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

by E. Heinrich Kisch

As regards inbreeding, many facts are on record showing the influence of this practice in leading to the birth of malformed offspring and to sterility. Darwin writes, “if in a pure race, characterized by a certain tendency to sterility, we allowed only brothers and sisters to pair, in a few generations the stock would become extinct.” If animals closely related by blood pair, the number of their offspring is always less than the average.

In the case of the human species, however, the influence of the marriage of near kin in diminishing fertility cannot be regarded as definitely proved.

Occasionally the incapacity for ovulation and the sterility dependent thereupon are hereditary—paradoxical as this may appear. It is necessary to assume, that just as the sperm is at times unsuited for effective fertilization, so also the ova may be in a less or greater degree insusceptible of fertilization. In the present state of our knowledge, indeed, we are not in a position to be precise as to the exact nature of such incapacity. It is possible that the enveloping membrane of the ovum varies in its resistance to penetration, as Schenk claims to have proved in respect of certain of the lower mammals. In his experiments on artificial fertilization outside the body of the mother, he ascertained that the cells derived from the discus proligerus, surrounding the ovum in immediate contact with the zona pellucida, are in some instances easily separable one from another, so that the spermatozoa can readily obtain access to the zona pellucida; whereas in other instances, in which the ovum is of the same size and apparently in the same stage of maturation as before, these cells remain closely attached each to the other, and thus prevent the passage of the spermatozoa. This condition of the ovum, so unfavourable to fertilization, may be hereditary in certain families, and its transmission may render certain members of the stock infertile. Such instances as the following from my own practice are by no means rare. Of three sisters, whose family life was intimately known to me, one had one child only, a girl, whilst the two others remained childless. The girl of the second generation married and remained childless. In England it is well established that when, in cases of only-child-sterility, the offspring is of the female sex, this child will probably herself be barren. Galton found that in the case of 14 heiresses (i. e. the only children of wealthy parents), all of whom were married, 8 remained absolutely barren, whilst of the others, 2 had each an only child.

It was formerly believed that when a woman gave birth to twins of opposed sexes, the female infant would prove to be barren, this barrenness being associated with defective development of her reproductive apparatus. John Hunter (Animal Economy) ascertained that in the case of twin calves of opposed sex, the genital organs of the female twin were almost invariably imperfectly developed. But the supposition that this is true also of the human species has not been confirmed by experience. I know several married women who had twin brothers, and these women have borne normal children; however, the number of their offspring is remarkably small. Simpson, in Edinburgh, recorded the results of the marriage of 113 women who had been born with twin brothers; of these, 103 had proved fruitful, and 10 (i. e., about one eleventh of the whole) barren, although of these latter women, one had been married upwards of 5 years, and the remaining 9 for periods ranging from 10 to 40 years. Simpson also gave the history of four women who were all the fruit of triple births, some of which had consisted of two boys and one girl, others of two girls and one boy. All four of these women were parous. Again, a woman who had been one of a quadruple birth (three boys and one girl), herself gave birth to triplets. A collection of all the figures accessible to me relating to this subject, indicates that about ten per cent of the women born in such circumstances prove barren—a ratio which corresponds closely with the ratio of infertility in general.

Interference with Conjugation, Conditions Preventing Access of the Spermatozoa to the Ovum.

A condition essential to fertilization is a material union between the sexual products of the male and the female respectively—the act of conjugation. Thus, all conditions which prevent the spermatozoa from obtaining access to the ova, bring about sterility.

Spermatozoon and ovum being normal, a great variety of pathological conditions may prevent the one from gaining access to the other. It is necessary for fertilization that the mature ovum should leave the ovary, enter the Fallopian tube, and there come into contact with the male sperm. Interference with any one of these essentials may lead to sterility.

Thus, the constitution of the ovum itself may be at fault; or the entrance of the ovum into the Fallopian tube may not be normally effected; defects in these earliest stages of the process of fertilization are precisely the commonest and the most important. The emergence of the ovum from the graafian follicle may be rendered difficult or entirely prevented by pathological states of the ovary; again, by inflammatory processes in the ovary, the tubes, or the ligaments, by developmental defects in the tube, and by obstructions in its interior, the entrance of the ovum into the tube, and its free passage along the tube may be prevented. Numerous abnormalities and diseases of the uterus may on the one hand prevent the entrance of the ovum into the uterine cavity, and on the other may prevent the upward passage of the spermatozoa to their goal. Amongst conditions competent to produce these effects we must enumerate: displacements of the uterus, structural changes in this organ and its annexa, and other congenital defects and acquired states; more particularly must be mentioned, uterus infantilis, acquired atrophy of the uterus, flexions and versions of the uterus, new-growths and inflammatory states of that organ, abnormalities in the shape or size of the cervix uteri, and, finally, all conditions of the vagina or vulva which hinder the proper performance of the act of intercourse.

In diagnosing the cause of sterility, in determining whether in any particular instance it is due to some hindrance to the indispensable conjugation between the male and female reproductive elements, we have in the first place to ascertain the presence or absence of any of the numerous conditions which interfere with the proper passage of the ovum from the ovary through the Fallopian tube to the interior of the uterus. The simpler mechanical hindrances to conception, such as displacements of the uterus, or tumours of that organ or its annexa, are easily recognized; and the same is true of atresia of the cervix uteri, and of congenital or acquired stenosis of the vagina. When obliteration or stricture of the genital tract exists, a very careful examination, visual, digital, and instrumental, must be made, rectal examination not being forgotten. Not infrequently, amenorrhœa is attributed to ovarian disease, and only subsequently on local examination is the cause ascertained to be hymeneal atresia, with haematocolpos; many a woman has believed herself to be pregnant, until examination has disclosed the fact that the hymen is still intact, and that coitus has hitherto been effected through the urethra. The importance of these stenotic conditions as causes of sterility must not, however, be overestimated, for, although they are common among the hindrances to conception, the obstacle is by no means always insuperable.

Morbid changes in the secretions of the genital passages, whereby the vitality of the spermatozoa may be destroyed before they have time to reach the ovum and effect fertilization, are hard to diagnose, for the conditions upon which such changes depend have not as yet been adequately investigated.