pregnancy is often put to the physician. Some extremists and theorists
demand complete abstinence during the entire duration of pregnancy.
Such abstinence is not only not feasible, but is unnecessary and may
prove a disrupting factor; it may create not only dissension, it may
wreck the love-life of husband and wife. I know of cases where the
wife, influenced by the wrong teachings about the necessity of
complete abstinence during pregnancy, about the possible injury to the
child from intercourse, persisted in keeping the husband away; and the
result was that the husband began to go to other women, and he got in
the habit to such an extent that he refused to give up entirely, even
after the child was born. It cannot be expected from a married man,
who is used to more or less regular sexual relations, to abstain
entirely for nine or ten months. Such a demand is unreasonable and
uncalled for. All claims about the injurious effects of intercourse on
the mother and child lack proof and foundation. During the first four
months of pregnancy no change need be made in the usual sex relations.
Their "intensity" should be moderated, their frequency need not.
During the fifth, sixth and seventh months intercourse should be
indulged in at rarer intervals--once in two or three weeks--the act
should be performed without any violence or intensity, and the usual
position should be reversed or changed to a lateral one. During the
eighth and ninth months relations had best be given up altogether.
And this abstinence should last until about six weeks after the birth
of the child. During this period the uterus undergoes what we call
involution; that is, it goes back to the size and shape it had before
pregnancy, and it is best not to disturb this process by sexual
excitement, which causes engorgement and congestion.
CHAPTER THIRTY-SEVEN
SEXUAL INTERCOURSE FOR PROPAGATION ONLY
Belief in Sexual Intercourse for Propagation Only--What Such
Practice Would Lead to--Nature and the Sex-fanatics--Sexual
Desire in Woman After Menopause--Sex Instinct of Sterile Men and
Women--Sex Instinct Has Other High Purposes.
Some people sincerely believe that the sexual instinct is for
reproductive purposes only; they claim we should never indulge in
sexual intercourse unless it be for the purpose of bringing a child
into the world. The act performed without such aim in view is
stigmatized by them as carnal lust, as a sin. Some even say that such
an act is equivalent to an act of prostitution. To _argue_ the
question with such people would be a waste of time. It is not fair to
impugn the good faith, the sincerity of your opponents, because I have
convinced myself that the most insane, most bizarre notions may be
held by otherwise sane people in perfect sincerity. But we cannot help
questioning the reasoning faculties of people holding such beliefs.
Let us see where the belief of "sex relations for procreation only"
would lead us to. In a normal healthy couple impregnation follows one
connection. So if a couple wanted to limit themselves to three or four
or six children, they would be entitled to have relations only three,
four or six times in their lives. For it must be remembered that
during pregnancy sexual relations would be prohibited, as during
pregnancy no further impregnation can take place, and no intercourse
must take place which has not for its purpose the conception of a new
human being. If the people were believers in big families, and agreed
to have twelve children--no anti-Malthusian would expect more than
that--they would be entitled to twelve relations during their marital
life. Assuming that not every act is followed by pregnancy, but that
it takes on the average three or four times to bring about the desired
result, we will have it that during the wife's childbearing period the
couple may indulge in sex relations from once in three or four years
to once or twice a year.
Can a sane person knowing anything about the sexual instinct make any
such demands from married people living in the same house and perhaps
occupying the same bed? It must be borne in mind that as soon as the
wife has reached the menopause all relations must cease, because she
can no longer become pregnant, and intercourse without a probable or
possible pregnancy is a sin. Also remember that no matter how
beautiful, young and passionate the wife may be, if she has some
little trouble which makes pregnancy impossible, sex relations must be
absolutely abstained from. And of course if the husband or wife is
sterile, all relations must be renounced forever, no matter how strong
the libido may be in one or both.
It is strange that Nature did not act according to the formula of our
sex fanatics; no pregnancy, no intercourse. If she had meant it to be
that way, she would have abolished sexual desire in woman immediately
after the menopause. Unfortunately this is not the case. For we know
that the sexual libido in women after the menopause is often and for
several years stronger than before. Why? Nor has Nature abolished the
sexual instinct and the passionate desire for sex relations in all
those men and women who are for some reason or other sterile, or
otherwise so defective that no child can result from the union.
As I stated at the beginning, it is a waste of time to _argue_ the
matter. Those who believe that sex relations are for racial purposes
only, are welcome to their belief, and are welcome to live up to it.
(How few of them do, though, honestly and consistently?) We must
reiterate our opinion that the sex instinct has other high purposes
besides that of perpetuating the race, and sex relations may and
should be indulged in as often as they are conducive to man's and
woman's physical, mental and spiritual health. No iron-clad rules can
be laid down as to the frequency. For some people three times a year
may be sufficient, others may require relations three times a month
(the best for the average) and still others may not be satisfied with
less than three times a week. The human _libido sexualis_ cannot be
put into an iron mould, and you should pay no attention to religious
fanatics who are ignorant of physiology and psychology and who can
only blunder and bungle up things.
CHAPTER THIRTY-EIGHT
VAGINISMUS
Vaginismus--Dyspareunia--Difference Between Vaginismus and
Dyspareunia--Adherent Clitoris a Cause of Masturbation and
Convulsions.
By the term vaginismus we understand a painful spasm or contraction of
the vaginal orifice which makes intercourse very difficult, or
impossible.
Certain cases of vaginismus, or rather false vaginismus, may be due to
laceration or inflammation of the vaginal orifice, but in genuine
cases of vaginismus no local disease can be found, because genuine
vaginismus is of nervous origin.
_Dyspareunia_ means painful or difficult intercourse, from whatever
cause. It differs from vaginismus in that the cause is generally a
local one, that is, it may be inflammation, laceration as after a
confinement, small size or atresia of the vagina, etc. When vaginismus
is present, it is present in reference to all men, in fact the mere
touch of the finger or an instrument may call forth a painful spasm;
while dyspareunia may show itself with one man and be absent with
another. The origin of the word dyspareunia shows that this may be
the case, for _dyspareunos_ in Greek means badly mated.
Dyspareunia must not be confused with true vaginismus. In dyspareunia
the sexual act can be freely indulged in, only the act is painful or
disagreeable. In vaginismus intercourse is _impossible_. In
exceptional cases where the husband attempts to use brute force, the
wife may faint away, she may get a convulsion or become wildly
hysterical. If the husband insists in attempting relations, the wife
may run away, or in exceptional cases even attempt suicide.
ADHERENT CLITORIS OR PHIMOSIS
The word phimosis means "muzzling," and it is a term applied to a
constriction or narrowing of the foreskin, so that the glands of the
clitoris cannot be freely uncovered. This condition may give rise to
an accumulation of smegma or secretion which may cause inflammation,
itching, and nervous irritation. This in its turn may be the cause of
masturbation. It is claimed by some that an adherent clitoris may even
be the cause of convulsions resembling epilepsy. In some cases it
leads to an irritable bladder, inability to retain the urine, and
nocturnal bed-wetting.
In all girls, big or little, that show a tendency to masturbate or
simply to handle the genitals, or that complain of itching, the
clitoris should be examined and if adhesions are found they should be
separated. This can easily be done under a local anesthetic.
CHAPTER THIRTY-NINE
STERILITY
Definition of Sterility--Husband Should First be Examined--
One-child Sterility--The Fertile Woman--Salpingitis as a
Cause of Sterility--Leucorrhea and Sterility--Displacement of
Uterus and Sterility--Closure of Neck of Womb and Sterility--
Sterility and Constitutional Disease--Treatment of Sterility.
Sterility or barrenness is a condition of inability to have children.
In former years the opinion prevailed generally, whenever a couple was
childless, that the fault was exclusively the woman's. It wasn't even
thought that the man could be to blame. We now know that in at least
_fifty per cent._ of cases of sterility, or childless marriages, the
fault is not the woman's but the man's. It is therefore very unwise in
conditions of sterility to subject the wife to treatment without first
examining the husband. Nevertheless, this is still often the case,
particularly among the lower classes or among the ignorant. There are
cases where the woman goes from one doctor to another for years and is
subjected to all kinds of treatment, when a simple examination of the
husband would show that the fault lies with him.
Some women have one child and are unable afterwards to give birth to
any more. Such a condition is called one-child-sterility. It is
generally due to an inflammation of the Fallopian tubes which closes
up the openings of the tubes into the womb, so that no more ova can
pass _from_ the ovaries _through_ the tubes _into_ the womb. This
inflammation may be the result of childbirth, for childbirth alone may
set up an inflammation, or it may be due to an infection contracted
from the husband.
In order to be fertile, that is, to be able to conceive and give birth
to a living child, the woman's external and internal genital organs
must be normal, her ovaries must produce healthy ova, and there must
be no obstruction on the way, so that the ova and the spermatozoa can
meet. The mucous membrane of the womb must also be healthy, so that
when the impregnated ovum gets attached to the womb it may develop
there without any trouble, and not become diseased or poorly nourished
and cast off.
We must always remember that the woman's share in bringing forth
children and perpetuating the race is much more important than the
man's. When a man has discharged his spermatozoa his work is done--the
woman's only commences.
The conditions which cause sterility in women are many, but the most
common cause is a salpingitis or an inflammation of the Fallopian
tubes, which may be caused by gonorrhea or any other inflammation. A
severe leucorrhea may also be the cause of sterility, because the
leucorrheal discharge may be fatal to the spermatozoa. Another cause
is a severe bending or turning of the uterus either forwards or
backwards. The opening of the neck of the womb, the os, may also be
closed, or practically so, from ulceration, from strong applications,
etc. In some cases sterility may be due to severe constitutional
disease, when the person is very much run down and so anemic that
menstruation stops. Unfortunately this is not always the case, for
women even in the last stages of consumption may, and often do, become
pregnant. Syphilis unfortunately does not cause sterility; it only
causes miscarriages until controlled by treatment.
The treatment of sterility can be successfully carried out only by a
competent physician, particularly by one who is devoting himself
specially to this kind of work. But I want once more to impress upon
every woman who is sterile, and who wants to have a child, not to have
herself treated or even examined until her husband has been subjected
to an examination.
CHAPTER FORTY
THE HYMEN
Difference Between Chastity and Virginity--Worship of Intact
Hymen--Sacrificing Hymen Sometimes Essential for Health of the
Girl--Certificate from Physician who has Ruptured Hymen.
I have mentioned in a previous chapter that the absence of the hymen
was no proof of unchastity, just as the presence of the hymen was no
proof of perfect chastity. Chastity and virginity are not synonymous,
and a girl may possess physical virginity, that is, an intact hymen,
and still be morally unchaste. She may be in the habit of indulging in
unnatural sexual practices. But the laity does not know these facts or
does not want to know them, and the intact hymen is still worshipped
like a fetish. This would be of little consequence, if it did not
often result in unnecessary suffering to the female child or girl.
Much disease and a good deal of sterility result from the fear of
tampering with the hymen.
When a boy gets some trouble with his genital organs, such as
phimosis, or balanitis or whatever it may be, he is at once taken to a
physician, who institutes the necessary treatment. When a little girl
complains of itching around the genitals or of some discharge, the
mother will hesitate long before taking her to a doctor. She will be
afraid he will do something to the hymen. And so she will temporize,
using salves and washes, and the disease will in the meantime be
making progress, that is, getting worse. When she does take her to a
physician, and he says that in order to treat the case thoroughly the
hymen has to be stretched or opened, the mother will withhold her
consent, and the disease will be allowed to progress. I know of many
such cases. This is wrong. When the health of the girl demands and her
future child-bearing power is at stake, no hesitation should be felt
in sacrificing the hymen.
Though in the future the fuss which is now made about the hymen, the
excessive veneration in which it is held, will appear ridiculous, and
though I consider it foolish and rather humiliating to the girl,
nevertheless, now, when the average husband does lay so much stress on
the presence of an unruptured hymen, a physician who in the course of
an operation or treatment has occasion to cut or rupture the hymen,
will do well to give the patient a certificate to that effect. In case
any question regarding the girl's chastity comes up in the future, she
can prove by the doctor's certificate that her loss of virginity was
not due to sexual relations. Of course the relations between husband
and wife, or between prospective husband and wife, should be such that
no "certificate" should be necessary; but reality differs from the
ideal, and in some cases that we know the husband's suspicions were
allayed by the doctor's oral or written statement.
This is as good a place as any to emphasize, that if the bride has a
very strong, tough and resistant hymen, the new husband should not use
brute force in rupturing it. First, because the pain may be too
excruciating and this may create in the wife an aversion to
intercourse which may last for many months or years--in some cases
forever. Second, a severe hemorrhage may result, which may require the
aid of a physician to stop. Wherever a case of very resistant hymen is
encountered, the husband should make several attempts; gradual and
gentle dilatation, with the aid of a little vaseline and not forcible
rupture should be the aim; the result will usually be satisfactory. In
exceptional cases, a physician may have to be called in. The operation
of cutting the hymen is a trifling one.
It is also interesting to know that some wives have sex relations for
months and years, and the hymen remains unruptured. Pregnancy may also
result with an intact hymen.
CHAPTER FORTY-ONE
IS THE ORGASM NECESSARY FOR IMPREGNATION?
Suppression of Orgasm by Woman to Prevent Impregnation--Bad
Results of Suppression by the Woman--Orgasm: Relation of to
Impregnation--A Hypothesis--A Fanciful Hypothesis--Why Passionate
Women Frequently Fail to Become Mothers--Advice to Passionate
Women who Desire to Conceive.
Among the laity the opinion is quite prevalent that in order for a
woman to conceive she must experience an orgasm, she must have had a
pleasurable voluptuous sensation during the act. If she has no orgasm,
impregnation cannot take place. So sure are some women that this is so
that when they want to avoid conception they repress any orgastic
feeling; as they say, they don't let themselves go. Which, I will say,
by the way, is one of the causes of female frigidity. If you don't
habitually permit a certain feeling to develop, if you repeatedly
repress it at the very beginning, at its first manifestation, it is
apt to atrophy altogether, to become permanently suppressed, or the
suppression develops into a nervous disorder.
Among the medical profession no perfect unanimity has been reached as
to the rôle of the orgasm in impregnation. Some sexologists like Kisch
and Vaerting believe it does play an important rôle; others, like
Forel, believe it plays none. That the orgasm is not _necessary_ for
impregnation admits of no discussion. Women who suffer from frigidity
in an extreme degree, women who never experienced an orgasm, women who
repress their orgasm, women in sleep or under narcosis, women who have
been raped, women who loathe their husbands, become pregnant
frequently and readily. But does it play any rôle at all? Does it
facilitate impregnation? Other things being equal, will intercourse
accompanied by an orgasm be more likely to prove fruitful than one in
which the orgasm was entirely absent? This question I am forced to
answer in the affirmative. Because from the various investigations I
have made it can hardly be subject to doubt that the uterus during an
orgasm exerts a certain amount of suction; and that impregnation is
_more likely_ to follow when the spermatozoa are sucked up into the
uterus than when left to make their own way by their own power of
motion, stands to reason and goes without saying. In the former
instance it takes less time for the spermatozoa to reach the ovum, and
there is less chance for them to perish on the way--from malnutrition
or from coming in contact with secretions of an acid reaction. There
is another point. I do not bring it forth as a proved fact or as a
fact susceptible to proof. It is a mere hypothesis, but in my opinion
it is a correct and plausible hypothesis. I believe that the strong
spasmodic contractions that take place during the orgasm have an
influence not only in accelerating the bursting of a Graafian follicle
and the extrusion of an ovum, but they are instrumental in aiding the
Fallopian tube to grasp the ovum and helping it along on the road
towards the uterus. It is therefore not at all inconceivable that
conception may take place during or within a very short time after an
act which is accompanied by a proper orgasm. Many women claim to
experience peculiar unmistakable sensations as soon as conception has
taken place, and by calculating the day of probable delivery we know
that they are right. Taking therefore all the various data into
consideration we are fully justified in saying that while an orgasm or
a voluptuous sensation during the act is not at all _necessary_ to
impregnation, it is in many cases a helpful factor.
It is claimed by some that the offspring resulting from an orgastic
act is apt to be healthier and better developed than offspring
resulting from sexual intercourse in which the parties experience no
orgasm. The reason given being that conception in the first instance
taking place quickly, the spermatozoa are better nourished and more
vigorous. In my opinion this is merely a fanciful hypothesis which
needn't be taken seriously.
It will be found rather frequently that women of strong passionate
natures, with strong orgastic feelings, and normal in every way, fail
to become mothers. A careful investigation of their menstrual
discharge will show that _it is not because they failed to conceive_,
but because the impregnated ovum is expelled each time; in other
words, they have each month a miniature miscarriage. And these
miscarriages, or rather abortions, are due to the spasmodic
contractions of the uterus and its adnexae which accompany the orgasm.
In such cases I have advised the woman to try to remain passive during
the act, to repress the orgasm, and the results have in some instances
shown the wisdom of my advice. After conception has taken place, after
one period has been missed, the woman should abstain from intercourse
altogether or at least for two or three months until the fetus is
securely attached to, or ensconced in, the uterus.
CHAPTER FORTY-TWO
FRIGIDITY IN WOMEN
Meaning of Term Frigidity--Types of Frigidity--Large Percentage of
Frigid Women--Repression of Sexual Manifestations and Frigidity--
Frigidity and Masturbation--Frigidity and Sexual Weakness of
Husband--Frigidity and Dislike of Husband--Organic Causes of
Frigidity--A Frigid Woman May Become Passionate--Treatment of
Frigidity.
The word frigidity means coldness, and when a woman has no desire for
sexual relations or experiences no pleasure when she has sexual
relations, she is said to be frigid.
Some cases suffer only from lack of desire, others only from lack of
pleasure, and still others from both. In some cases the frigidity is
congenital, that is, the lack of desire with inability to experience
pleasure during the act is inborn. In most cases, however, it is
acquired, or is only temporary, and is due to various causes.
Frigidity is much more widespread among women than it is among men.
Some physicians claim it is present in fifty per cent. of all women.
This may be an exaggeration, but if we put the number at twenty-five
per cent. we will be quite near the truth.
The causes of frigidity in women are many, but here are the most
important ones: First and foremost is the repression of all sexual
manifestations which the unmarried woman has to practice, and has had
to practice for many centuries. So that a part of the frigidity is
hereditary. You cannot entirely eradicate a natural instinct, but that
by continually repressing it, by giving it no chance to assert itself,
you may weaken it--about this there can be no question.
The second cause is masturbation. Cases that have been addicted to
excessive masturbation are very apt to develop not only frigidity, but
complete aversion to the sexual act, and inability to experience any
pleasure or orgasm. Such cases we come across every day.
A third very important cause is sexual weakness in the husband. When
the husband is sexually weak (suffering with premature ejaculations)
he either fails to awaken the sexual instinct in the woman, or if it
has been awakened it is apt to turn not only into frigidity but into
aversion to the act.
The fourth cause is often merely dislike towards the husband. The last
two causes, weakness of the husband and dislike towards him, are
unfortunately very frequent, and a wife who was frigid with one
husband may show herself very passionate on marrying another man.
The fifth cause is fear of pregnancy.
The above are the five principal causes. Other causes may be disease
of the uterus, laceration of the cervix, inflammation of the ovaries,
vaginismus, disease of the thyroid gland, etc.
It is an unfortunate fact that women who were frigid up to the age of
forty or so may become very passionate after that age.
As to the treatment of frigidity, little or nothing can be done for
frigidity that is congenital. Most of the other kinds of frigidity,
however, can be cured.
CHAPTER FORTY-THREE
ADVICE TO FRIGID WOMEN, PARTICULARLY WIVES
Advice to Frigid Women--Attitude of Different Men Towards Frigid
Wives--Orgasm a Subjective Feeling--A Justifiable Innocent
Deception--The Case of a Demi-Mondaine.
I wish to give you a piece of advice which is of extremely great
importance to you. I hesitated somewhat before writing this chapter,
but the welfare of so many women depends upon following this advice,
and I have seen the lives of so many wives spoiled on account of not
having followed it, that I decided to devote a few words to the
subject.