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

by E. Heinrich Kisch

TABLE OF CONTENTS.

				PAGE
	The Sexual Life of Woman—Introduction			[1]
I.	The Sexual Epoch of the Menarche			[37]
		First Appearance of Menstruation		[45]
		Anatomical Changes in the Female Genital Organs at the Period of the Menarche		[50]
		Menarche Praecox et Tardiva		[78]
			Precocious and Retarded Menstrual Activity	[78]
		Pathology of the Menarche		[82]
			Anomalies of Menstruation	[83]
			Inflammatory Processes	[87]
			Disorders of Haematopoiesis	[89]
			Cardiac Disorders	[94]
			Diseases of the Nervous System	[99]
			Masturbation	[104]
			Disorders of Digestion	[107]
			Diseases of the Respiratory Organs	[107]
			Diseases of the Organs of the Senses	[108]
			Hygiene during the Menarche	[111]
			Menstruation	[128]
			Pathology of Menstruation	[143]
			Amenorrhœa, Menorrhagia, and Dysmenorrhœa	[160]
			Vicarious Menstruation	[164]
		The Sexual Impulse		[166]
		Nymphomania, Anæsthesia and Psychopathia Sexualis		[184]
II.	The Sexual Epoch of the Menacme			[200]
		Anatomical Changes in the Female Genital Organs in the Period of the Menacme		[209]
		Pathology of the Menacme		[218]
			Dyspepsia Uterina	[227]
			Cardiopathia Uterina	[235]
			Nervous Diseases Secondary to Diseases of the Genital Organs	[243]
		Competence for Marriage of Women suffering from Disease		[250]
		Hygiene during the Menacme		[261]
		Copulation and Conception		[284]
			Copulation	[284]
			Conception	[304]
			Pathology of Copulation	[323]
			Vaginismus	[337]
			Cardiac Troubles Due to Sexual Intercourse	[344]
			Dyspareunia	[347]
		Fertility in Women		[363]
			The Restriction of Fertility and the Use of Means for the Prevention of Pregnancy	[388]
		The Determination of Sex		[420]
			I. Statistical Investigations	[422]
			II. Anatomical Investigations	[446]
			III. Experimental Investigations	[452]
		Sterility in Women		[462]
			Incapacity for Ovulation	[470]
			Interference with Conjugation, Conditions Preventing Access of the Spermatozoa to the Ovum	[487]
			Diseases of the Ovaries and the Fallopian Tubes	[489]
			Diseases of the Uterus	[494]
			Pathological Changes in the Cervix Uteri	[501]
			Displacements of the Uterus	[515]
			Myoma of the Uterus	[523]
			Diseases of the Vagina and the Vulva	[526]
			Secretions of the Genital Organs	[528]
			A. Absolute	[540]
			B. Relative Sterility	[540]
			Sexual Sensibility in Women	[542]
			Incapacity for Incubation of the Ovum	[549]
			Only-Child-Sterility	[561]
			Operative Sterility	[563]
			Table Showing the Causes of Sterility in Women	[569]
III.	The Sexual Epoch of the Menopause			[571]
		The Menopause		[571]
		Changes in the Female Reproductive Organs at the Menopause		[583]
		The Time of the Menopause		[593]
		The Age at which the Menopause occurs		[593]
			1. Race	[594]
			2. The Age at which the Menarche Occurred	[595]
			3. The Woman’s Sexual Activity	[597]
			4. The Social Circumstances of the Woman’s Life	[599]
			5. General Constitutional and Pathological Conditions	[599]
			6. Premature, Delayed, and Sudden Onset of the Menopause	[600]
		Pathology of the Menopause		[608]
			Diseases of the Genital Organs	[608]
			Diseases of the Organs of Circulation	[620]
			Diseases of the Digestive Organs	[630]
			Diseases of the Skin	[632]
			Disorders of Metabolism	[635]
			Diseases of the Nervous System	[637]
			Climacteric Psychoses	[643]
		Hygiene during the Menopause		[653]

LIST OF ILLUSTRATIONS (Kisch).

Fig.		Page
1.	Curve of the sexual life of woman from the tenth to the sixtieth year of life	[4]
2.	Portion of the pelvic viscera in the female, etc.	[9]
3.	The distribution of the pudic nerve in the female perineal and pubic regions	[11]
4.	The distribution of the lateral sacral arteries, etc.	[14]
5.	Curve of menstrual cycle	[19]
6.	Curve of rhythmical variations	[20]
7.	Curve of beauty of woman.	[24]
8.	Internal genital organs of new-born female infant	[51]
9.	Reproductive organs of a new-born female infant	[52]
10.	Internal genital organs of a girl aged eight years	[52]
11.	Reproductive organs of a girl aged ten years	[53]
12.	Female external genital organs of a virgin	[54]
13.	The external genital organs of a virgin	[55]
14.	Sagittal section of the female pelvis	[56]
15.	Primitive follicles	[58]
16.	Ripening follicles	[61]
17.	Graafian follicles	[62]
18.	Annular Hymen	[64]
19.	Annular Hymen	[64]
20.	Semilunar Hymen	[65]
21.	Annular Hymen with Congenital Symmetrical Indentations	[65]
22.	Fimbriate Hymen	[65]
23.	Deflorated Fimbriate Hymen	[65]
24.	Septate Annular Hymen	[67]
25.	Septate Semilunar Hymen	[67]
26.	Extremely tough Annular Hymen with an obliquely disposed Septum	[67]
27.	Septate Hymen with Apertures of unequal Size	[67]
28.	Septate Hymen with Apertures of unequal Size	[68]
29.	Hymen with rudimentary Septum	[68]
30.	Hymen with posterior rudimentary Septum	[68]
31.	Labiate Hymen with posterior rudimentary Septum	[68]
32.	Hymen with anterior rudimentary Septum	[69]
33.	Hymen with anterior rudimentary Septum projecting in a opiniform Manner	[69]
34.	Hymen with anterior and posterior rudimentary Septa	[69]
35.	Hymen with filiform Process projecting from the anterior Margin	[69]
36.	Hymen in which there are two symmetrically disposed thinned Areas. The left of these is perforated	[69]
37.	Very unusual form of Hymen	[70]
38.	Semilunar Hymen with cicatrized Lacerations in its Border	[70]
39.	Deflorated Semilunar Hymen with laterally disposed symmetrical Lacerations	[70]
40.	Deflorated Annular Hymen with several cicatrized Lacerations	[70]
41.	A. Septate Hymen in which defloration has been effected through one of the Apertures. U. Urethra. Cl. Clitoris. H. Cicatrized Margin. C. Septum. B. Lateral view of Septum	[70]
42.	Deflorated Septate Hymen	[71]
43.	Hymen with larger anterior and smaller posterior Apertures	[71]
44.	Carunculæ Myrtiformes in a Primipara	[71]
45.	Vaginal Inlet of a Multipara, without Carunculæ Myrtiformes. Slight Prolapse of Anterior and Posterior Vaginal Walls	[71]
46.	The breast of a virgin aged eighteen years	[73]
47.	Horizontal section through the female breast	[75]
48.	The female pudendum, or vulva, with the labia majora	[204]
49.	Vestibule of the vagina, with the labia minora or nymphæ, etc	[205]
50.	The uterus, the left Fallopian tube and the left ovary, etc	[207]
51.	Female internal genital organs in the fully developed state	[208]
52.	Sagittal Section through the Cervix Uteri of a Woman twenty-six years of age. Dendriform branched glands	[217]
53.	Cervix of a Woman seventy-two years of age, with glands that have undergone cystic degeneration	[217]
54.	Sagittal Section through the Cervix Uteri of a Woman sixty-five years of age. The glands have undergone cystic degeneration	[217]
55.	First Stage. A. Entrance of a Spermatozoon into the Ovum of Ascaris Megalocephala. B. After preparations by M. Nussbaum. (Half of the ova only are depicted)	[306]
56.	Ovum of Asterakanthion ten minutes after Fertilization	[306]
57.	Fusion of Male Pro-nucleus and Female Pro-nucleus to form the Segmentation Nucleus of the Fertilized Ovum	[306]
58.	Passage of Spermatozoon through the Zona Pellucida of the Ovum of Asterakanthion	[307]
59.	Ovum of Scorpæna Scrofa Thirty-five Minutes after Fertilization	[307]
60.	Male Pro-nucleus and Female Pro-nucleus in Fertilized Ovum of Frog, prior to the Formation of the Segmentation Nucleus	[307]
61.	a. b. c. Prostatic calculi from normal semen, d. Spermatozoa. e. Large and small cells, some containing granules, as morphological elements of semen. f. Spermatozoon distorted by imbibition of water. g. Crystals (after Bizzozero)	[311]
62.	Normal Semen	[311]
63.	Semen consisting chiefly of sperm-crystals, cylindrical epithelium, and small granules exhibiting molecular movement—but containing no spermatozoa	[315]
64.	Oligozoöspermia. a. Living Spermatozoa, b. Dead Spermatozoa, c. Pus Corpuscles, d. Erythrocyte, e. Seminal granules	[317]
65.	Septate Hymen, the septum having a tendinous consistency	[324]
66.		[326]
67.	Lipoma of the Right labium majus, including the Vaginal Inlet	[328]
68.	“Hottentot Apron” in an adult Woman, hanging down between the thighs (after Zweifel)	[329]
69.	Elephantiasis of the Labia Majora	[330]
70.	Congenital Atrophy of the Uterus (after Virchow), oi, Ostium internum; oe, Ostium externum	[500]
71.		[500]
72.	Normal Shape of the Portio Vaginalis	[503]
73.	Conoidal Shape of the Portio Vaginalis	[503]
74.	“Apron-Shaped” Vaginal Portion, a. Greatly elongated anterior lip; b. Shorter posterior lip of the cervix	[504]
75.	“Beak-Shaped” Vaginal Portion. Posterior aspect	[504]
76.	Simple Hypertrophy of the Portio Vaginalis, which projected from the Vulva	[506]
77.	Elongated Cervix, bent upwards	[506]
78.	Cervical Polypus, originating from an Ovulum Nabothi	[510]
79.	Ectropium in a Case of Bilateral Laceration of the Cervix (after A. Martin)	[514]
80.	Anteflexio Uteri (after A. Martin)	[518]
81.	Retroflexio Uteri (after A. Martin)	[520]
82.	Mucus from the Cervical Canal, taken one hour after sexual intercourse, from a woman suffering from chronic endometritis. Among the epithelial cells, pus cells, and finely granular masses, we see a few motionless, dead spermatozoa	[531]
83.	Uterine Mucous Membrane in Endometritis (after A. Martin)	[554]
84.	Sagittal section through the ovary of a girl aged sixteen	[583]
85.	Sagittal section through the ovary of a woman aged seventy-two years	[584]
86.	Diagrammatic Representation of the Graafian Follicle	[585]
87.	Ovary of a Girl aged nineteen years (Normal Size)	[585]
88.	Ovary of a Woman seventy-two years of age (Normal Size)	[585]
89.		[586]
90.		[587]
91.		[588]
92.	Sagittal Section through the Cervix of a Woman twenty-six years of age. Dendriform branched glands	[588]
93.	Sagittal Section through the Cervix of a Woman sixty-five years of age. Glands which have undergone Cystic Degeneration	[589]
94.	Cervix of a Woman seventy years of age. The Cervical Glands have undergone Cystic Degeneration	[589]
95.	Ovula Nabothi in the Portio Vaginalis	[590]
96.	Vesicle (Ovula Nabothi) from the Uterine Mucous Membrane	[591]
97.	Mucous Glands undergoing Cystic Degeneration	[592]

THE SEXUAL LIFE OF WOMAN.

By the sexual life of woman we understand the reciprocal action between the physiological functions and pathological states of the female genital organs on the one hand and the entire female organism in its physical and mental relations on the other; and the object of this book is to give a complete account of the influence exercised by the reproductive organs, during the time of their development, their maturity, and their involution, on the life history of woman.

From the earliest days of the medical art this sexual life of woman has aroused in the leaders of medical thought the highest interest, and for this reason great attention has been directed, not only to the anatomy of the genital organs and to the diseases of the reproductive system, but also to the individual manifestations of sexual activity and to the influence exercised by these on the female organism as a whole.

Several works by Hippocrates are extant on this subject, among which may be mentioned: περι Γυναικειης Φυσεος,[^[1]] a treatise on the physiology and pathology of woman; περι Αφορων,[^[2]] which discusses sterility in women; περι παρθενιων,[^[3]] a treatise on the pathological states of virgins. These writings of Hippocrates contain some very remarkable observations on the influence exercised by disorders of the reproductive organs on the general health of women.

Aristotle wrote at some length on the functions of the female genital organs. In the writings of Aretæus and Galen on the diseases of women we find striking observations, as for instance, in Galen’s De Locis Affectis,[^[4]] which contains a “Statement of the Similarity and Dissimilarity of Man and Woman.” Another notable work is that of Albertus Magnus, entitled De Secretis Mulierum.[^[5]]

The numerous works on the diseases of women published in the sixteenth century consisted for the most part of a repetition of the observations of ancient writers. The gynecological treatises of the eighteenth century, however, bore witness to an increased knowledge of the anatomy of the female reproductive organs, and were illumined by Haller’s researches on the functions of these organs.