In that decisive moment in which the maiden loses her virginity, she must find in her husband, not the brutal man who forcibly takes possession of her body, but the chosen man of all, to whom her love can refuse nothing.
“Delicate foresight and restraint,” writes Ribbing, “are needful above all at the commencement of married life. The young wife, coming to the bridal bed a pure virgin, is not, like her husband, fully prepared for what is to take place. In all cases she is somewhat fearful of the new experience. The first act of intercourse involves for her a certain amount of pain, and this pain is not solely physical. * * * Moreover, we must remember that the entire change in her mode of life makes a deep impression upon a woman’s mind; time and quiet are needed before she can find herself at home in the novel surroundings, before she can adapt to the changed circumstances her moral and religious convictions, and before she can ‘think true love acted simple modesty’ (Romeo and Juliet, III, 2.16). Impatient husbands, through want of knowledge and lack of consideration during the honeymoon, have often ruined the happiness of subsequent married life.”
It happens often, unfortunately, that the wife has reason to complain of the reckless manner in which her husband has used, or misused, his sexual powers. Frequently enough, on the bridal night, the man proceeds with such violence in his assault on the virgin reproductive organs of his newly-wedded wife, that we must actually speak of him as ravishing an ignorant and timid girl. Later, when the stimulus of novelty has passed away, the husband often performs intercourse in a manner more calculated to awaken his wife’s sexual desires, but in seeking his own lordly gratification and obtaining it he is still apt to leave out of the reckoning the need for effecting coitus in such a way as will give complete satisfaction also to his wife.
The wedding journey likewise deserves consideration from the hygienic standpoint. Much is to be said in favor of such a journey, inasmuch as it endows the necessarily somewhat brutal first act of intercourse with an aspect of romance. The removal to a foreign country, to a strange environment, will spare the chaste maiden much shame and vexation. On the journey, moreover, the young couple are much in each other’s company, and the process of mutual adaptation is agreeably favored. And yet this modern custom of making a wedding journey entails certain serious disadvantages. The young woman leaves her home and her nearest relatives, and is in a moment involved in the excitement of travel, an excitement liable to increase to the degree of morbid anxiety. The fatigues of railway-travel, of wandering about strange towns, of visits to museums and picture-galleries, are apt to cause general loss of nervous tone, and also local hyperæmia of the genital organs. In addition, false modesty and the prescribed arrangements for the journey may lead the onset of menstruation to be ignored and the customary rest at this period to be dispensed with. Still more, the possibility of the occurrence of conception and of the commencement of pregnancy is usually left altogether out of the account. Many an attack of menorrhagia, of perimetritis, and of endometritis, many a miscarriage, and many instances of protracted sterility, are dependent upon the hygienic mistakes of the wedding journey, and less, indeed, upon the abuses arising out of the intoxication of passion, than upon the fatigues of excessive travel both by day and by night. The bride who on her wedding-day was young, healthy, and full of vitality, not infrequently returns from the wedding journey a sickly and debilitated woman.
With regard to wedding journeys in relation to the causation of chronic metritis, Scanzoni has expressed an authoritative opinion. “After many weeks of unsatisfied sexual desire, the young married pair, now freed from all restraint, give themselves up to the joys of love; the intense sexual excitement causes great stimulation and hyperæmia of the female sexual organs; in addition, the noxious influences of travel make themselves felt, and also hygienic indiscretions are perpetrated, dependent upon the young wife’s modesty; it is, therefore, by no means to be wondered at that, having left home a perfectly healthy woman, she returns from her wedding journey with the germs of an illness from which she never fully recovers, and which is the source of unending suffering, and more particularly of a sterile marriage.”
Sexual hygiene demands a certain moderation in the enjoyment of physical love, and also a certain constancy, such as may be expected in a happy marriage.
It is not possible to lay down a general rule with regard to the frequency of sexual intercourse, notwithstanding the earnestness with which religious zealots, physicians, and moral teachers have in all ages endeavored to determine how often it was proper for a man to cohabit with his wife. The rules that have been prescribed by the various authorities had in view, for the most part, the protection of the wife from excessive demands on the part of her husband; sometimes, however, by the establishment of a minimum period, a certain amount of sexual gratification was secured to the wife; finally, also, the generation of a healthy posterity had to be taken into consideration. Ribbing, however, justly observes: “Sexual intercourse results from a natural impulse, and he whose senses are unimpaired, and who has learned, at the same time, amid the tumult of his sensations, to preserve proper consideration for his wife—such a man runs little danger of making any mistake. In opposition to the opinion of many, I regard it as entirely right and reasonable that husband and wife should have intercourse whenever physically and mentally impelled to that act. Nor do I see any reason why, during the first period in which they are able to enjoy without intermission the pleasures of sexual intercourse, they should, in accordance with any theory whatever, impose on themselves further restraints than those demanded by care for their physical and mental health. The touchstone of marital hygiene is this, that on the day following intercourse both husband and wife should feel perfectly fresh, vigorous, and lively, alike in body and mind—even more so, perhaps, than on other days. In the absence of such feelings, we may feel assured of the occurrence of sexual excesses.” The same author quotes a saying of Pomeroy’s: “We may quaff the nectar as freely as we will—nature herself mixes the draught and holds the goblet to our lips; if, however, we drink too much, she first dilutes the draught with water, later adds gall, and ultimately perhaps deadly poison.”
The occupation, trade, or profession, and the nutritive condition and physical constitution of the married pair, have an important bearing on the frequency with which, without detriment to health, cohabitation is permissible. The rules of the Hebrew Talmud already take these circumstances into account, ordering as they do that young and powerful men not engaged in any regular occupation shall have intercourse with their wives daily; manual labourers, on the other hand, once a week only; whilst brain-workers, finally, or those whose work is extremely arduous, should allow an interval of one or more months to elapse between the acts of intercourse. Acton also prescribes that in the case of brain-workers and of those manual workers whose labours are exhausting, intercourse must not occur more frequently than once every week or ten days.
The married couple should understand how to impose on themselves a certain restraint in the matter of marital intercourse, without, however, going so far as on altogether trifling grounds to refuse the husband access to his wife. In this respect also, the opinions that have recently come to prevail concerning the rights of women have had an influence. W. Acton relates a case that came under his observation in which the wife refused to allow her husband any voice in determining when and how often intercourse should take place; the wife, she maintained without hesitation, since she had to bear the consequences of intercourse, was fully justified, whenever she thought fit, in refusing her husband’s embraces.
The dangers to the sexual life of woman which are involved by the modern woman’s rights agitation are seen already in the changes which the emancipation of women in North America has produced in the functions of woman as wife and mother. In that part of the world, everything possible has been done “to transform” (to quote the words of a brilliant journalist) “the doll into an independent existence, to enable the helpless woman to earn her own subsistence, and the result of these endeavors has been most striking. The American woman has obtained the right to enter every profession and to follow every kind of occupation which have hitherto been reserved for men; she is physician, lawyer, merchant, professor; her boudoir has become an office, often connected with the stock exchange by a private wire. Legally, also, she now possesses the same rights as man; in many States she has both the suffrage and the right of entering the house of representatives; she has fully emancipated herself from her former condition of tutelage, and in her shrillest tones can cry to heaven ‘I am free, I am independent, I am emancipated, I am myself!’ And observe, as the result of all these attempts at the conversion of woman into man, that in the matter of marriage also she acts as if she were no longer woman. The American woman no longer marries; perhaps, indeed, because she no longer has the capacity. So long and so eagerly has she given herself up to masculine occupations, that her inward feminine nature has also perhaps undergone transformation, so that she has become affected with a kind of neutral lack of desire. Unquestionably, the desire for marriage on the part of this modern ‘emancipated’ woman has vanished in the most alarming manner, there is a notable fall in the birth-rate, and the indigenous (white) population actually threatens to disappear.”
The wife acts wisely, not on hygienic grounds alone, in not always acceding at once and unconditionally to her husband’s demand for the repetition of intercourse. Her modest reluctance enhances her desirability in the eyes of her amorous husband. Thus, Shakespeare makes Posthumus exclaim (Cymbeline, Act II., Sc. 5, l. 9):
Especially justified is such refusal when coitus has been already once or twice performed, or when the consumption of alcoholic beverages has made the husband unduly lustful. On the other hand, the refusal of intercourse when demanded by the husband should never depend upon baseless feminine caprice, or upon the now so frequently asserted “rights of women.”
Experience has long ago established as a fact that unduly frequent satisfaction of the sexual impulse entails serious consequences to the health of the individual. And in the case of the wife these consequences may be especially disastrous when intercourse is indulged in recklessly during menstruation, during all stages of pregnancy, and even during the puerperium. “Incontinence during menstruation leads to serious circulatory disturbances and to the consequences of these disturbances; during pregnancy it is likely to give rise to miscarriage; during the puerperium, to congestions and inflammations. Should conception occur as a result of intercourse during the lying-in period (and this may happen very shortly after childbirth), abortion, and even more serious consequences, are likely to ensue. By intercourse during lactation, the premature recurrence of the menstrual flow is induced, and the gradual reversion of the reproductive apparatus to the condition in which it was before pregnancy (the process of involution) is hindered; moreover, the secretion of milk is diminished or even entirely suppressed.” In these terms Hegar depicts the consequences of premature resumption of marital intercourse, taking perhaps a somewhat extreme view of the matter.
Nevertheless, this author is undoubtedly right in declaring that one of the principal disadvantages to a woman of excessively frequent sexual intercourse is that pregnancy occurs too often. It is astonishing to observe the number of full-term deliveries and miscarriages that a woman will experience within a comparatively short period of time, as is seen too frequently among the labouring classes and more especially among factory workers. “If we assume the ordinary mortality of childbed to be 6 per mille, a woman who in the course of 15 years undergoes labour (at full term or prematurely) 16 times, runs a risk of death to be expressed by the ratio of 6 × 16 = 96 per mille; that is to say, on the average, of 1,000 women who become pregnant as often as this, nearly 1 in 10 will die in childbed.”
Young men who have previously suffered from gonorrhœa and who wish to marry, must, unless they wish to cause unspeakable misery, undergo an exact and thorough examination; not only must the physician inquire as to the presence of certain symptoms, such as smarting during micturition, adhesion of the lips of the urethral meatus, “clap-threads” in the urine, etc., but during a considerable period of time repeated microscopical examinations of the urine must be undertaken, and the filaments, if present, must be examined for gonococci. The physician will also have to determine whether any vestiges remain of epididymitis, and whether the quality of the semen has been impaired by the attack of gonorrhœa. Unfortunately, it is not yet within our power absolutely to forbid marriage to a man exhibiting all the symptoms of chronic gonorrhœa; but it is the duty of the physician to explain to such a man the scientific views regarding this matter that now prevail, in order to furnish him with the grounds for a decision.
It is not possible, when discussing the hygiene of married life, to preserve silence respecting the extremely pressing question of the use of measures for the prevention of conception, for in recent years their use has become extraordinarily general, chiefly, indeed, in the upper and middle classes of society, but to some extent also among the working-class population. Although we devote a special chapter to this topic, we must here express the opinion that, except in certain instances in which their employment can be justified on carefully weighed and well-established medical grounds, the use of any mechanical or chemical means for the prevention of conception must be discountenanced as injurious to health. The wife who wishes to preserve her psychical purity and moral chastity, which is not only possible in marriage but also greatly to be desired, must not concern herself much with the technique of the sexual life, but must give herself up to sexual enjoyment only as the result of a delicate and immediate bodily and mental desire. Not only for reasons of national economy regarding the means of providing for the family, but also for well-grounded personal reasons regarding the wife’s health, must the latter be spared an unduly rapid succession of pregnancies and confinements. And this should be effected by a certain degree of continence and by the observation of extensive periods of sexual quiescence.
To preserve a woman’s health during the acme of her sexual activity, a careful general hygiene is an important requisite. The dwelling should be dry and roomy; above all the bedroom should not be too small, neither damp nor dark, and it should be well ventilated. The wife’s occupations should be so arranged as to afford a suitable alternation of activity and repose, and there should be as little night work as possible. Certain occupations are especially potent in the causation of the diseases peculiar to women, principally, for the reason that they do not permit of the requisite repose during menstruation. Thus, washerwomen, vocalists, and sewing-machine operatives, suffer with especial frequency from diseases of the genital organs.
Great care in the cleansing of the genital organs is indispensable in the case of women; the vulva and its environment should be frequently and carefully washed; and an occasional vaginal injection is advantageous. As regards the last-named measure, however, we must point out that it is possible to err by excess as well as by defect, and that a daily vaginal douche can by no means be regarded as a necessary part of the hygiene of the reproductive organs. For recent researches have shown, on the one hand, that the vagina constitutes a natural mechanism for the destruction of pathogenic organisms, and on the other hand, that complete disinfection of the vagina is extremely difficult to effect. Inflammations of the vulva, which are somewhat frequent in consequence of excessive perspiration and undue discharge from the genital canal, demand careful cleansing with soap and water and the use of a soft brush. The addition to the water of lysol (in the proportion of ¼ to ½ per cent.) is advantageous. A general bath or a local sitz bath, the water being moderately warm (95°–99° F.; 35°–37° C.), may be recommended on grounds of beauty as well as of health, and should be taken at least once a week.
The regular use of lukewarm sitz baths is a most valuable hygienic measure for the prevention of various general or local disturbances consequent upon increased flow of blood to the genital organs. These local baths are best taken at a temperature of 95° F. (35° C.), and should last twenty minutes; they should be taken just before going to bed, and while sitting in the hip bath the skin of the abdomen and of the lower part of the back should be rubbed with the hand encased in a friction-glove. The bather on leaving the bath should get straight into bed, and should dry herself beneath the bedclothes, rubbing the skin till it glows. Such sitz baths serve also to keep the external genitals clean, and to guard against infection. For vaginal douching, water sterilized by boiling should be employed, and where any catarrh of the vaginal mucous membrane is present, some alum, permanganate of potassium, or boric acid may be added with advantage; the pressure of water, when a vaginal douche is given, should never be high, the reservoir of the irrigator being raised not more than twenty inches above the outlet of the nozzle; as a rule the water should be lukewarm; the patient should be in the recumbent posture. The reservoir of the irrigator and the intra-vaginal nozzle are most suitably made of glass, to insure cleanliness; the nozzle should not be thrust too far in, two inches being quite sufficient. After the use of the douche, the woman should remain ten or fifteen minutes in the recumbent posture.
In addition to the hygienic employment of such full baths and local baths, a number of mineral baths have important therapeutic applications in cases of disease of the female genital organs, the traditional value of such baths having been scientifically endorsed by the modern science of balneo-therapeutics. By means of suitably selected mineral water baths, a powerful derivative stimulus may be given to the skin, and the affected reproductive organs may thus be beneficially influenced. Further, in acute inflammatory conditions or hyperæmia of the uterus or its annexa, these baths have an antiphlogistic influence; on the other hand, when intrapelvic exudations have formed, the baths promote the absorption of these inflammatory products; again, in congestive states of the female genital organs, with relaxation, thickening, and hypersecretion of the genital mucous membrane, the baths have an astringent and tonic influence on the tissues; finally, they have a favorable effect on the innervation and nutrition, not only of the reproductive apparatus, but of the entire organism. It is easy to understand why women during the menacme are frequent visitors to spas.
At this period of life, and especially in women who lead luxurious “society” lives, the thoughts tend strongly in the sexual direction; to avoid this, and to prevent the ever more and more frequent breaches of marital fidelity, the best means are the practice of vigorous bodily exercises, and active employment, either in household affairs or in intellectual occupations. Cold sponging of the body or cold full baths will also be found an excellent measure for the prevention of sexual excess. In such cases also the diet should be limited, strong and stimulating food should be avoided, but little butcher’s meat should be taken, whilst green vegetables and raw and cooked fruits should be liberally consumed; at the same time, all alcoholic beverages must be rigidly prohibited. Moreover, care must be taken that during the night there should be no undue physical stimulation in consequence of excessively warm and soft bedding; hair mattresses are to be preferred to feather beds, with light down quilts for a covering. Finally, no stimulation of an erotic character should be offered to the imagination, and for this reason equivocal literature and lascivious dramatic representations must be avoided. By a sufficiency of occupation, regular, interesting, and demanding a considerable expenditure of physical energy, a woman may be enabled to a great extent to escape the inconvenience and distress attendant on entire or partial lack of gratification of the sexual impulse.
It cannot be disputed that a certain and moderate amount of sexual gratification is requisite for the perfect maintenance of physical health in woman, and that the absence of this gratification, or the gratification of the impulse in an abnormal or incomplete manner, entails disturbance of alike the mental and the physical equilibrium; but, on the other hand, the deleterious consequences of sexual abstinence have been greatly exaggerated by many writers—both by physicians and social economists. Owing to the fact that to the cultivated woman sexual gratification is possible only in the married state, whilst social conditions render marriage impossible to many women greatly in need of such gratification; in consequence, also, of the modern and ever more widely diffused practice by husbands of coitus interruptus altogether regardless of the woman’s need for complete sexual gratification—there arise in women numerous local disorders and nervous disturbances, hysteria and even insanity being results by no means infrequent. The significance of ungratified sexual impulse in the pathogenesis of nervous disorders has been established by von Krafft-Ebing, who points out that in unmarried women insanity most frequently occurs between the ages of twenty-five and thirty-five years, during the decade, that is to say, in which youthful bloom and the hopes of marriage simultaneously disappear; whereas in the male sex the greatest incidence of insanity is between the ages of thirty-five and fifty years, the period of life in which the struggle for existence is fiercest.
Hegar, on the other hand, is a firm opponent of the view that the favourable influence of marriage is overrated. According to this author, the favourable effect of marriage in respect of mental disorders is to be found, not in the gratification of the sexual impulse, but in the ethical factors of marriage. Statistics show that even in the favourable circumstances of marriage, sexual gratification has in women an unfavourable influence, inasmuch as the proportion of sufferers from mental disorders is higher among married women than it is among married men. A study of the mental disorders which in women are especially associated with the process of reproduction (puerperal mania) confirms this impression. Hegar insists that he has never seen nymphomania arise in women in consequence of forcible repression of the sexual impulse; but that he has not infrequently seen this disorder result from unnatural excesses or from long-continued sexual irritation, especially in hereditarily predisposed persons. Such unnatural stimulation of the female is not infrequently practiced by the male—by the lover and even by the husband—it may be because he himself derives pleasure from such perverted practices, and wishes to obtain sexual gratification without the risk of impregnation, or because he is himself incompetent for normal complete intercourse. Hegar is further of opinion that in the causation of hysteria and also in that of chlorosis the repression of the sexual impulse plays a quite subordinate rôle. And he regards as pure fable the belief that continence in women is liable to lead to the formation of mammary, uterine, or ovarian tumors. He would more readily incline to the contrary opinion; the reproductive process being in this respect distinctly disadvantageous to the female sex. The unfavorable influence of the reproductive process is shown most clearly in the case of carcinoma of the uterus; the majority of the patients suffering from this disease are either married or widowed, and many of them have given birth to a large number of children. “Gratification of the sexual impulse, and more particularly the reproductive process, give rise in women to the formation and growth of tumors, cause numerous mechanical disturbances, and open the way to infection with various pathogenic organisms.”
Hegar considers that there is hygienic justification for the limitation of the number of children to which a woman gives birth. The most suitable age for motherhood lies in his opinion between the ages of twenty and forty years. Childbirth in women younger or older than this entails too much danger both to mother and child. At least two and a half years ought to elapse between two successive births; and these figures give us eight as the maximum family. If we assume that the duration of pregnancy is nine months, and that of lactation nine to twelve months (or in cases in which the mother does not nurse her own infant, that a like period must be devoted to the careful supervision of the wet-nurse or of the methods of artificial feeding), we cannot consider it unreasonable to devote a further period of from six to nine months to the complete reestablishment of the woman’s health. “Moreover, woman does not exist solely for the purpose of subserving during two decades of her life the processes of reproduction. And to permit the maximum number of children to be as great as eight, we must presuppose that the woman is in perfect health, and that she lives in a perfectly healthy environment. Any illness or infirmity which renders the duties of housekeeping and the rearing of the existing family unduly difficult, indicates the need for a further limitation of child-bearing. And if the reproductive function is to be rationally controlled, we must above all attend to the age and the health of the parents. Occupation, habitation, and general environment have also to be considered. The correct ideal is indeed not difficult to discover.”
Hegar concludes that strict moderation and even absolute continence in sexual matters are often, and for long periods of time, a pressing duty. “The numerous and various disasters which are brought upon the world by unbridled and unregulated sexual passion can be prevented only by enlightenment, moderation, and continence. If marriage were postponed until the attainment of complete physical maturity, in women till the age of 20, in men till the age of 25, while at the same time procreation were no longer undertaken by women above the age of 40 or by men above the age of 45 to 50 years; if, again, between successive pregnancies a sufficient pause for the woman’s recuperation were insisted upon, and intercurrent illnesses and states of debility were taken into account; and if, finally, sickly individuals, those hereditarily predisposed to disease, and those in any way below par either mentally or physically, were more than heretofore prevented from marrying; then the increase of population, which in Germany is unquestionably too rapid, would to some extent be checked. Thoroughgoing regulation of the reproductive process will not, however, be thus attained without the adoption of a method of selection too rigorous for present-day notions; and for a further advance we must in the meantime depend upon moderation and continence.” As regards the modern demand of the “right to love,” the same experienced gynecologist writes: “Whoever preaches to mankind the doctrine that ‘a man sins against his own personality if he neglects to exercise every limb he possesses, and if he denies himself the gratification of every natural impulse,’ or the doctrine that ‘it is the duty of every human being to gratify all his natural impulses, since these are most intimately inter-connected with his personality—are indeed his personality itself;’ such a preacher does harm to his kind. Such rights and such duties are chimerical for this reason if for no other, because two persons are necessary in the case of sexual gratification, and sometimes—though not as often as might be wished—Hans fails to find his Grete, without any consequent loss to society at large.”
An especially important chapter in the history of woman at this period of life relates to the dietetics of pregnancy and parturition, and to the regulations to be observed for the maintenance of health at this time and in connection with the processes of pregnancy, parturition, puerperal involution of the uterus, and lactation. This subject cannot now however be considered at length, and for our present purposes it is sufficient to point out how important it is alike for mother and child, alike for family and society, that the ever more and more widely and generally diffused practice of the artificial feeding of infants should be abandoned, and that there should be a return to the natural method according to which each mother nurses her own infant. The prevailing custom costs every year thousands of mothers their health, and thousands of children their lives.
The reproduction of the species is effected by means of an act of copulation on the part of a male and a female individual, both of whom must have attained complete sexual development. In all the sequence of reproductive processes it is copulation alone that is a voluntary act, all the other processes being independent of the will and even of consciousness.
A characteristic difference between man and the lower animals lies in the fact that in the human species sexual pleasure and the act of copulation may occur at any season of the year; and a further characteristic difference may perhaps be found in the fact that in the great majority of individuals of the human species the psychical process of “love” plays a determinative part. Voltaire pointed out that to man alone among animals are known the embrace and the joy of the kiss.
The significance of the kiss is depicted by Grillparzer in the following verses:
In this act of conjugation between two individuals of the same species, differentiated each from the other by the characteristics of sex, the active, provocative rôle is allotted to the male, the passive, receptive rôle, to the female. The modest and coy reluctance characteristic alike of the maiden and of the wife, promote an increase of sexual excitement in the opposite sex, and this not only in a man of purely sensual character, whose vanity is stimulated by his being the chosen one among many—a circumstance which, in view of the great dependence of the sexual act upon psychical processes and imaginative influences, is by no means devoid of importance. The woman’s coy reluctance must be overcome by means of a tender strategy before she is willing to grant the final possession of her body; and the act of copulation forms at the same time the conclusion of the physical and mental yearnings of the lover, and the commencement of the new-coming being. There is thus a physiological reason for the advice given by the celebrated surgeon, Ambroise Paré, that a man, before completing coitus, should employ some of the delicate and sensually stimulating manipulations of the earlier stages of courtship, for, he writes, “aucunes femmes ne sont pas si promptes à ce jeu que les hommes.”
The potency for intercourse of the sexually mature man, his capacity for the introduction of the erect penis during the act of copulation, is dependent on the fact that sexual excitement gives rise to a sufficient stimulus which, acting on the erection centre (and presuming that the centre and its afferent and efferent tracts are normal), leads to an increased flow of arterial blood to the penis and a diminished outflow through the veins of that organ, and consequently to its erection. The cerebrum is the organ in which the sensation of libido sexualis, of sexual excitement, has its seat; with this higher centre is connected by means of intercentral nerve tracts a lower, mechanical, reflex centre, situated in the lumbar enlargement of the spinal cord, and presiding over the performance of the act of copulation; it is moreover probable that nerve fibres proceed from the spinal cord direct to the blood vessels of the erectile tissue, by means of which the calibre of these vessels can be lessened or their extensibility diminished. The relation of the erector nerves (nervi erigentes) to the penis is by many physiologists compared to the relation of the vagus nerve to the heart. In the quiescent state the small arteries of the penis and perhaps also the cavernous spaces of that organ are in a state of mean contraction, so that they offer a considerable resistance to the passage of the blood current. When now the nervi erigentes are excited to activity, the hitherto tonically contracted vessels of the penis undergo, according to the school of physiologists just mentioned, relaxation, so that they dilate under the pressure of the blood within their walls, and, the previous resistance to the flow being now removed, the blood pours freely into the cavernous spaces of the penis, and distends these to the uttermost. In this manner erection is effected, rendering possible the insertion of the penis into the genital passage of the female; with the culmination of the sexual act, the semen is ejaculated, the muscles of the prostate and the membranous portion of the urethra together with the ischiocavernosus and bulbocavernosus muscles, all acting strongly and simultaneously.
By the contraction of the muscular apparatus just described, the penis is constricted in the neighborhood of the pubic symphysis, and this further hinders the outflow of the blood from the corpora cavernosa, increasing the intensity of the state of erection of the penis. Should the relaxation of the corpora cavernosa, dependent upon the stimulation of the nervi erigentes, be incomplete, it is not possible for sufficient blood to pass into the cavernous spaces to exercise considerable pressure upon the efferent veins, and thus complete erection fails to occur. If, again, the contraction of the muscular apparatus at the root of the penis is insufficiently vigorous, complete erection likewise fails to occur; the organ becomes semi-erect only, or erect for a period too short to permit of the completion of intercourse.
Since, physiologically speaking, conception is the purpose with which copulation is effected, the ejaculation of the semen must be regarded as the principal object of that act; now in normal conditions, ejaculation takes place only when the penis is fully erect. Associated with the erection of the corpora cavernosa is a swelling of the caput gallinaginis, whereby the orifices of the ejaculatory ducts are directed forwards toward the membranous portion of the urethra, and at the same time the backward passage to the bladder is cut off. By this mechanism, the urethra, which usually serves as the canal for the outflow of urine, is made for the time being solely subservient to the purposes of the sexual act. That the outlet from the bladder is obstructed by the swollen caput gallinaginis when the penis is erect, is shown by the familiar fact that a man whose penis is erect cannot pass water, although the way is freely open for the ejaculation of the semen.
Before ejaculation begins, the urethral glands already begin to secrete; and when erection is powerful and prolonged, this secretion often makes its appearance at the urethral orifice in the form of drops of a clear somewhat tenacious fluid. Ultzmann considers that the function of this secretion is probably to moisten the walls of the urethra, over which the acid urinary secretion is continually flowing, with a protective alkaline fluid, and thus to prepare the canal for the passage of the semen. An analogy may be found in the secretion of the cervical glands of the uterus in the female, for this secretion has been found to enhance the activity of the movements of the spermatozoa. If now during copulation the moment of ejaculation begins, the male experiences at the same time a sense of voluptuous pleasure and a feeling of muscular spasm in the perineal region, and this indicates the commencing evacuation of the contents of the seminal vesicles through the ejaculatory ducts. Simultaneously, the secretion of the prostate is poured into the urethra. The semen now gradually passes out through the narrow ejaculatory ducts, and, since in consequence of the swelling of the caput gallinaginis, it cannot pass backwards towards the bladder, it runs forwards, and accumulates in the bulb of the urethra, the physiological excavation of that tube. As soon as a considerable quantity of the semen has collected in this situation, so that the bulb of the urethra becomes distended, reflex contractions of the bulbocavernosus muscles ensue, by means of which the seminal fluid is forced out of the urethral orifice. In cases in which this muscular apparatus does not function properly, as in the paralytic form of impotence, the semen during ejaculation is not ejected in a forcible jet, but rather flows slowly, as from a lax tube partially filled with fluid, from the urethral orifice.
We are indebted to Roubaud for a classical description of the phenomena of copulation, and this description is here appended. It runs as follows: “As soon as the penis enters the vaginal vestibule, it first of all pushes against the glans clitoridis, which yields and bends before it. After this preliminary stimulation of the two chief centres of sexual sensibility, the glans penis glides over the inner surfaces of the two vaginal bulbs; the collum and the body of the penis are then grasped between the projecting surfaces of the vaginal bulbs, but the glans penis itself, which has passed further onward, is now in contact with the fine and delicate surface of the vaginal mucous membrane, which membrane itself, owing to the presence of erectile tissue between its layers, is now in an elastic, resilient condition. This elasticity, which enables the vagina to adapt itself to the size of the penis, increases at once the turgescence and the sensibility of the clitoris, inasmuch as the blood that is driven out of the vessels of the vaginal wall passes thence to those of the vaginal bulbs and the clitoris. On the other hand, the turgescence and the sensitiveness of the glans penis itself are heightened by compression of that organ, in consequence of the ever increasing fulness of the vessels of the vaginal mucous membrane and the two vaginal bulbs.
“At the same time the clitoris is pressed downward by the anterior portion of the compressor muscle, so that it is brought into contact with the dorsal surface of the glans and of the body of the penis; in this way a reciprocal friction between these two organs takes place, repeated at each copulatory movement made by the two parties to the action, until at length the voluptuous sensation rises to its highest intensity and culminates in the sexual orgasm, marked in the male by the ejaculation of the seminal fluid, and in the female by the aspiration of that fluid into the gaping external orifice of the cervical canal; so true, indeed, is this, that it is a difficult matter to give a picture at once accurate and complete of the phenomena attending the normal act of copulation. Whilst in one individual the sense of sexual pleasure amounts to no more than a barely perceptible titillation, in another that sense reaches the acme of both mental and physical exaltation.
“Between these two extremes we meet with innumerable states of transition. In cases of intense exaltation, various pathological symptoms make themselves manifest, such as quickening of the general circulation, and violent pulsation of the arteries; the venous blood, being retained in the larger vessels by general muscular contractions, leads to an increased warmth of the body; and further, this venous stagnation, which is still more marked in the brain in consequence of the contraction of the cervical muscles and the backward flexion of the neck, may cause cerebral congestion, during which the consciousness and all mental manifestations are momentarily in abeyance. The eyes, reddened by injection of the conjunctiva, become fixed, and the expression becomes vacant; lids close conclusively, to exclude the light. In some, the breathing becomes panting and labouring; but in others, it is temporarily suspended, in consequence of laryngeal spasm, and the air, after being pent up for a time in the lungs, is finally forcibly expelled, and they utter incoherent and incomprehensible words.”
The impulses proceeding from the congested nerve-centres are confused. There is an indescribable disorder both of motion and of sensation, the extremities are affected with convulsive twitchings, and may be either moved in various directions or extended straight and stiff; the jaws are pressed together so that the teeth grind against each other; and certain individuals are affected by erotic delirium to such as an extent that they will seize the unguarded shoulder, for instance, of their partner in the sexual act, and bite it till the blood flows.
A period of exhaustion follows, which is the more intense in proportion to the intensity of the preceding excitement. The sudden fatigue, the general sense of weakness, and the inclination to sleep, which habitually affect the male after the act of intercourse, are in part to be ascribed to the loss of semen; for in the female, however energetic the part she may have played in the sexual act, a mere transient fatigue is observed, much less in degree than that which affects the male, and permitting far sooner of a repetition of the act. “Triste est omne animal post coitum, praeter mulierem gallumque,” wrote Galen, and the axiom is essentially true, at any rate so far as the human species is concerned.
The question has been mooted, and many earnest inquirers have devoted much thought thereto, whether in this moment of most intense sexual gratification it is the male or the female that experiences the greatest amount of pleasure. As in the case of all questions the data for the solution of which are at once very various and very variable, so in this case also, very different opinions have been put forward. “In fact,” writes Roubaud, “when we take into consideration all the circumstances by which the intensity of sexual sensation is influenced, it may well be doubted if it is at all possible to find an a priori solution for the problem. When we take into consideration the influence exercised by temperament, constitution, and a large number of conditions both general and special, on sexual sensibility, we cannot fail to be convinced that this problem, in consequence of all the complicated characteristics it presents, is actually insoluble.”
In regard to the pleasure experienced in the act of intercourse, a remarkable distinction is drawn by Gutceit. The male, in every case and with every woman, experiences the full degree of pleasure; and even though from the mental point of view this pleasure may be enhanced by inclination, attraction, and mutual love, from the physical point of view there is no difference between different acts of intercourse, so that the cynical old Roman was right when he wrote. “Sublata lucerna nullum discrimen inter foeminas.” But in the case of the female it is very different. Her first experience of sexual relations is a very painful one, and this pain prevents all enjoyment as long as it continues, as it does in many women for one, two, or even four weeks. And when this period is once over, not more than two women in every ten experience the pleasure of sexual intercourse in its full intensity. Of the remaining eight, four have indeed an agreeable sensation during the rubbing movements of the sexual act, but it is a long time before they experience a sensation analogous in its intensity to that which in man accompanies the act of ejaculation. In some women it may be six months after marriage before the true sexual orgasm is experienced, in others it may be a year, or even several years; in a considerable number this does not happen until after they have given birth to several children. As a result of numerous observations on this point, Gutceit asserts that in women sexual pleasure is experienced only in intercourse with a man who is beloved, or against whom, at least, no repulsion is felt; and that no pleasure is felt by a woman in intercourse with a man towards whom she feels an actual dislike. Further, he maintains, that a woman, loving another man, and feeling pleasure in intercourse with him, has on the other hand no voluptuous sensations during intercourse with her husband, whose embraces she permits only from a sense of duty. Thus in the male, intercourse is always pleasurable, while in the female, pleasure is experienced only when certain conditions are fulfilled.
Contact with the male genital organs stimulates in the female the sensory nerves of the vulva, the vestibule, and the vagina; the nervous stimulus is transmitted to the cerebral cortex, where it gives rise to the sensation of sexual pleasure, and causes, through the intermediation of the genito-spinal centre, a number of reflex actions. As sensory nerve terminals of such reflex arcs, the final ramifications of the pudic branch of the sciatic plexus play the most important part; in the clitoris these nerves are beset with a peculiar kind of end-bulbs, the genital corpuscles discovered by W. Krause; from their structure these corpuscles seem admirably adapted to respond to the very slightest stimulation, producing voluptuous sensations and perceptions, and giving rise to various reflex manifestations. The first part of the path of the afferent impulses by which sexual pleasure is aroused is constituted by the dorsal nerves of the clitoris. The reflex changes consequent upon sexual excitement begin already in the vestibule, inasmuch as the secretion of Bartholin’s glands, which are compressed by the action of the constrictor cunni muscle, is expelled during coitus, the secretion, owing to the situation of the orifices of Bartholin’s ducts, passing over the external genitals. The clitoris becomes erect; the blood in the bulbs of the vestibule, the venous plexus situated around the margin of the vestibule along the boundary between the labia majora and the labia minora, is pressed into the glans clitoridis, the erection and sensibility of this structure being proportionately heightened. By the action of the constrictor cunni and ischiocavernosus muscles, the clitoris, the distal extremity of which is bent downwards at a right angle, is drawn down and pressed against the penis.
At the entrance of the vagina is the sphincter vaginæ muscle, whose action is reinforced by muscular fibres running in the middle coat of the vagina itself. It is probable that the muscular activity of the vagina and the uterus facilitates the entrance of the semen into the cavity of the uterus.
Dorsal decubitus is rightly regarded as the most correct position, physiologically speaking, for the woman to assume during coitus. That from the earliest times and in the most diverse races, this position has been customary, is shown by numerous antique paintings and statues, and by the reports of those who have studied the customs of savage races. Various other positions are, however, occasionally assumed; thus, Ploss and Bartels report, that among the Soudanese, coitus is practiced in the erect posture, with the man standing behind the woman; that among the Inuits (Eskimo), the act is performed in the manner usual among quadrupeds; that among the Swahelis in Zanzibar, and among the indigens of Kamschatka, the lateral posture is customary; and that among the Australian blacks, coitus is usually effected in the crouching posture, both parties squatting on their hams. The same writers remind us, that in the old calendars of the fifteenth, sixteenth, seventeenth, and eighteenth centuries, definite commands and prohibitions for the conduct of marital intercourse are to be found, and that lucky and unlucky days, respectively, are specified for the performance of the act. These recommendations would appear to be relics of antiquity, for in the Sanscrit work Kokkogam, under the heading “Sexual Intercourse According to the Days of the Month,” exact instructions are given for the proper performance of coitus.
In the Kamasutra (the Indian ars amatoria, a work only in recent days rendered accessible to European readers in the translation of R. Schmidt), several chapters are devoted to the detailed description of the various methods of copulation, and rules are given for the carnal union of man and wife. But, as the Indian author justly remarks, “Rules are of value only for the control of moderate desire; when the wheel of passion has once begun to roll, to prescribe a course is no longer of any avail.” In this work, sixty-four varieties of erotic enjoyment are enumerated, and we find an explicatio coitus secundum mensuram, tempus, naturam, de modis inter coitum procumbendi, de minis coitibus, de coitu inverso, de viri inter coitum consuetudinibus.
At times, in order that coitus may be effective, some other position than the natural one is indispensable. Such a necessity has been recognized even by theologians, by whom any divergence from nature in this matter has usually been regarded as sinful. For instance, in the work of Craisson, De Rebus Venereis ad Usum Confessariorum, we read: “Situs naturalis est ut mulier sit succuba et vir incubus, hic enim modus aptior est effusionis seminis virilis et receptioni in vas femineum ad prolem procreandum. Unde si coitus aliter fiat, nempe sedendo, stando, de latere, vel praepostere (more pecudum), vel si vir sit succubus et mulier incuba, innaturalis est.... Sed tamen minime peccant conjuges si ex justa causa situm mutent, nempe ob aegritudinem, vel viri pinquetudinem, vel ob periculum abortus; quandoque ait St. Thomas, sine peccato esse potest quando dispositio corporis alium modum non patitur.”
In certain pathological states, as for the prevention of sterility, an abnormal posture during coitus may advantageously be recommended, in order to favour the entrance of the semen into the cervical canal, and to allow the semen to stay longer in the vagina before it flows out. An old and often efficacious means for this purpose is the performance of coitus with the woman in the knee-elbow posture. In order to favour the entrance of the semen into the deeper portion of the genital tract, Hegar and Kaltenbach recommend that after coitus the woman should remain for some time in the knee-elbow posture, while the man from time to time gently presses up the anterior abdominal wall, and then abruptly relaxes the pressure.—In the Talmud, coitus was regarded as unfruitful if performed when the woman was in the erect posture.
Casper reports the case of a woman with severe scoliosis, who had long remained sterile, and who only conceived (and was subsequently happily delivered) after performing coitus in the abdominal decubitus.
Guéneau de Mussy suggests the following, very characteristic, method of ensuring fertilization, one which also certainly dates from great antiquity: “Sed haud illicitum mihi visum est, si post diversa tentamina diutius uxor infecunda manserit, ipsum maritum digitum post coitum in vaginam immittere, et ita receptum semen uteri osteo admovere. Et cum ostiolo uteri haeret, ut in pervium canalem spermatozoidum motibus faventibus, prodeat, sperare non absurdum.” Eustache reports a case, the wife of a physician, in which this manoeuvre was effective in ensuring conception.
A similar procedure has been employed with success by Kehrer, in a case of enfeebled potency on the part of the male, leading to premature ejaculation. A speculum was introduced into the vagina, and through this instrument the semen, ejaculated in consequence of sexual excitement, was introduced into the vaginal fornix; conception ensued. In an analogous manner, A. Peyer recommended, in a case of partial impotence, in which special manipulations were needed to bring about ejaculation, that conception should be favoured in the following manner: Erection having been effected by ordinary sexual contact, the manipulations needed to produce ejaculation were carried out, and the penis was intromitted into the vagina the moment before ejaculation occurred. This has been done with fruitful results. Englisch reports the case of a hypospadiac who, in order to render coitus effective, used a condom in the anterior extremity of which he made an aperture. In this way he became the father of three children.
In very obese men with extremely protuberant abdomens, we may recommend for the furtherance of conception that they should have intercourse with their wives a parte posteriori; and the same recommendation may be made in cases in which the wife herself is extremely obese. In Australia, it is said that among the indigens, coitus is usually practiced a posteriori; and there is a saying in the Talmud to the effect that sexual intercourse performed in the ordinary manner does not lead to the conception of infants so good, wise, talented, and promising as those whose conception is the result of coitus a posteriori. Mohammed, on the other hand, declares, “Your wives are your tillage, go therefore unto it in whatsoever manner ye will.”
In cases of retroflexion of the uterus, with a markedly forward direction of the vaginal portion of the cervix, I have recommended to the husband that he should perform coitus with his wife in the upright sitting posture. In this posture the fundus uteri passes downwards and forwards, whilst the vaginal portion of the cervix passes upwards and backwards.
In cases of retroversion of the uterus with the formation of a cul-de-sac in the posterior vaginal fornix, Pajot recommends, with the aim of temporarily restoring the uterus to a position in which the occurrence of conception is favored, that for three or four days prior to coitus the patient should retain the fæces, eating the while freely of eggs and rice, and taking a small opium pill every evening; in cases of anteversion, the patient should retain her urine for a considerable time—five or six hours—before coitus; and in cases of lateral version he recommends that the patient should have intercourse while lying on that side towards which the vaginal portion of the cervix is directed.
Edis recommends that in cases in which there is sterility dependent upon backward displacements of the uterus, that the organ should be replaced while the patient is in the genu-pectoral posture, and a pessary inserted; coitus should then be effected without the patient’s changing her posture.
In the human species as compared with the lower animals, there has been a notable diminution in the frequency of the separate acts of intercourse, a diminution dependent upon the higher vital aims of the former. Burdach formulates as a physiological law that the frequency of sexual intercourse is inversely related to the duration of the act.
Amongst all civilized races, sexual intercourse ceases during menstruation, since in the normal man there is aversion to intercourse with a menstruating female.
By the Mosaic law, intercourse with a woman during menstruation and for seven days after the cessation of the flow, was forbidden under pain of death. The Talmud further ordains that a purifying bath shall be taken by the woman a week after menstruation. By intercourse itself, moreover, both man and woman were rendered unclean to the evening; and, according to the Mosaic law, both must bathe after the act of coitus. In the Koran, also, intercourse is forbidden during menstruation, and until the woman has been purified with water. The law’s of Islam demand from a man who marries a virgin that he shall have intercourse with her the first seven nights in succession; whilst he who marries a wife no longer virgin, needs to visit her only the first three nights in succession. Subsequently, during married life, the Mohammedan shall have intercourse with his wife regularly once a week. Amongst many savage races, intercourse is forbidden with a woman during pregnancy, the puerperium, and lactation.
The first act of intercourse is difficult and painful to the virgin. At times the rupture of the hymen is exceedingly difficult. Even after this, it is some time before genuine pleasure is experienced in sexual intercourse.
To the female, intercourse is harmful when performed with undue frequency, or during menstruation, or indiscriminately throughout pregnancy, or during the puerperium, or incompletely or in an unnatural manner, or finally when performed in an unsuitable bodily attitude.
“Unduly frequent performance of the act of coitus,” writes Hegar, “which is liable to occur either in marital or in illicit intercourse, gives rise to anæmia, defective nutrition, muscular weakness, intellectual and nervous exhaustion. Young and healthy individuals recuperate rapidly after excesses of brief duration, as is often seen in young married pairs. Sickly and elderly persons, on the other hand, are much more severely affected by sexual excess, and recover therefrom but slowly if at all. Long continued sexual excesses ultimately wear out even the strongest.”
Intercourse effected by force, or with a girl of immature age, is distinguished as rape, a punishable offence both in Germany and in Austria. The offence is defined as extra-marital intercourse with a female under the age of fourteen years, with or without the latter’s consent; or extra-marital intercourse with a female of any age against her will or deprived of the power of resistance—either by the use of actual force, by the employment of threats, or by loss of consciousness. With regard to the last specification, the law regards as rape intercourse with a woman unable to resist through loss of consciousness, whether that loss of consciousness is or is not produced by the direct action of the violator.
In the female, the act of intercourse, alike physically, in its natural consequences, and mentally, is at once more difficult and of more enduring results than in the male. A writer of the new school, who according to his own admission has no other interest than the study of the sexual life, writes of himself: “I have often enough had intercourse with members of the other sex, in a few cases, indeed, out of pure inclination; but in all cases alike the aim and the result were the same—as soon as I had gained my end, the affair was finished. Passion, a bestial act, exhaustion, commonly a feeling of loathing; in the best possible case a fugitive but not an agreeable memory; voilà tout.” To women, such a description, happily, is applicable only in the most exceptional cases.
With the completion of coitus, the voluntary and conscious action of the two parties to the act is at an end; the subsequent stages of the function of generation are independent alike of consciousness and will.
When complete intromission of the penis has been effected, and ejaculation takes place, the semen is usually deposited at the os uteri or in the immediate neighborhood of that orifice. During the act of ejaculation, a peristaltic contraction of the vagina occurs, by means of which the semen at the os uteri is subjected to a moderate degree of pressure; the contraction and the pressure may perhaps persist for some little time after the completion of the coitus. In rabbits on heat, such contractions of the vagina, by means of which the semen was forced under pressure into the interior of the uterus, have been actually observed.
During coitus, the uterine muscle is also active. During strong sexual excitement, the uterus descends in the pelvis, the downward movement being increased by the pressure on the woman’s abdomen. The os uteri externum is drawn open, and the aperture, hitherto flattened, now becomes rounded. At the same time, the secretion of the cervical glands is expelled, and small quantities of semen are sucked into the cervical canal. The plicae palmatae offer a certain hindrance to the entrance of the semen; but the surface of the interior of the canal is rendered much smoother by the free secretion of mucus by the cervical glands. Further, it appears highly probable that during the excitement of coitus, the mouths of the Fallopian tubes, ordinarily more or less tightly closed, become widely opened, so that the entrance of the spermatozoa is favored.
The muscular movements of the uterus were observed by J. Beck in a woman suffering from prolapse. During sexual excitement, the os uteri opened and closed rapidly five or six times in succession, remaining at last firmly closed. Further, in bitches on heat, Basch and Hoffmann observed the vaginal portion of the cervix to descend in the vagina, the os uteri opened, mucus was extruded, and the os was then retracted.
Hohl, Litzmann, and others have reported, that in women endowed with great nervous susceptibility, friction of the vaginal portion of the cervix with the finger arouses sexual sensation, with rounding of the os uteri externum, descent of the uterus, and hardening of the vaginal portion; this latter is regarded by Graily Hewitt and by Wernich as a necessary accompaniment of copulation. Henle believes that the hardening and protrusion of the vaginal portion of the cervix are due to a change in the tension of the delicate vessels of this structure, which have an exceptionally thick muscular coat; Rouget compares the mechanism with that by which erection of the penis is produced. These authors consider that sexual excitement is indispensable for the erection of the vaginal portion of the cervix.
Thus, Hohl writes: “Numerous observations have shown that in females endowed with a considerable degree of nervous susceptibility, and especially in nulliparae, during examination and during any increasing irritation, not only is there an increased secretion of the vaginal mucus, but also a momentary descent of the uterus and an opening of the os uteri externum, so that this orifice has the appearance for the instant of the open mouth of a tube.” Litzmann reports that during the vaginal examination of a young, extremely erethistic woman, the uterus suddenly assumed a more vertical position, and came lower down in the pelvis; at the same time, the lips of the cervix became equal in length, the os uteri externum became rounded, soft, and penetrable by the finger; whilst the breathing and the voice indicated the occurrence of intense sexual excitement. Rouget assumes that the body and the fundus of the uterus constitute an erectile organ, which however possesses capability for erection only during the period of ovulation; Hewitt, on the other hand, considers it extremely probable that the erection may occur at any time during sexual intercourse, whether ovulation is proceeding or not. A. Wernich considers, basing his views in part on personal observations, that erection of the lower segment of the uterus occurs, like erection of the penis, whenever a moderate degree of sexual excitement is experienced; in women, however, he believes that erection is seldom extreme, and that it declines with the other symptoms of sexual excitement, viz., flushing of the face, moisture and glistening of the eyes, peculiar groaning expiration, etc. Whereas during ovulation, erection is merely a necessary concomitant of the other menstrual processes; during coitus, erection not only occurs much more powerfully, but it is also an important—perhaps the most important—contributory factor in effecting fertilization.
It is no longer possible to accept the view of earlier physiologists that the purpose of this erection of the lower segment of the uterus is “to constitute with the penis a continuous canal between the male and the female genital organs.” Contact between the glans penis and the os uteri externum is not indeed an occurrence of extreme rarity; but, on the other hand, it is in no sense a constant nor even a frequent incident of sexual intercourse. It is ejaculation, especially, which is subserved by the erection of the vaginal portion of the cervix. In the female, ejaculation occurs at the moment of the most intense sexual pleasure, and is marked by the evacuation from the os uteri externum of a moderate quantity of mucous fluid with an alkaline reaction. In some cases, in which a chronic discharge of this cervical mucus occurs, it forms an elongated coagulum of delicate vitreous jelly, the “mucus-string” of Kristeller. The last-mentioned author is of opinion that the spermatozoa slowly, but by active movements, find their way along this string into the cavity of the uterus. This assumption, however, is met by C. Mayer and Marion Sims with the objection, that Kristeller’s observations were for the most part carried out on women who were out of health, and that a gelatinous secretion of this character obstructs the orifice of the cervical canal, and hinders the occurrence of conception. From the erection of the portio vaginalis during sexual excitement, and its sudden relaxation post cohabitationem, Wernich deduces the occurrence of a process of aspiration, by which the semen is drawn up through the cervical canal into the cavity of the uterus; a process which has been seen in actual occurrence in vivisected animals. It is said that to many women this feeling of a process of suction is so well known, that thereon, in association with the consequent almost complete absence of mucus and seminal fluid from the vagina, they are accustomed to base a belief that conception will occur. It is said that this aspiratory activity on the part of the uterus may be perceived during coitus by the male also (?). It is assumed by Grohe that the wave motion of the cilia of the epithelium lining the cervical canal, is of importance in promoting the ascent of the spermatozoa; it may be that the vibration of the cilia exercises a motile stimulus on the spermatozoa, it may be that the continually repeated stroke of the cilia serves to prevent the permanent agglutination of the spermatozoa into groups.
According to Sims, the aspiratory action of the uterus is effected in the following manner: By the contraction of the constrictor vaginae superior muscle, the cervix is pressed downwards against the glans penis, and by this pressure its contents are evacuated; the parts then relax, the uterus suddenly returns to its normal state, and thus the seminal fluid with which the vagina is filled is drawn into the interior of the cervical canal.
Eichstadt also attributes to the uterus an aspiratory force, dependent upon coitus, and competent to force into the interior of the uterus the semen ejaculated into the os uteri. The changes in the uterus which are the necessary antecedents of this aspiration, namely, an engorgement with blood whereby the flattened form of the uterus gives place to a more rounded form, and the cavity of the organ is increased in capacity, take place, in the opinion of this author, only when during intercourse the woman has attained the acme of sexual gratification, by which alone can the aforesaid change in the uterus be brought about. E. Martin and Chrobak have also directed attention to the fact, that some importance in this connexion must be attached to the facultative enlargement in the size of the os uteri externum.
Lott, by his researches into the behaviour of the cervix uteri in relation to the act of conception, is led to the conclusion that the locomotive capacity of the spermatozoa forms the principal factor in effecting a fertilizing contact between the spermatozoa and the ovum. This locomotive capacity may be increased or diminished by a number of conditions, among which the principal are: the activity of the cervix uteri (the ciliated epithelium); the character of the secretions; and the position, shape, and size of the cervix. Thus, this author concludes, the part played in conception by the normal cervical canal is a purely passive one, with the sole exception of the activity of the ciliated epithelium—and the influence of this factor must be regarded as extremely doubtful. That during ejaculation the external orifice of the male urethra and the os uteri externum are in close apposition, is denied by Lott, who adduces in support of his views data derived from comparative investigations on various animals. In the dog, the configuration of the genital organs is such that it is impossible to suppose that any apposition can occur; the same is the case with the sheep; and still more so with the rabbit, who possesses two quite distinct portions vaginales, projecting freely into the vagina. In the human species also, the character of the walls of the cervical canal, where in the normal state the plicae palmatae may almost be said to interlock, separated only by a thin stratum of mucus, offers a hindrance to the entrance of the ejaculated semen by the direct force of ejaculation itself. As regards the independent motile powers of the spermatozoa, the researches of Lott showed that not only can they overcome strong capillary currents, and can traverse the width of a coverglass (18mm.—about ¾ in.) in about five minutes; but further that they are capable of migration through the finest interstices (those of an animal membrane) provided that the fluid with which the membrane is moistened is one favourable to their vital activity.
Kehrer, who in general supports the view that the modus coeundi and an active attitude on the part of the female have an important influence on the occurrence of conception, assumes that independent contractions of the cervix occur, whereby is expelled the delicate plug of mucus that fills the cervical canal and offers an obstacle to the passage of the spermatozoa. He believes that the duration of the act of intercourse, the mechanical relations between the penis and the vagina, the activity of the uterine muscle, the secretory activity of the utero-vaginal mucosa during the act, and the posture of the female post coitum, are all important factors in the occurrence of conception. Thus, he believes that if during intercourse there is a failure of the uterine contractions, which should expel the plug of cervical mucus, the semen flows away without effecting fertilization; if an unsuitable posture is assumed during intercourse the woman remains sterile, but can be fertilized without difficulty by coitus effected in the proper manner.
Haussmann has shown, that in the same woman, and in similar conditions, spermatozoa will on one occasion be found in the cervical canal, and on another occasion will not be found there; and he has further shown, that in some women we fail to find spermatozoa in the cervical canal in circumstances in which, in other women, we regularly find them in that situation.
Far as we may be from a complete knowledge of the conditions upon which conception depends, this at least is certain, that the passage of spermatozoa through the os uteri externum is a sine qua non of fertilization. Indeed, it would seem that we must accept as true the assumption of Meyerhofer, that fertilization is possible only if the semen passes at once into the cervical canal, mingles, that is, at once with the alkaline cervical mucus—unless, indeed, the coitus takes place during the catamenial flow, when the blood has neutralized the acid reaction in the vagina, or takes place when some morbid condition has had the same result. The theory of Johann Müller, regarding the piston-like action of the penis during coitus, by which the semen is actually forced through the cervix, must be rejected; equally unsound is Holst’s assumption that during intercourse the semen is ejaculated through the enlarged cervical canal directly into the cavity of the uterus. It would appear, however, to be a necessary condition of fertilization, that the semen should be ejaculated into the uppermost segment of the vagina, so that the fluid comes into actual contact with the os uteri externum; it may be that the alleged aspiratory force of the uterus then comes into play, by means of which the semen is sucked into the cavity of that organ; it may be, on the other hand, that Beigel is right in his theory of the existence of a receptaculum seminis, formed by the anterior and posterior lips of the cervix uteri and the uppermost segment of the vagina—in this space, he supposes, a part of the semen is retained in contact with the orifice of the cervical canal.