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

by E. Heinrich Kisch

For the elucidation of the manifold reflex and other processes which are dependent upon or accompany the sexual phases of woman, we must in the first place consider the anatomical changes and physiological functions of the female reproductive organs characteristic of the several periods of sexual life which have already been distinguished. We must not fail also to take into consideration the mental states which accompany and characterize these respective phases.

The anatomical changes which occur in the female genital organs during these different phases of sexual life give rise to a number of manifold local stimuli, increasing and decreasing, varying greatly in intensity and area of distribution, upon which depend the reflex effects and remote manifestations in the sphere of the nervous and circulatory systems.

We must first consider the changes in the ovaries, which play an etiologically important part. At the onset of puberty, the follicular masses of the ovary exhibit a more active growth, the follicles increase in size, with their contained ova they approach the surface, and finally, by the bursting of the follicles, the ova are extruded. Then, in the life-phase in which conception occurs, and under the influence of the hyperæmia of all the pelvic viscera that accompanies this process, a notable development of the corpus luteum takes place, this latter body reaching its maximum size in the eleventh week of pregnancy, subsequently undergoing involution and leading to the formation of a considerable scar. Finally, in the critical period of life in which the menstrual flow ceases, a continually increasing growth and new formation of connective tissue-stroma takes place in the ovaries at the expense of their cellular constituents, and a regressive metamorphosis of the graafian follicles occurs.

In association with these sexual processes there ensues a series of striking changes in the shape and consistency of the ovaries, affecting both the surface and the parenchyma of these organs, and capable of stimulating the nervous ramifications in their tissue. In this connection it is worthy of note that the branches supplying the ovaries from the spermatic plexuses of the sympathetic contain a considerable proportion of sensory fibres.

Quite as significant, moreover, as the changes in the ovaries, are those which, in the course of the sexual life, the uterus undergoes, in shape and size, in its muscular substance and mucous lining, and in its vascular and nervous supply.

Fig. [2].—Portion of the pelvic viscera in the female, and their relation to the muscles of the pelvic outlet (or perineal muscles), shown in the left half of the pelvis, seen from the right side.—The parametrium. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.)

At the time of puberty the infantile uterus undergoes changes affecting both its external form and the shape of its interior cavity. The body of the uterus enlarges to the size characteristic of sexual maturity, and its mucous membrane becomes the seat of periodic changes. This waxing and waning growth and transformation of the uterine mucous membrane continues throughout the period of menstrual activity, the most superficial layers of the membrane being shed during menstruation, a process followed by regeneration, which is itself succeeded by the premenstrual thickening. When conception occurs, still more extensive changes ensue, the fertilized ovum becoming imbedded in the uterine mucous membrane, and the pregnant uterus, in shape and structure and in the respective relations of the body and neck of the organ, in the increasing distension of its veins and the increasing size of its nerves, becoming adapted to the important functions it has now to fulfil. When these have been fulfilled, and, parturition having taken place, the uterus is empty once more, the organ again adapts itself to altered circumstances by the process of involution. Later, in the climacteric period, a slow regressive process occurs, the outward manifestation of which is the cessation of the menstrual flow, characterized anatomically by atrophy of the muscular tissue of the uterus and of its vascular apparatus, by the dessication of its mucous membrane, by obliteration of the lumen of the uterine cavity, and ultimately by senile degeneration and atrophy of the now entirely functionless organ, so that it becomes an insignificant, cicatrized, solid body.

Next to the ovaries and the uterus, it is the pelvic fascia which in its entire architectonic structure as well as in its individual parts undergoes the most notable changes in consequence of the processes of generation.

A short account of the nerves and blood vessels of the female genital organs appears indispensable, to facilitate the comprehension of the manner in which sexual processes are influenced by the nervous system, and to demonstrate the intimate connection between the blood-supply of the genital apparatus and the general circulation.