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

by E. Heinrich Kisch

The researches of Kundrat and Engelmann on uteri obtained post mortem led these authors to describe as follows the anatomical changes that occur in the uterine mucous membrane at the time of the catamenial hæmorrhage. In the premenstrual epoch a round-cell infiltration occurs in the interglandular tissue, the lumina of the uterine glands become enlarged, and the bloodvessels dilated; subsequently, fatty degeneration of the superficial epithelium and the epithelium of the glands occurs, leading to laceration of the vessels and destruction of the affected area of tissue; after the cessation of the bleeding, regeneration of the mucous membrane occurs.

According to Gebhard, three stages may be distinguished. The first stage is that of premenstrual congestion, or stage of engorgement: the capillary vessels of the mucous membrane become distended with blood, the membrane itself becomes softened, the meshes of the stroma become enlarged and are filled with the morphological constituents of the blood, subepithelial hæmatomata are formed. The second stage is that in which the blood finds its way to the exterior: owing to the turgescence of the mucous membrane the blood is able to exude between the cells of the intact epithelium; further, the epithelium becomes lacerated in various places where hæmatomata have formed beneath it, allowing the blood to exude through the apertures thus formed; shreds of epithelium may be washed away by the blood-stream. The third stage is that of post-menstrual regeneration: the swelling of the mucous membrane disappears, the detached areas of epithelium readhere, the blood effused into the interstices of the tissue is reabsorbed, or is in part transformed into yellowish-brown flakes of pigment. According to Gebhard’s view, during menstruation destruction of the uterine mucous membrane does not occur. At no time is the membrane denuded of large areas of epithelium; a very active process of regeneration occurs, however, in the superficial epithelium and the epithelium of the glands, which fits the uterine mucosa for the reception of the fertilized ovum by keeping it in an ever-young and renovated condition. The mucous membrane of the cervix takes part in menstruation at most by an increased secretion of mucus.

According to Landau and Rheinstein, the mucous membrane of the Fallopian tubes contributes to the menstrual hæmorrhage; Fritsch and Strassmann, however, are opposed to the view that there is a regular tubal menstruation.

Pathology of Menstruation.

Only a small proportion of girls and women are entirely free, at the time of menstruation, from all change both in their bodily and in their mental state. A very great majority complain of feeling more or less unwell, of sensations of weight and pressure in the hypogastric region, of a general feeling of languor, loss of appetite, headache, irritability, sometimes of an inclination to weep; in women, a change in the intensity of the sexual impulse manifests itself, an increase in some, a decrease in others.

Not infrequently during menstruation, the cardiac activity is notably affected, so that, regularly at the commencement of each period, disagreeable sensations occur in the cardiac region, with increased frequency of the heart’s action; or complaint is made of coldness and dampness of the hands, of icy coldness of the feet, which feel as if “dead” to half way up the calves, and cannot be warmed—phenomena which, in the cases under consideration, occur only at the time of menstruation, and are to be regarded as manifestations of the menstrual reflex.

I examined 140 women in whom the heart and the vascular system were normal, during a number of successive menstrual periods, and in 12 of these women, either at the commencement or during the course of the flow, I observed an increase in the frequency of the heart to the extent of from 12 to 28 beats per minute; in young girls, a systolic murmur was sometimes audible during menstruation, but was inaudible in the intermenstrual intervals. In all these persons, menstruation was regular; there was no abnormality in respect either of the duration or of the quantity of the flow. The heart in these cases was, therefore, affected by the normal menstrual process.

A remarkable illustration of the alleged influence of menstrual disturbances on the pulse is reported by de Villeneuve, who states that Chinese physicians, being accustomed to feel the pulse in many different arteries, are able, by a comparison of the characters of the pulse in the two arms, to determine whether a woman menstruates regularly or irregularly.

Many women and girls show well-marked menstrual molimina, uneasy or actually painful local sensations in the genital organs, sacrache, painful uterine contractions, and disturbances of the general constitutional state, which are dependent upon menstrual congestion of the pelvic organs, upon local engorgement; sometimes such symptoms are the result of uterine contractions caused by hyperæmia of the uterus, and these cases often take a paroxysmal form.

Important disturbances of the general constitutional state result from sudden suppression of the normal menstrual flow, such as may be the effect of a severe chill, of sudden mental impressions, even of errors in diet or the use of certain drugs, and may sometimes follow artificial withdrawal of blood.