that does not greatly
shun publicity, to the modern would-be philosophical free love. And
throughout all variations the two darkest points remain, the
illegitimate child and venereal infection, both of which entail upon the
woman the most unspeakable anxieties and the greatest possible misery,
whilst the man who is in either case to blame passes comparatively
unscathed.
The social sexual position of woman suffers most at the present day from
the mature age at which under existing social conditions men are alone
able to marry and from the ever-increasing number of cases of venereal
infection. In both these directions social science and medical skill
must work hand in hand for the amelioration of the sexual life of woman.
On the twentieth century falls the duty of furnishing a solution for
these problems. Contesting voices are heard on all sides. _Tolstoi’s_
rigid demand for complete sexual abstinence, the exhortation of the
professors of the German universities to their students in favor of
moral purity, the associations for the official prevention of venereal
diseases, the agitation among young men in favor of abstinence from
sexual intercourse before marriage, finally, the clamorous voices of the
supporters of women’s rights—all these are influences within the sphere
of sexual morality, which must lead slowly but surely to extensive
social changes in the sexual life of women.
The discussion of the sexual life of woman, which for many centuries was
concealed by a thick veil from the eyes of the profane, or was viewed
only through the frosted glass of poetical metaphor, has in recent times
assumed a quite revolting character. Not only have the acquired
liberties and the social aims of the present day a tendency to give to
women in general a freer and higher position, to emancipate them from
the bonds in which owing to the conditions of family life they have so
long been shackled, but some members of the women’s rights party go even
farther, and demand for women greater freedom in the sphere of sexual
activity.
With this end in view the sexual life of woman is used as the fulcrum of
the lever, and is withdrawn from the twilight into the open light of
day, or indeed too often into a dazzling and altogether false
illumination. Women writers especially, who have hitherto been
accustomed to delude themselves and the world with sensational
representations of the feminine soul, of feminine modesty, and the
fineness of feminine sensibility in matters sexual, now find their
greatest joy in unveiling themselves and their sisters before the face
of all the world, and in discussing in the plainest language the most
intimate processes of the genital organs. In writings exhibiting but
little good taste, though all the more temperament, they emphasize again
and again one side only of the sexual life, to wit, the sexual impulse,
the force of which is intentionally exaggerated to a high degree, so
that it is described as a mighty current of passion, which may with
great pains be held in check for a season, but must ultimately break
loose, and with devastating rage must overwhelm everything which has
hitherto been regarded as discipline and good morals. Young girls, even,
step down into the arena to take part in the contest concerning the
reform that is to take place in the relations between men and women.
Especially sensational in this connection was _Eine für Viele_. _Aus dem
Tagebuche eines Mädchens von Vera_,[18] a book which, totally ignoring
the biological differentiation of the sexes and their diverse
sociological course of development, goes so far as to insist that from
the man entering upon marriage, as from the woman, sexual purity and
virginity are to be demanded. (The heroine of the book commits suicide
because her lover has in earlier years had experience of sexual
intercourse.)
From a mistaken standpoint other supporters of women’s rights oppose the
ideal method in sex-relations, life-long monogamy, and the ideal of
sexual sensibility, motherhood, and they put forward quite new sexual
pretensions on behalf of women, as belonging to them by natural right.
Upon these pretensions it is the duty of physicians, who truly know and
truly prize womanhood, to pass their judgment, and that judgment, which
will find ample justification in the ensuing descriptions of the
individual phases of the sexual life of woman, is that the modern
movement on behalf of the emancipation of women goes much too far. We do
not, however, mean to imply that this movement is totally unjustified.
The growing girl must not, as has hitherto been the case, be kept in a
state of ignorance (which is indeed in most cases apparent merely)
regarding the sexual processes of her own body, she must no longer, when
she asks to be informed concerning these matters, be put off with
conventional lies and prevarication. But her enlightenment must not be
effected in such a manner as to lead to excitement and excessive
stimulation, to the awakening of slumbering feelings, and to the
conversion of fantasy into a devouring flame. Sexual enlightenment must
not be made an excuse for the unchaining of sensibility. When about to
be married, a woman should certainly be instructed regarding her sexual
duties and rights, and enter as one well informed into the act in which
she is to play a leading part. But she ought not, with the excessive
valuation of herself attained in recent times, to regard the man as her
enemy, as one whom she is always justified in fighting and always ready
to fight with the equal weapons of sexual transgression. It cannot be
doubted that the ideal of “pure marriage” at an early age is one greatly
to be prized as the foundation of a powerful future generation; but the
real nature of the male must not be overlooked, nor must his sexual
honor be put to too difficult a test. We regard as reasonable the modern
demand of woman that in marriage her individuality should not be buried,
and that space should be given for the development of her personality;
but every sober-minded person will reject the “moral demand” for “ideal
passion” in accordance with “entire mutual freedom” in the sexual
relation between man and wife, and will regard such free love as social
insanity and as a barbaric retrogression toward the rude sexual habits
of savage peoples. Further, in view of the continually increasing
intensity of the struggle for existence and in view of the difficulties
of the task of rearing children, we cannot fail to recognize that it is
not right for women to be overburdened with the task of reproduction,
and that she does not live simply and solely for the bearing of
children—but those rush to the other extreme who undervalue motherhood
and the duties of maternity, who speak scornfully of the woman who is “a
mother, and a mother only,” who despise women whom they regard merely as
“means for the production of children,” and who employ all possible
methods to free women from the pressing claims of nature and of society.
In all social circumstances, and in all times the great principle of
sexual morality must dominate the sexual life of woman. As the ethical
characteristics of the three great epochs in that sexual life we
recognize the purity of the maiden, the faithfulness of the wife, and
the love of the mother. But within the limits imposed by these demands
it is still possible to satisfy the modern claim for a free development
of the personality, and to accommodate the circumstances of the sexual
life to the individual vital needs and vital claims of the present day.