I do not propose to discuss here the nature of the connexion between these periodic processes in the ovaries and the uterus, respectively—that is, between ovulation and menstruation. I shall, however, take this opportunity of stating that, as careful investigations have shown, the periodic processes in question are not limited to the uterus and the ovaries, but affect also the external genital organs, which become congested simultaneously with menstruation; and further, that the entire feminine organism is affected by an undulatory rhythm of nutrition, the rise and fall of which correspond to menstruation and to the intermenstrual interval, respectively.
I must now give some account of the peripheral processes occurring in the female genital organs in connexion with the sexual act. In part, they are completely analogous to those which take place in the male. I have already pointed out that in many respects the clitoris in the female corresponds to the penis in the male, In the clitoris, also, erection occurs, conditioned partly by psychical and partly by physical stimuli. The psychical stimuli consist of ideas relating to the male. The physical stimuli may, just as in the case of the other sex, vary in their nature. Thus, the condition of the reproductive glands may act as a physical stimulus to erection; also the touching of certain regions of the body, especially the clitoris, the labia minora, or other erogenic zones. Under the influence of such stimuli, the venus plexuses making up the vaginal bulbs also become distended with blood. In fact, speaking generally, sexual excitement is characterised by a vigorous flow of blood to the genital organs. During coitus, in woman, as in man, a process of ejaculation normally occurs, taking the form of rhythmical muscular contractions, affecting not only the perineal muscles, but also the muscular investment of the vagina, and occasionally, perhaps, the uterus itself. These muscular contractions also favour the expulsion of a secretion, but this secretion does not contain the reproductive cells of the female, and consists merely of a mixture of indifferent secretions—the secretion of Bartholin's glands, that of the uterine mucous membrane, and that of the mucous glands of the vagina and vulva. In the woman also, even at the outset of the sexual act, a secretion from the local glands takes place, whereby the genital region is moistened prior to the actual orgasm. We have as yet no precise knowledge as to which glands are concerned in the production of this phenomenon, which is homologous to the urethrorrhæa ex libidine of the male. In woman, as in man, the curve of voluptuousness exhibits four phases: an ascending limb, the equable voluptuous sensation, the acme, and the rapid decline. There are, however, in this respect, certain differences between man and woman, to which von Krafft-Ebing drew attention, and whose existence was confirmed by Otto Alder.[9] Whereas in the male the curve of voluptuousness both rises and falls with extreme abruptness, in the female both the onset and the decline of voluptuous sensation are slower and more gradual. There is an additional difference between man and woman. In woman very often voluptuous pleasure is entirely lacking; certainly such absence is far commoner in women than in men—a condition of affairs which must on no account be confused with absence of the sexual impulse. Even when the sexual impulse is perfectly normal, the entire voluptuous curve with its acme may be wanting. In such cases, the after-sense of complete satisfaction, which occurs more especially when ejaculation has been associated with an extremity of voluptuous pleasure, it is commonly also lacking. Finally, it is necessary to add that in woman, as in man, the reproductive glands appear to have a duplex function—such is, at least, the belief to which recent investigations more and more definitely point. The ovaries, that is to say, do not only produce ova; they also, like the testicles, furnish an internal secretion, and the absorption and distribution of this secretion by the blood are supposed to cause the development of the secondary sexual characters in woman.
Having now concluded our account of the structure and functions of the productive organs of adults, let us turn to consider the differences between these organs and those of children. In the child, the testicles are considerably smaller; smaller also are the penis and the other genital organs. In the adult, the root of the penis is surrounded by the pubic hair; this hair is absent in the child. The most important distinctive characteristic, however, lies in the fact that in the child the morphological elements upon which the capacity for procreation depends, namely, the spermatozoa, are not yet present in the testicles. The spermatozoa first make their appearance during that year of life which is usually regarded as the year of the puberal development. The microscopical appearances of the testicle, of which an account has previously been given, thus naturally differ according as the specimen under examination has been taken from a child or from an adult. As regards the other glands considered to form part of the genital organs, some of these secrete even in childhood. This matter will be subsequently discussed in some detail.
In the female sex, also, there are notable differences in the condition of the genital organs between the adult and the child. In the first place, the relative sizes of the various organs differ greatly. But other differences are also noticeable, not dependent, however, on differences in age, but on whether there has or has not been experience of sexual intercourse, and on whether pregnancy and parturition have occurred. When we compare a female child with an adult woman, the first obvious difference is in the shape of the external genital organs. In the child, the vulva is placed much higher and more to the front, so that it is distinctly visible even when the thighs are in close apposition. In the child, also, the labia majora are less developed, for as womanhood approaches a great deposit of fat takes place in these structures. Again, in the child, the outer surfaces of the labia majora and that part of the skin of the abdomen just in front of the labia (the mons veneris) are as hairless as the rest of the body, whereas in the adult woman these regions are covered with the pubic hair. According to Marthe Francillon,[10] to whom we are indebted for an elaborate study of puberty in the female sex, during the puberal development changes occur also in the clitoris. The genital corpuscles of Krause and the corpuscles of Finger (Wollustkörperchen), the terminals of the nerves passing to the erectile tissue of the clitoris, undergo at this time a marked increase in size. The clitoris itself, hitherto comparatively small, now attains a length of three to four centimetres (1.2 to 1.6 inch), in the quiescent state, and of four and a half to five centimetres (1.8 to 2 inches) when erect. In the virgin also, as previously mentioned, the hymen is present, a structure of very variable form. After defloration its remnants persist in the form of small prominences around the margin of the vaginal inlet (carunculæ myrtiformes). But, quite independently of defloration, in the child the vaginal orifice is much smaller than in the riper girl. The uterus undergoes remarkable changes. In the foetus, during the latter part of intra-uterine life, this organ grows very rapidly; but immediately after birth its growth is arrested, so that in a girl of nine it is little larger than in the new-born infant. During the period of puberal development, however, the growth of the organ is once more extremely rapid. Its shape also changes at this time. In the child, the uterus is longer in proportion to its thickness; in childhood, too, the comparative length of the cervix in relation to that of the body of the organ is much greater than in the adult woman. We need only allude in passing to the fact that later in life marked changes occur in the uterus as a result of pregnancy and parturition. The hyperæmia and the bleeding that take place periodically during menstruation lead to certain changes in the mucous surface of the uterus. Ovulation, which in the sexually mature woman recurs at four-weekly intervals, also gives rise to certain permanent changes in the ovaries. The site of each ruptured Graafian follicle becomes cicatrised, and in consequence of the formation of these little scars, the ovary no longer retains the smoothness of surface which was characteristic of the organ in childhood. From birth onwards the ovaries gradually increase in size, but the growth is disproportionate in different diameters. Thus, for instance, during the eighth year of life, growth is chiefly in thickness, so that the ratio between the length and the thickness becomes less than before. The structure of the ovaries also varies at different ages. In a girl of three years, the primitive ovarian follicles number about 400,000; at the age of eight it is estimated that their number has been reduced to about 36,000. Certainly the majority of the primitive follicles come to nothing. True Graafian follicles, of which an account has already been given, are not usually formed prior to the beginning of the puberal development; occasionally, however, they are formed in the ovaries of immature girls.
Let us now pass to the consideration of the sexual impulse. We learn from personal observation that two entirely distinct processes participate in this impulse. In the first place, we have the physical processes that take place in the genital organs; these are in part unperceived, but in part they affect consciousness in the form of common sensations, or as ordinary tactile and other similar sensations. In the second place, we have those higher psychical processes by means of which man is attracted to woman, and woman to man. In our actual experience of the normal sexual life, both these groups of processes do, as a matter of fact, work in unison; but not only is it possible for us to distinguish them analytically; it is, in addition, possible in many instances to observe them in action clinically isolated each from the other. A long while ago I utilised this distinction for the analysis of the sexual impulse, describing the impulse in so far as it was confined to the peripheral organs as the detumescence-impulse (from detumescere, to decrease in size), and in so far as it takes the form of processes tending towards bodily and mental approximation to another individual, as the contrectation-impulse (from contrectare to touch, or to think about). The distinction will become clearer to our minds if we familiarise ourselves first with cases in which either process occurs independently of the other. The detumescence-impulse is sometimes the sole manifestation of the sexual impulse. Certain idiots practise masturbation as a physical act, because sensations proceeding from the genital organs impel them to do so, precisely as itching of an area of the skin impels us to scratch. They masturbate without thinking of another person, and they feel no impulsion whatever towards sexual contact with another person. Analogous phenomena may be witnessed in the animal world also, in connexion with the masturbatory acts of monkeys, bulls, and stallions. When a stallion kicks its genital organs again and again with its hind-foot, and repeats the action until ejaculation ensues, we are hardly justified in assuming that the animal has the idea of a mare before its mind. We must rather suppose that we have to do with a local physical stimulus, to which the stallion reacts in the manner above described. The other component, also, of the sexual impulse, the contrectation-impulse, manifests itself, occasionally, at any rate, in isolation. Certain boys, long before the appearance of any signs of the puberal development, are impelled towards physical contact with members of the other sex, to kiss them, to think of them, although these boys may exhibit no tendency whatever to masturbate, or to manipulate their genital organs. It often happens, indeed, that such a boy is himself greatly astonished to find, some day, that these ideas are reflected to the genital organs, giving rise to erection; or, when he is embracing a girl, to experience erection and ejaculation. In the sexually mature normal man, the detumescence-impulse and the contrectation-impulse act in unison, and hence he is impelled towards intimate contact with the woman, and is ultimately driven to effect detumescence by the practice of coitus. Nevertheless, we must hold fast to the idea that in the normal adult man the sexual processes may also be theoretically analysed into these two components.
This is true also of woman, in whom the processes in the genital organs are equally separable from those which impel to contact with a member of the other sex. But in woman, the processes in the genital organs do not culminate in the ejection of the reproductive cells, that is, of the ovum, but, as we have seen, in the ejaculation of indifferent secretions. In the woman, also, the detumescence impulse is occasionally met with in isolation—for example, in many female idiots. In the animal world, too, we encounter it as an isolated phenomenon. Certain mares, when rutting, rub their hind quarters against some object in their stalls. The contrectation-impulse may also manifest itself in isolation in woman. It is then directed towards the male, but is not in any way associated with the wish for a definite sexual act. Most commonly, however, in woman also the two components of the sexual impulse are united, and from this union results the impulsion towards coitus. But to this extent the conditions in woman are apt to differ from those in man, inasmuch as, in the former, voluptuous sensations are more often in abeyance; or in woman voluptuous pleasure may not arise during coitus, but may be produced in some other way, as, for instance, by a masturbatory act.
The sexual impulse, and indeed either of its components, may be excited either by bodily or by mental stimuli; but we must always bear in mind the fact that in normal adults, both male and female, the two components are so intimately associated that they can as a rule be separated only by artificial analysis. The nature and mode of operation of the stimuli need not be further discussed, since enough has been said about the matter in our description of erection. Nor is it necessary in this place to deal with such differences as may exist between the psychosexual life of the child and that of the adult, since this matter will be fully considered in the fourth chapter. In this chapter my aim has merely been to give a general description of the sexual impulse.
Here I need allude to one more point only, a knowledge of which is indispensable for the understanding of the sexual life of the child, namely, the connexion between the central processes and the peripheral voluptuous sensation. Let us ask, in the first place, by what means the voluptuous sensation, the voluptuous acme, and the sense of satisfaction, are produced. Various factors are here operative. A homosexual man, in heterosexual coitus, by keeping present to his imagination the idea of coitus with a man, may succeed in obtaining erection and ejaculation; but he does not experience the voluptuous acme, nor does he feel the sense of satisfaction. Notwithstanding the fact that the peripheral processes occur in normal fashion, the sense of satisfaction remains in abeyance; because the act is in his case inadequate, the sexual act in which he is engaged lacks harmonious relationship to his sexual impulse. But the same homosexual man, embracing a man with whom he is in full sympathy, will experience alike the voluptuous acme and the sense of satisfaction. Mutatis mutandis, the like is true of woman. Many cases which have been regarded as instances of sexual anæsthesia would appear in quite another light if the woman concerned were to have intercourse with a sexually sympathetic man. I have myself known cases in which women were able to experience the voluptuous acme in intercourse with men whom they earnestly loved, whilst in intercourse with men to whom they were indifferent, the voluptuous sensation and the sense of satisfaction were wanting, even though in some of these cases the peripheral processes culminated in ejaculation. Such a physically complete sexual act, without voluptuous acme or sense of satisfaction, may occur when the woman, having intercourse with a man whom she does not love, pictures in imagination that she is having intercourse with her lover. Unquestionably, the psychical processes are of the greatest importance in contributing to the occurrence of the voluptuous sensation and the sense of satisfaction. On the other hand, of course, certain peripheral conditions must also be fulfilled if the voluptuous acme is to ensue. Among these conditions may be mentioned a certain anatomical state of the skin and the nerves concerned. Experience also shows that in the adult the voluptuous acme coincides with the act of ejaculation. Ejaculation is effected by the rhythmical contraction of certain definite muscles, and Otto Adler believes that it is these contractions which are principally effective in producing the voluptuous acme, and that actual ejaculation is not indispensable. He believes, that is, that the voluptuous acme may occur in the absence of any discharge of actual secretion.
In any case, let us hold fast to the fact that in the adult, for the occurrence of the voluptuous acme and of the sense of full satisfaction, certain central processes are, in general, indispensable.