Universality of the s.e.x Instinct--Not Responsible for Our Thoughts and Feelings.

THE s.e.x instinct, which runs all through nature from the lowest animal to the highest, is the inborn impulse, craving or desire which one s.e.x has for the other: the male for the female and the female for the male. This instinct, this desire for the opposite s.e.x, which is born with us and which manifests itself at a very early age, is not anything to be ashamed of. There is nothing disgraceful, nothing sinful in it. It is a normal, natural, healthy instinct, implanted in us by nature for various reasons, and absolutely indispensable for the perpetuation of the race. If there were anything to be ashamed of, it would be the lack of this s.e.x instinct, for without it the race would quickly die out.

=Not Responsible for Thoughts and Feelings.= It is necessary to impress this point, because many girls and women, whose minds have been perverted by a vicious so-called morality, worry themselves to illness, brood and become hypochondriac because they think they have committed a grievous sin in experiencing a desire for s.e.xual relations or for the embrace of a certain man. Altogether it is necessary to impress upon the growing girl, when the occasion presents itself, that a thought or a feeling can never be sinful. An action may be, but a thought or a feeling cannot. Why? Because we are not responsible for our thoughts and feelings; they are not under our control. Though it does not mean that when they do arise we are to give them full sway.

We should attempt to combat them and drive them away, but there is nothing to be ashamed of, because for their origin we are not responsible.

=Responsible for Actions.= Our actions are under our control, to a certain extent at least, and if we do a bad or injurious act, we have committed a sin and are morally responsible. The _desire_ for the s.e.xual act is no more sinful than the desire for food is when one is hungry. But the performance of the act may, under certain circ.u.mstances, be as sinful as the eating of food which the hungry man obtained by robbing another fellow-being, just as poor as himself.

I am not preaching to you. But I am not an extremist nor a hypocrite.

I am advocating neither asceticism nor licentiousness. One is as bad, or almost as bad, as the other.

What I am trying to do is to inculcate in your minds, if possible, a sane, well-balanced view of all things s.e.xual.

For I believe that wrong, perverted views of the physiology and hygiene of the s.e.x act and of s.e.x morality, that is, the proper relationship of the s.e.xes, are responsible for untold misery, for incalculable suffering. Both s.e.xes suffer, but the female s.e.x suffers more. The woman always pays more. This is due to her natural disabilities (menstruation, pregnancy, lactation), to her age-long repression, to the fact that she must be sought but never seek, and to her economic dependence.

For the above reasons, s.e.x instruction is a matter of double importance to woman--this fact has been emphasized in the first chapter. But woman's disabilities impose upon us another duty: _because_ she carries the heaviest burden, _because_ she always pays more dearly than the man, it becomes inc.u.mbent upon man to treat her with special consideration, with genuine kindness and chivalry.

CHAPTER FIVE

p.u.b.eRTY

Physical Changes in p.u.b.erty--Physical Changes in the Genital Organs and in the Rest of the Body--Psychic Changes--p.u.b.erty and Adolescence--Nubility.

p.u.b.erty is the most wonderful, the most significant period in a girl's life. Important as it is in a boy's life and development, it is still more so in a girl's. At this period there are often laid the foundations which either make or mar the girl's future life.

The meaning of the word p.u.b.erty is maturity. It is the period at which the girl and the boy reach s.e.xual maturity; in other words, the period at which the s.e.x glands of the boy begin to generate spermatozoa, and the s.e.x glands of the girl begin to mature and expel eggs or ova; with the girl p.u.b.erty is marked by an additional phenomenon, which has no a.n.a.logue in the boy, namely, menstruation.

=Physical Changes.= The word p.u.b.erty is derived from the word _p.u.b.er_, which in Latin means mature, ripe. But the word p.u.b.er is itself derived from the word _p.u.b.es_, which in Latin means fine hair or down. For at this period of maturity all mammals (that is animals which have b.r.e.a.s.t.s and nurse their young) begin to develop a growth of hair. You know that our entire body, with the exception of the palms of the hands and the soles of the feet, is covered with innumerable hair follicles, and from our birth our entire body, with the exception named, is covered with fine hair. The hair may be too delicate to be seen, but it is there, and with a magnifying gla.s.s you can see it without any trouble. But at p.u.b.erty the hair increases in thickness and in quant.i.ty, and becomes abundant in places where it was hardly noticeable before--the upper lip and face in boys, and the armpits and lower part of the abdomen in both boys and girls.

And so the first apparent physical sign of p.u.b.erty in a girl is the gradual appearance of hair in the armpits, on the mons Veneris and the l.a.b.i.a majora. But all the genital organs are undergoing rapid development; the v.u.l.v.a, the v.a.g.i.n.a, the uterus and the ovaries become larger, and the ovaries which up to that time were elaborating an internal secretion only, now also begin to manufacture ova; in other words, the monthly process of ovulation is begun. Synchronously with the process of ovulation, there commences the monthly function of menstruation. The b.r.e.a.s.t.s also increase in size, a.s.sume the characteristic contour, develop their glandular substance, and become capable of secreting milk for the use of any possible offspring.

During this period of development they are often very sensitive to the touch or feel painful without being touched.

But not only the genital organs undergo growth and development--the entire body partic.i.p.ates in the process. The growth in height is the most rapid at this period; the greatest growth takes place in the limbs--legs and arms. The pelvis becomes broader, and the chest or thorax also becomes broader and larger. The muscles become larger and rounder and finally give the girl the beautiful womanly form.

=Psychic Changes.= But the changes are not only physical; the changes that take place in the girl's psychic sphere during the p.u.b.ertal years are also highly important. That is the period of the development of the emotions; she is overflowing with emotion; she becomes sensitive; in her relations with boys and men she becomes self-conscious.

Distinct s.e.xual desire fortunately does not make its appearance in the girl at this period, as it does in the boy, but she becomes filled with vague undefined and undefinable longings. It is the period of "crushes" when the girl is apt to bestow her overflowing emotion on a girl friend. There is nothing reprehensible in these crushes--they act as a safety valve--and only in rare cases are they apt to lead to abnormal development. This is also the period of day-dreaming and of romancing; the girl likes to read love-stories and novels in which she identifies herself with the heroine. And it makes quite some difference as to what the girl reads during this period, for literature has a strong influence on the young in the most plastic period of their lives; and it is important that older persons see to it that those in their care spend their time on books of n.o.ble ideals and high artistic value.

Girls of a highly sensitive or so-called "nervous" temperament, especially if there is "nervousness" in the family, must be particularly looked after. For it is during the years of p.u.b.erty and adolescence that any neurotic traits are apt to develop and become emphasized. It is also the period when bad s.e.xual habits (masturbation) are apt to develop, and the careful mother will devote special attention to her girls in their years of p.u.b.erty, and guard them as much as possible against physical and emotional shocks.

The age of p.u.b.erty in girls is by many writers considered as synonymous or synchronous with the onset of menstruation, which in this country in the majority of cases occurs between the ages of thirteen and fourteen. The year of gradual development before the onset of menstruation is by some referred to as the pre-p.u.b.ertal year; and the first year after the onset of menstruation is the post-p.u.b.ertal year. The period from p.u.b.erty to full s.e.xual maturity is called adolescence, and this term is applied generally to the period between thirteen and eighteen. For at eighteen the boy and the girl have reached full maturity. Mentally we acquire things as long as we live, and even physically the body gets larger for some years after eighteen. But s.e.xually both boys and girls are fully mature at eighteen, though in order to become parents it is best, for various reasons, to wait to the ages of twenty or twenty-five.

=Nubility.= Nubility is the age or state when a boy or a girl is "fit"

for marriage. This is a vague and unsatisfactory term. At the age of thirteen to fifteen boys and girls are physically "fit" for marriage, that is at that age a boy is capable of begetting and a girl of having children. But it does not mean that it would be advisable for them to marry at such an early age. Neither their bodies nor their minds are fully developed, and children begotten of such young parents are apt to be weaklings, both mentally and physically. The youngest age for girls to marry should be eighteen, and for boys twenty; but the youngest age for becoming parents should be twenty to twenty-two for the mother and twenty-three to twenty-five for the father.

CHAPTER SIX

MENSTRUATION

Definition of Menstruation--Where Menstrual Blood Comes From--Age of Menstruation--Age of Cessation of Menstruation--Duration--Amount--Regularity and Irregularity.

The first function with which the girl will be confronted, which will impress upon her that she is a creature of s.e.x, that she is decidedly different from the boy, is _menstruation_. And this function we will now proceed to study.

What is menstruation? Menstruation is a monthly discharge of blood.

The word is derived from the Latin word mensis, which means a month; and menstruation is also frequently spoken of as _the menses_. It is also called the catamenia or catamenia-flow (Greek, kata--by, men--a month). Other terms are: the periods, courses, monthlies, turns, monthly changes, monthly sickness, sickness, flowers, to be unwell, to be regular. "Not to see anything" is a common term for having missed the menses. This flow of blood recurs in most cases with remarkable regularity once a month; not a calendar month, but once a lunar month, i.e., once every twenty-eight days. And as there are thirteen lunar months a year, a woman menstruates not twelve but thirteen times a year.

Where does the menstrual blood come from? The menstrual blood comes from the inside of the womb. Every month, for a few days prior to menstruation, the inside lining of the womb (what we call the mucous membrane or endometrium) becomes congested and its bloodvessels become distended with blood. If the woman has s.e.xual intercourse and pregnancy happens to take place, then this extra blood is used to nourish and develop the new child; but if no pregnancy takes place, that extra blood exudes from the bloodvessels (some of the bloodvessels rupture) and is discharged from the uterus into the v.a.g.i.n.a, and from there to the outside, where it is caught on cotton, sanitary napkins or some other pad.

=At what age does menstruation begin?= The usual age at which menstruation begins in this country is thirteen or fourteen; in some it may occur as early as twelve, in others as late as fifteen, sixteen or even seventeen. For menstruation to begin earlier than twelve or later than seventeen is in this country a rare exception. But in cold northern climates the age of eighteen is not rare, and in the hot southern climates menstruation often starts at the ages of ten or eleven. Change of climate or of country will often have an influence on the menses. In the early years of his medical practice, the author had many Finnish girls as patients. It was a very common occurrence for them to stop menstruating for the first few months or even for the first year of their residence in this country.

=At what age does menstruation cease?= The age at which menstruation ceases is called the _menopause_ or _climacteric_. It usually takes place at the age of forty-eight or fifty. In some cases it does not take place until the age of fifty-two, in others it takes place as early as forty-five or forty-four. In general, it may be said that the woman's menstruating period, during which she is able to have children, lasts about thirty-five years. And if no restraint be taken, and if no precautions be taken against conception, a woman could have twenty or thirty children during her childbearing period.

=How many days does a woman menstruate?= The usual number of days is from three to five; in some cases menstruation lasts only two days, in others as long as seven. As a rule, the greatest amount of blood pa.s.sed is during the first two days.

=The amount of blood.= It is hard to estimate the exact amount of blood pa.s.sed by a woman during her menses, but it reaches about an ounce and a half to three ounces. In some women the amount may reach as much as four or five ounces and in exceptional cases as much as eight ounces. Where it exceeds this amount, it is an abnormal condition, requiring treatment. The usual statement that a normally menstruating woman should not have to use more than three napkins during the twenty-four hours is correct.

_The periodical regularity_ with which menstruation recurs in many women is remarkable. I know a woman who has not missed her menses in twenty years; during those twenty years the menses have started every fourth Friday, almost always at the same hour. I know another one who has her menses every fourth Wednesday, about seven in the morning. She skipped her periods during her two pregnancies, then they were irregular for a while, then they came back to Wednesday. Other women have their menses on a certain day of the month, say the first or the fifth, regardless of the number of days in the month (such cases are, however, exceptional). And in some women the menses are irregular: every three weeks, every five or six weeks, every six or seven weeks, etc. Some women never know when they may expect their menses, so irregular they are.

CHAPTER SEVEN

ABNORMALITIES OF MENSTRUATION

Disorders of Menstruation--Menorrhagia--Metrorrhagia--Amenorrhea-- Vicarious Menstruation--Dysmenorrhea of Organic and of Nervous Origin.

In many girls and women menstruation is a perfectly normal, physiological process. They suffer no discomfort whatever from it.

They suffer no pains, no headache, no irritability, they have no admonition of its onset, until they feel the blood oozing or trickling out. But, unfortunately, this is true only of a small percentage. The majority of women have some unpleasant symptoms. Some have a headache for a day or two, some complain of a dragging down sensation, some are irritable, feel depressed or quarrelsome; some have no appet.i.te, no ambition, no desire for work or company, while some girls have such severe pains and cramps that they are obliged to go to bed for a day or two and call in medical aid.

When the menstruation is very profuse, resembling more a hemorrhage than normal menstruation, it is called _menorrhagia_; if the hemorrhage from the uterus occurs out of the regular menstrual periods, it is called _metrorrhagia_. When the menses are skipped, or when they are so scanty that you can hardly notice any blood, we use the term _amenorrhea_. In a few rare cases the menstruation instead of coming normally from the uterus, comes from some other part of the body, for instance, the nose. Some women have a hemorrhage from the nose every month. In some a b.l.o.o.d.y discharge may come from the b.r.e.a.s.t.s. To such a subst.i.tute menstruation we apply the term _vicarious menstruation_. Such cases, however, are rare, and are mere curiosities.

=Dysmenorrhea.= I mentioned before that in some girls and women the menses are accompanied by pains and cramps. This affliction, which is the lot of millions of women, and from which men are entirely free, is called _dysmenorrhea_. Dysmenorrhea means painful and difficult menstruation. A slight pain or at least a feeling of discomfort is present in most cases of menstruation. But in many cases the pain is so severe, so _excruciating_, that the sufferer, girl or woman, is incapacitated for any work, and must go to bed for a day or two. In some cases the pain is so severe as to necessitate the use of morphine, and as it is a very bad thing to have to give morphine every three or four weeks, every endeavor should be made to find out the cause of the trouble and to remove it. It is a mistake, however, to think that all or even most cases of dysmenorrhea are due to some local trouble, that is, to an inflammation of the ovaries, or a displacement of the womb. Many cases of dysmenorrhea are of _nervous_ origin; the cause resides in the central nervous system, and not in the genital organs themselves. It is, therefore, not advisable to undertake any local treatment, unless a competent physician has made a thorough examination and has decided that local treatment is advisable.

As to the percentage of dysmenorrhea, a recent statistical examination of 4,000 women showed that dysmenorrhea of some degree was present in over one-half, namely, 52 per cent.

CHAPTER EIGHT