The sexual life of woman in its physiological, pathological and hygienic aspects

by E. Heinrich Kisch

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.

It is, also, exceedingly probable that during coitus a reflex nervous mechanism becomes active, by means of which the uterine orifices of the Fallopian tubes are opened, the vaginal portion of the cervix descends in the vagina, the os uteri externum enlarges, the orifice becoming rounded where before it was flattened, and finally small quantities of semen may be aspirated into the cavity of the uterus.

I further regard it as important in promoting conception, that simultaneously with the changes above described, the reflex nervous stimulation should lead to the secretion by the cervical glands of a gelatinous material, alkaline in reaction, and therefore adapted to increase the locomotive powers of the spermatozoa, so that these latter, aided by the activity of the ciliated epithelium lining the cervical canal, will gain the interior of the cavity of the uterus, and thence pass onwards to the Fallopian tubes. The significance of the glands in the mucous membrane lining the cervical canal has hitherto been underestimated in this connexion.

Whereas in the primitive state of mankind, among savage races at the present day, as among our own prehistoric ancestry, nakedness is the rule, so also intercourse in these circumstances is effected altogether without any regulation by law or custom, on the mere prompting of unbridled natural passion, and, moreover, there is the fullest promiscuity in sexual relations; but civilization has led man to impose restraints upon sexual intercourse, and has introduced marriage as a sacred institution. Among certain primitive peoples, however, among whom the wives are common to all the men, transitory pairings nevertheless occur, especially when a woman becomes pregnant; to cease, however, during the period of lactation. “This is the origin of marriage, which has evolved from rape and prostitution, as law has evolved from crime” (Lombroso). This author makes an interesting observation when describing the entire freedom of sexual intercourse that obtains among the Red Indians of North America, to the effect that “often, times of general promiscuity occur, as with rutting animals, generally in the warm season of the year, when nutriment is abundant; it is difficult to indicate any distinction between the tumultuous orgies of the baboon, and those of the Australian Blackfellows, among whom the sexes keep apart during the greater part of the year, to intermingle like rutting beasts during the season of the yam-harvest.”