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

by E. Heinrich Kisch

A case of sterile marriage is reported by Lier and Ascher, in which the husband had suffered from hypospadias and had been operated upon for the relief of that condition. Although erection of the penis was normal, and coitus terminated in the usual orgasm, with sense of ejaculation, the semen did not find its way into the vagina; it accumulated in the artificial cul-de-sac between the former abnormal urethral orifice and the artificially constructed meatus, and after coitus the semen had to be expelled from this region by digital pressure.

Miclucho-Mackay reports that among the Australian aborigines, hypospadias is artificially induced, in order to prevent fertilization. In young boys, an incision is made through the lower wall of the urethra from the meatus as far up as the scrotum, and care is taken that the several surfaces do not reunite. During coitus, the semen flows away without entering the vagina. This mutilation is practised, not only in South and Central Australia, but also by the indigens of Port Darwin.

That hypospadias does not in all cases offer an insuperable obstacle to impregnation, is, however, shown by a striking case which came under the notice of Labalbary. He saw a hypospadiac who, in micturating, had to crouch down in the feminine posture, because he was unable to project the stream of urine forwards; in coitus, he deposited his semen only on his wife’s vulva. But his wife gave birth to two sons, about whose paternity there could be no reasonable doubt, since both exhibited the same malformation as their putative father.

Occasionally, phimosis offers an obstacle to impregnation, and only after relief of the condition by operation, is the wish for offspring fulfilled. A case of this nature is recorded by Amussat.

In cases of severe stricture of the urethra, sterility may result, although the constitution of the semen is perfectly normal. During erection of the penis, the stricture is completely closed, and the semen accumulates in the urethra above it; when the penis becomes flaccid, the semen flows away, outside the vagina. In some such cases, the semen regurgitates into the bladder, and is not discharged until the patient makes water. Although the supposition is not one in which strict proof is obtainable, it is probable that the man is at fault in cases in which the wives of two or more brothers fail to conceive. I have seen several instances of the kind. Three brothers, all quite healthy, and of virile aspect, were married to women in whom on gynecological examination no significant abnormality could be detected; they had been married respectively for 14, 9, and 8 years; all were childless. Three brothers, two of whom were practising physicians, had lived a number of years (20, 4, and 14, respectively) in sterile wedlock; one of them (a physician) informed me that he ejaculated always a very small quantity of semen, and thought it possible that this was the cause of the sterility. Of four brothers, two had lived long in barren wedlock; the third had no child for 14 years after marriage, when at last his wife became pregnant after a visit to a spa; the fourth brother is a misogynist and a confirmed bachelor.

Sexual Sensibility in Women.

In our consideration of the various influences by which the contact of ovum and spermatozoon may be prevented, the degree of sexual excitement experienced by the woman during the sexual act must not be overlooked, for this plays a part not to be underestimated, even though it is a matter on which it is difficult to obtain accurate information.

It is extremely probable that an active participation on the part of the woman in coitus has an important influence upon the attainment of fertilization, i. e., that sexual excitement in the woman is a link in the chain of conditions leading to conception. This excitement has a reflex influence, but the influence may be exercised in either (or both) of two ways: first, it may cause certain reflex changes in the cervical secretion, whereby the passage of the spermatozoa is facilitated; or, secondly, it may give rise to reflex changes in the vaginal portion of the cervix, to a rounding of the os uteri externum and a hardening of the consistency of the cervix (changes of an erectile nature) coupled with a slight descent of the uterus—changes which likewise favour the entrance of the semen into the uterine cavity. Theopold goes so far as to say that it is only women who experience erotic excitement who are capable of being impregnated.

My own opinion is that considerable importance is to be attached to voluptuous excitement of the woman during coitus, for the former of the two reasons mentioned above, namely, because such excitement leads to the occurrence of reflex secretion of the cervical glands, the secretion thus produced maintaining or enhancing the activity of the spermatozoa; and contrariwise, in the absence of voluptuous excitement on the woman’s part there is a failure of the reflex secretion, and the passage of the spermatozoa into the uterine cavity is consequently less easily effected. That sexual excitement has great influence upon the production of the first appearance of menstruation, has frequently been shown; and an analogy between such an influence and the suggested effect of sexual excitement in favouring the occurrence of conception, must not lightly be rejected. It is well known that the first menstruation occurs at an earlier age in girls living in towns than in those living in the country; not solely (if at all) in consequence of the better nutriment and easier life of the former, but also, unquestionably, owing to nervous influences. It is, moreover, a familiar experience that factory girls, who from early youth are exposed to sexual stimulation, attain sexual maturity at an extremely early age. Again, from early times it has been the prevailing opinion of the common people that for the impregnation of a woman it was necessary for her to experience voluptuous excitement, or at least, that in the absence of such excitement, conception was rendered difficult. Riedel relates of the indigens of the Island of Buru, that they often have sexual intercourse with foreigners, “but during such intercourse they remain quite passive, in order to avoid impregnation.” It is not an unusual experience in gynecological practice for a sterile woman, in the absence of any prompting, to complain that during coitus she has no “feeling” whatever, and to attribute to this lack of feeling her failure to conceive.

A cultured lady, the mother of several children, assured me, not only that she was always aware, whether an act of intercourse would or would not lead to impregnation, but further, that it was within her power to determine whether the intercourse should or should not be fruitful. If she was passive during intercourse, or if, to use her own expression, her attitude was one of “laisser faire, laisser aller,” conception would not occur; but if, on the other hand, she took an active part in the coitus, so that she experienced a powerful voluptuous sensation, pregnancy would result from the intercourse.