As I stated at the beginning, it is a waste of time to _argue_ the matter. Those who believe that s.e.x 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 s.e.x instinct has other high purposes besides that of perpetuating the race, and s.e.x 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 s.e.xualis_ 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 c.l.i.toris a Cause of Masturbation and Convulsions.

By the term vaginismus we understand a painful spasm or contraction of the v.a.g.i.n.al 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 v.a.g.i.n.al 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 v.a.g.i.n.a, 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 s.e.xual 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 c.l.i.tORIS 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 c.l.i.toris cannot be freely uncovered. This condition may give rise to an acc.u.mulation of s.m.e.g.m.a 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 c.l.i.toris 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 m.a.s.t.u.r.b.a.t.e or simply to handle the genitals, or that complain of itching, the c.l.i.toris 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 Const.i.tutional 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 cla.s.ses 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 pa.s.s _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 const.i.tutional 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 Chast.i.ty 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 unchast.i.ty, just as the presence of the hymen was no proof of perfect chast.i.ty. Chast.i.ty 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 s.e.xual 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 inst.i.tutes 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 chast.i.ty comes up in the future, she can prove by the doctor's certificate that her loss of virginity was not due to s.e.xual 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 s.e.x relations for months and years, and the hymen remains unruptured. Pregnancy may also result with an intact hymen.

CHAPTER FORTY-ONE

IS THE o.r.g.a.s.m NECESSARY FOR IMPREGNATION?

Suppression of o.r.g.a.s.m by Woman to Prevent Impregnation--Bad Results of Suppression by the Woman--o.r.g.a.s.m: Relation of to Impregnation--A Hypothesis--A Fanciful Hypothesis--Why Pa.s.sionate Women Frequently Fail to Become Mothers--Advice to Pa.s.sionate 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 o.r.g.a.s.m, she must have had a pleasurable voluptuous sensation during the act. If she has no o.r.g.a.s.m, 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 role of the o.r.g.a.s.m in impregnation. Some s.e.xologists like Kisch and Vaerting believe it does play an important role; others, like Forel, believe it plays none. That the o.r.g.a.s.m is not _necessary_ for impregnation admits of no discussion. Women who suffer from frigidity in an extreme degree, women who never experienced an o.r.g.a.s.m, women who repress their o.r.g.a.s.m, 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 role at all? Does it facilitate impregnation? Other things being equal, will intercourse accompanied by an o.r.g.a.s.m be more likely to prove fruitful than one in which the o.r.g.a.s.m 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 o.r.g.a.s.m 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 o.r.g.a.s.m 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 o.r.g.a.s.m. 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 o.r.g.a.s.m 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 s.e.xual intercourse in which the parties experience no o.r.g.a.s.m. 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 pa.s.sionate 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 o.r.g.a.s.m.

In such cases I have advised the woman to try to remain pa.s.sive during the act, to repress the o.r.g.a.s.m, 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 s.e.xual Manifestations and Frigidity-- Frigidity and Masturbation--Frigidity and s.e.xual Weakness of Husband--Frigidity and Dislike of Husband--Organic Causes of Frigidity--A Frigid Woman May Become Pa.s.sionate--Treatment of Frigidity.