certain extent at least, and if we do a bad or injurious act, we have
committed a sin and are morally responsible. The _desire_ for the
sexual act is no more sinful than the desire for food is when one is
hungry. But the performance of the act may, under certain
circumstances, be as sinful as the eating of food which the hungry man
obtained by robbing another fellow-being, just as poor as himself.
I am not preaching to you. But I am not an extremist nor a hypocrite.
I am advocating neither asceticism nor licentiousness. One is as bad,
or almost as bad, as the other.
What I am trying to do is to inculcate in your minds, if possible, a
sane, well-balanced view of all things sexual.
For I believe that wrong, perverted views of the physiology and
hygiene of the sex act and of sex morality, that is, the proper
relationship of the sexes, are responsible for untold misery, for
incalculable suffering. Both sexes suffer, but the female sex suffers
more. The woman always pays more. This is due to her natural
disabilities (menstruation, pregnancy, lactation), to her age-long
repression, to the fact that she must be sought but never seek, and to
her economic dependence.
For the above reasons, sex instruction is a matter of double
importance to woman--this fact has been emphasized in the first
chapter. But woman's disabilities impose upon us another duty:
_because_ she carries the heaviest burden, _because_ she always pays
more dearly than the man, it becomes incumbent upon man to treat her
with special consideration, with genuine kindness and chivalry.
CHAPTER FIVE
PUBERTY
Physical Changes in Puberty--Physical Changes in the Genital
Organs and in the Rest of the Body--Psychic Changes--Puberty and
Adolescence--Nubility.
Puberty is the most wonderful, the most significant period in a girl's
life. Important as it is in a boy's life and development, it is still
more so in a girl's. At this period there are often laid the
foundations which either make or mar the girl's future life.
The meaning of the word puberty is maturity. It is the period at which
the girl and the boy reach sexual maturity; in other words, the period
at which the sex glands of the boy begin to generate spermatozoa, and
the sex glands of the girl begin to mature and expel eggs or ova; with
the girl puberty is marked by an additional phenomenon, which has no
analogue in the boy, namely, menstruation.
=Physical Changes.= The word puberty is derived from the word _puber_,
which in Latin means mature, ripe. But the word puber is itself
derived from the word _pubes_, which in Latin means fine hair or
down. For at this period of maturity all mammals (that is animals
which have breasts and nurse their young) begin to develop a growth of
hair. You know that our entire body, with the exception of the palms
of the hands and the soles of the feet, is covered with innumerable
hair follicles, and from our birth our entire body, with the exception
named, is covered with fine hair. The hair may be too delicate to be
seen, but it is there, and with a magnifying glass you can see it
without any trouble. But at puberty the hair increases in thickness
and in quantity, and becomes abundant in places where it was hardly
noticeable before--the upper lip and face in boys, and the armpits and
lower part of the abdomen in both boys and girls.
And so the first apparent physical sign of puberty in a girl is the
gradual appearance of hair in the armpits, on the mons Veneris and the
labia majora. But all the genital organs are undergoing rapid
development; the vulva, the vagina, the uterus and the ovaries become
larger, and the ovaries which up to that time were elaborating an
internal secretion only, now also begin to manufacture ova; in other
words, the monthly process of ovulation is begun. Synchronously with
the process of ovulation, there commences the monthly function of
menstruation. The breasts also increase in size, assume the
characteristic contour, develop their glandular substance, and become
capable of secreting milk for the use of any possible offspring.
During this period of development they are often very sensitive to the
touch or feel painful without being touched.
But not only the genital organs undergo growth and development--the
entire body participates in the process. The growth in height is the
most rapid at this period; the greatest growth takes place in the
limbs--legs and arms. The pelvis becomes broader, and the chest or
thorax also becomes broader and larger. The muscles become larger and
rounder and finally give the girl the beautiful womanly form.
=Psychic Changes.= But the changes are not only physical; the changes
that take place in the girl's psychic sphere during the pubertal years
are also highly important. That is the period of the development of
the emotions; she is overflowing with emotion; she becomes sensitive;
in her relations with boys and men she becomes self-conscious.
Distinct sexual desire fortunately does not make its appearance in the
girl at this period, as it does in the boy, but she becomes filled
with vague undefined and undefinable longings. It is the period of
"crushes" when the girl is apt to bestow her overflowing emotion on a
girl friend. There is nothing reprehensible in these crushes--they
act as a safety valve--and only in rare cases are they apt to lead to
abnormal development. This is also the period of day-dreaming and of
romancing; the girl likes to read love-stories and novels in which she
identifies herself with the heroine. And it makes quite some
difference as to what the girl reads during this period, for
literature has a strong influence on the young in the most plastic
period of their lives; and it is important that older persons see to
it that those in their care spend their time on books of noble ideals
and high artistic value.
Girls of a highly sensitive or so-called "nervous" temperament,
especially if there is "nervousness" in the family, must be
particularly looked after. For it is during the years of puberty and
adolescence that any neurotic traits are apt to develop and become
emphasized. It is also the period when bad sexual habits
(masturbation) are apt to develop, and the careful mother will devote
special attention to her girls in their years of puberty, and guard
them as much as possible against physical and emotional shocks.
The age of puberty in girls is by many writers considered as
synonymous or synchronous with the onset of menstruation, which in
this country in the majority of cases occurs between the ages of
thirteen and fourteen. The year of gradual development before the
onset of menstruation is by some referred to as the pre-pubertal year;
and the first year after the onset of menstruation is the
post-pubertal year. The period from puberty to full sexual maturity is
called adolescence, and this term is applied generally to the period
between thirteen and eighteen. For at eighteen the boy and the girl
have reached full maturity. Mentally we acquire things as long as we
live, and even physically the body gets larger for some years after
eighteen. But sexually both boys and girls are fully mature at
eighteen, though in order to become parents it is best, for various
reasons, to wait to the ages of twenty or twenty-five.
=Nubility.= Nubility is the age or state when a boy or a girl is "fit"
for marriage. This is a vague and unsatisfactory term. At the age of
thirteen to fifteen boys and girls are physically "fit" for marriage,
that is at that age a boy is capable of begetting and a girl of having
children. But it does not mean that it would be advisable for them to
marry at such an early age. Neither their bodies nor their minds are
fully developed, and children begotten of such young parents are apt
to be weaklings, both mentally and physically. The youngest age for
girls to marry should be eighteen, and for boys twenty; but the
youngest age for becoming parents should be twenty to twenty-two for
the mother and twenty-three to twenty-five for the father.
CHAPTER SIX
MENSTRUATION
Definition of Menstruation--Where Menstrual Blood Comes From--Age
of Menstruation--Age of Cessation of
Menstruation--Duration--Amount--Regularity and Irregularity.
The first function with which the girl will be confronted, which will
impress upon her that she is a creature of sex, that she is decidedly
different from the boy, is _menstruation_. And this function we will
now proceed to study.
What is menstruation? Menstruation is a monthly discharge of blood.
The word is derived from the Latin word mensis, which means a month;
and menstruation is also frequently spoken of as _the menses_. It is
also called the catamenia or catamenia-flow (Greek, kata--by, men--a
month). Other terms are: the periods, courses, monthlies, turns,
monthly changes, monthly sickness, sickness, flowers, to be unwell, to
be regular. "Not to see anything" is a common term for having missed
the menses. This flow of blood recurs in most cases with remarkable
regularity once a month; not a calendar month, but once a lunar month,
i.e., once every twenty-eight days. And as there are thirteen lunar
months a year, a woman menstruates not twelve but thirteen times a
year.
Where does the menstrual blood come from? The menstrual blood comes
from the inside of the womb. Every month, for a few days prior to
menstruation, the inside lining of the womb (what we call the mucous
membrane or endometrium) becomes congested and its bloodvessels become
distended with blood. If the woman has sexual intercourse and
pregnancy happens to take place, then this extra blood is used to
nourish and develop the new child; but if no pregnancy takes place,
that extra blood exudes from the bloodvessels (some of the
bloodvessels rupture) and is discharged from the uterus into the
vagina, and from there to the outside, where it is caught on cotton,
sanitary napkins or some other pad.
=At what age does menstruation begin?= The usual age at which
menstruation begins in this country is thirteen or fourteen; in some
it may occur as early as twelve, in others as late as fifteen, sixteen
or even seventeen. For menstruation to begin earlier than twelve or
later than seventeen is in this country a rare exception. But in cold
northern climates the age of eighteen is not rare, and in the hot
southern climates menstruation often starts at the ages of ten or
eleven. Change of climate or of country will often have an influence
on the menses. In the early years of his medical practice, the author
had many Finnish girls as patients. It was a very common occurrence
for them to stop menstruating for the first few months or even for the
first year of their residence in this country.
=At what age does menstruation cease?= The age at which menstruation
ceases is called the _menopause_ or _climacteric_. It usually takes
place at the age of forty-eight or fifty. In some cases it does not
take place until the age of fifty-two, in others it takes place as
early as forty-five or forty-four. In general, it may be said that the
woman's menstruating period, during which she is able to have
children, lasts about thirty-five years. And if no restraint be taken,
and if no precautions be taken against conception, a woman could have
twenty or thirty children during her childbearing period.
=How many days does a woman menstruate?= The usual number of days is
from three to five; in some cases menstruation lasts only two days, in
others as long as seven. As a rule, the greatest amount of blood
passed is during the first two days.
=The amount of blood.= It is hard to estimate the exact amount of
blood passed by a woman during her menses, but it reaches about an
ounce and a half to three ounces. In some women the amount may reach
as much as four or five ounces and in exceptional cases as much as
eight ounces. Where it exceeds this amount, it is an abnormal
condition, requiring treatment. The usual statement that a normally
menstruating woman should not have to use more than three napkins
during the twenty-four hours is correct.
_The periodical regularity_ with which menstruation recurs in many
women is remarkable. I know a woman who has not missed her menses in
twenty years; during those twenty years the menses have started every
fourth Friday, almost always at the same hour. I know another one who
has her menses every fourth Wednesday, about seven in the morning. She
skipped her periods during her two pregnancies, then they were
irregular for a while, then they came back to Wednesday. Other women
have their menses on a certain day of the month, say the first or the
fifth, regardless of the number of days in the month (such cases are,
however, exceptional). And in some women the menses are irregular:
every three weeks, every five or six weeks, every six or seven weeks,
etc. Some women never know when they may expect their menses, so
irregular they are.
CHAPTER SEVEN
ABNORMALITIES OF MENSTRUATION
Disorders of Menstruation--Menorrhagia--Metrorrhagia--Amenorrhea--
Vicarious Menstruation--Dysmenorrhea of Organic and of Nervous
Origin.
In many girls and women menstruation is a perfectly normal,
physiological process. They suffer no discomfort whatever from it.
They suffer no pains, no headache, no irritability, they have no
admonition of its onset, until they feel the blood oozing or trickling
out. But, unfortunately, this is true only of a small percentage. The
majority of women have some unpleasant symptoms. Some have a headache
for a day or two, some complain of a dragging down sensation, some are
irritable, feel depressed or quarrelsome; some have no appetite, no
ambition, no desire for work or company, while some girls have such
severe pains and cramps that they are obliged to go to bed for a day
or two and call in medical aid.
When the menstruation is very profuse, resembling more a hemorrhage
than normal menstruation, it is called _menorrhagia_; if the
hemorrhage from the uterus occurs out of the regular menstrual
periods, it is called _metrorrhagia_. When the menses are skipped, or
when they are so scanty that you can hardly notice any blood, we use
the term _amenorrhea_. In a few rare cases the menstruation instead of
coming normally from the uterus, comes from some other part of the
body, for instance, the nose. Some women have a hemorrhage from the
nose every month. In some a bloody discharge may come from the
breasts. To such a substitute menstruation we apply the term
_vicarious menstruation_. Such cases, however, are rare, and are mere
curiosities.
=Dysmenorrhea.= I mentioned before that in some girls and women the
menses are accompanied by pains and cramps. This affliction, which is
the lot of millions of women, and from which men are entirely free, is
called _dysmenorrhea_. Dysmenorrhea means painful and difficult
menstruation. A slight pain or at least a feeling of discomfort is
present in most cases of menstruation. But in many cases the pain is
so severe, so _excruciating_, that the sufferer, girl or woman, is
incapacitated for any work, and must go to bed for a day or two. In
some cases the pain is so severe as to necessitate the use of
morphine, and as it is a very bad thing to have to give morphine every
three or four weeks, every endeavor should be made to find out the
cause of the trouble and to remove it. It is a mistake, however, to
think that all or even most cases of dysmenorrhea are due to some
local trouble, that is, to an inflammation of the ovaries, or a
displacement of the womb. Many cases of dysmenorrhea are of _nervous_
origin; the cause resides in the central nervous system, and not in
the genital organs themselves. It is, therefore, not advisable to
undertake any local treatment, unless a competent physician has made a
thorough examination and has decided that local treatment is
advisable.
As to the percentage of dysmenorrhea, a recent statistical examination
of 4,000 women showed that dysmenorrhea of some degree was present in
over one-half, namely, 52 per cent.
CHAPTER EIGHT
THE HYGIENE OF MENSTRUATION
Lack of Cleanliness During Menstrual Period--Superstitious
Beliefs--Hygiene of Menstruation.
The hygiene of menstruation can be expressed in two words: cleanliness
and rest. Common sense would suggest these two measures, and as far as
rest is concerned, many women do rest or take it easy while they are
unwell. Some are forced to do it, because, if they don't, their
dysmenorrhea is worse and the amount of blood they lose is
considerably increased. The same cannot be said of cleanliness. Due
undoubtedly to the superstitious opinions about menstruation, which
came over to us from the ages-of-long-ago, menstruation is still
considered a _noli-me-tangere_, and women are afraid to bathe, to
douche or even to wash during the periods. And if there is any period
when a woman needs a douche it is during menstruation. Any leucorrhea
that a woman may be suffering from becomes aggravated around the
periods; the menstrual blood of some women has a decided odor, and if
no cleansing douche is taken during four or five days, some of the
blood decomposes and acquires a decidedly offensive odor, which can be
noticed at some distance and to which some men and women are very
susceptible. There are some women who never take a vaginal douche.
Some consider it a useless and unnecessary luxury; while some orthodox
puritanical women consider it an ungodly procedure (forgetting that
cleanliness is next to godliness) fit only for women of gay and
questionable character. If these orthodox women knew what was good for
them--and for their health--they would take a douche at least during
menstruation, if at no other time.
=Cleanliness.= When the girl reaches the age of twelve or thirteen the
mother should explain to her the phenomenon of menstruation and the
likelihood of its making its appearance in a short time. Of course she
should be told that there is nothing shameful in it, that when it
makes its appearance she should at once tell her mother, who will
instruct her what to do. She should be shown the use of sanitary
napkins. Rags, unless recently washed and kept wrapped up and
protected from dust, should not be used. Unclean rags may lead to
infection. I have no doubt that many cases of leucorrhea date back
their origin to unwashed rags. Every morning and every evening the
girl should wash the external genitals with warm water, or plain soap
and water. Married women should also take a douche once a day--the
douche may consist of two quarts of water in which has been dissolved
a teaspoonful of common table salt, or a tablespoonful of borax or
boric acid. Such things like alum, potassium permanganate, carbolic
acid, lactic acid, or tincture of iodine should only be used when
there is leucorrhea present and generally only under a physician's
directions. Bathing is permissible, but it is safe to use only a
lukewarm bath. Cold tub baths, cold shower baths, as well as ocean and
river bathing are best avoided during the period; at least during the
first two days. I do not give this as an absolute rule; I know women
who bathe and swim in the ocean during their menstrual periods without
any injury to themselves, but they are exceptionally robust women;
advice in books is for the average person, and it is always best to be
on the safe side.
=Rest.= Rest is just as important during menstruation as cleanliness,
if not more so. Some women as mentioned before feel during their
menses just as well as they do at other times, and do not need any
special hygiene. But these are in the minority. Most girls and women
do feel somewhat below par during that period, and it is very
important that they take it easy, particularly during the first two
days. It is an outrage that many delicate, weak girls and women must
stay on their feet all day or work on a machine when they should be at
home in bed or lying down on a couch.
The womb is congested during the period, is larger and heavier than
normal, and it is then that there is often laid the foundation for
some future uterine disease, the well-known "womb trouble," or "female
disease." It is not necessary that work be given up altogether, but
there certainly should be less of it and there should be as much rest
as possible. For delicate and sensitive girls it is always best to
stay away from school during the first and second days. Speaking again
of the average and not the exception, it is best that dancing, bicycle
riding, horseback riding, rowing, and other athletic exercises be
given up altogether during the menses. Automobile riding and railroad
and carriage travelling prove injurious in some instances, greatly
increasing the flow of blood. But these are the exceptions at the
other extreme.
CHAPTER NINE
FECUNDATION OR FERTILIZATION
Fecundation or Fertilization--Process of Fecundation--When the
Ovum Matures--Fate of Ovum When no Intercourse Has Taken
Place--Entrance of Spermatozoa as Result of Intercourse--The
Spermatozoa in Search of the Ovum--Rapidity of Movements of
Spermatozoa--Absorption of Spermatozoön by Ovum--Activity of
Impregnated Ovum in Finding Place to Develop--Pregnancy in the
Fallopian Tube and Its Dangers--Twin Pregnancy--Passivity of Ovum
and Activity of Spermatozoön Foretell the Contrasting Rôles of
the Man and the Woman Throughout Life.
Fecundation and fertilization are important terms to remember. They
stand for the most important phenomenon in the living world. Without
it there would be no plants and no animals, excepting a few very low
forms of no importance, and of course no human beings.
=Fecundation= or fertilization is the process of union of the female
germ cell with the male germ cell; speaking of animals, it is the
process of union of the egg or ovum of the female with the
spermatozoön of the male. When a successful union of these two cells
takes place a new being is started. The process of fertilization or
fecundation is also known as impregnation and conception. We say, to
fertilize (chiefly, however, when speaking of plants) or to fecundate
an ovum, or to impregnate a female or woman, and to conceive a child.
We say the woman has become impregnated or has conceived.
_The Process._ The process of fecundation is briefly as follows. An
ovum becomes mature, breaks through its Graafian follicle in the ovary
and is set free. It is caught by the fimbriated or trumpet-shaped
extremity of the Fallopian tube and, moved by the wave-like motion of
the cilia[4] of the lining of the tube, it begins its travel towards
the uterus. If no sexual intercourse has taken place nothing happens.
The ovum dries up, or "dies," and either remains somewhere in the tube
or womb or is removed from the latter with the menstruation, or mucous
discharge. But if intercourse has taken place, thousands and thousands
of the male germ cells or spermatozoa enter the uterus through its
opening or external os, and begin to travel upward in search of the
ovum. The spermatozoa are capable of independent motion, and they
travel pretty fast. It is claimed that they can travel an inch in
seven minutes, which is pretty fast when you take into consideration
that a spermatozoön is only 1/300 of an inch long. Many of the
spermatozoa, weaker than the others, perish on the way, and only a few
continue the journey up through the uterus to the tube. When near the
little ovum, which remains passive, their movements become more and
more rapid, they seem to be attracted to it as if by a magnet, and
finally one spermatozoön--just one--the one that happens to be the
strongest or the nearest, makes a mad rush at it with its head,
perforates it, and is completely swallowed up by it. As soon as the
spermatozoön has been absorbed by the ovum, the opening through which
it got in becomes tightly sealed up--a coagulation takes place near
it--so that no other spermatozoa can enter the ovum. For if two or
more spermatozoa got into the same ovum a monstrosity would be apt to
be the result.
[Illustration: SPERMATOZOÖN PENETRATING THE OVUM.]