It is sometimes stated that menstruation may be entirely absent in perfect health. Few cases of this condition have, however, been recorded with the detail necessary to prove the assertion. One such case was investigated by Dr. H. W. Mitchell, and described in a paper read to the New York County Medical Society, February 22, 1892 (to be found in Medical Reprints, June, 1892). The subject was a young, unmarried woman, 24 years of age. She was born in Ireland, and, until her emigration, lived quietly at home with her parents. Being then twenty years of age, she left home and came to New York. Up to that time no signs of menstruation had appeared, and she had never heard that such a function existed. Soon after her arrival in New York, she obtained a situation as a waiting-maid, and it was noticed, after a time, that she was not unwell at each month. Friends filled her ears with wild stories about the dreadful effects likely to follow the absence of menstruation. This worried her greatly, and as a consequence she became pale and anæmic, with loss of flesh, appetite, and sleep, and a long train of imaginary nervous symptoms. She presented herself for treatment, and insisted upon a uterine examination. This revealed no pathological condition of her uterus. She was assured that she would not die, or become insane, nor a chronic invalid. In consequence she soon forgot that she differed in any way from other girls. A course of chalybeate tonics, generous diet, and proper care of her general health, soon restored her to her normal condition. After close observation for several years, she submitted to a thorough examination, although entirely free from any abnormal symptoms. The examination revealed the following physical condition: Weight, 105 pounds (her weight before leaving Ireland was 130); girth of chest, twenty-nine and a half inches; girth of abdomen, twenty-five inches; girth of pelvis, thirty-four and a half inches; girth of thigh, upper third, twenty inches; heart healthy, sounds and rhythm perfectly normal; pulse, 76; lungs healthy; respiratory murmur clear and distinct over every part; respiration, easy and twenty per minute; the mammæ are well developed, firm, and round; nipples, small, no areola; her skin is soft, smooth, and healthy; figure erect, plump, and symmetrical; her bowels are regular; kidneys, healthy. She has a good appetite, sleeps well, and in no particular shows any sign of ill health. The uterine examination reveals a short vagina, and a small, round cervix uteri, rather less in size than the average, and projecting very slightly into the vaginal canal. Depth of uterus from os to fundus, two and a quarter inches, is very nearly normal. No external sign of abnormal ovaries. She is a well-developed, healthy young woman, performing all her physiological functions naturally and regularly, except the single function of menstruation. No vicarious menstruation takes the place of the natural function, though she has been watched very closely during the past two years, nor the least periodical excitement. It is added that, though the clitoris is normal, the mons veneris is almost destitute of hair, and the labia rather undeveloped, while, "as far as is known," sexual instincts and desire are entirely absent. These latter facts, I may add, would seem to suggest that, in spite of the health of the subject, there is yet some concealed lack of development of the sexual system, of congenital character. In a case recorded by Plant (Centralblatt für Gynäkologie, No. 9, 1896, summarized in the British Medical Journal, April 4, 1896), in which the internal sexual organs were almost wholly undeveloped, and menstruation absent, the labia were similarly undeveloped, and the pubic hair scanty, while the axillary hair was wholly absent, though that of the head was long and strong.
We may now regard as purely academic the discussion formerly carried on as to whether menstruation is to be regarded as analogous to heat in female animals. For many centuries at least the resemblance has been sufficiently obvious. Raciborski and Pouchet, who first established the regular periodicity of ovulation in mammals, identified heat and menstruation.[[101]] During the past century there was, notwithstanding, an occasional tendency to deny any real connection. No satisfactory grounds for this denial have, however, been brought forward. Lawson Tait, indeed, and more recently Beard, have stated that menstruation cannot be the period of heat, because women have a disinclination to the approach of the male at that time.[[102]] But, as we shall see later, this statement is unfounded. An argument which might, indeed, be brought forward is the very remarkable fact that, while in animals the period of heat is the only period for sexual intercourse, among all human races, from the very lowest, the period of menstruation is the one period during which sexual intercourse is strictly prohibited, sometimes under severe penalties, even life itself. This, however, is a social, not a physiological, fact.
Ploss and Bartels call attention to the curious contrast, in this respect, between heat and menstruation. The same authors also mention that in the Middle Ages, however, preachers found it necessary to warn their hearers against the sin of intercourse during the menstrual period. It may be added that Aquinas and many other early theologians held, not only that such intercourse was a deadly sin, but that it engendered leprous and monstrous children. Some later theologians, however, like Sanchez, argued that the Mosaic enactments (such as Leviticus, Ch. XX, v. 18) no longer hold good. Modern theologians—in part influenced by the tolerant traditions of Liguori, and, in part, like Debreyne (Moechialogie, pp. 275 et seq.) informed by medical science—no longer prohibit intercourse during menstruation, or regard it as only a venial sin.
We have here a remarkable, but not an isolated, example of the tendency of the human mind in its development to rebel against the claims of primitive nature. The whole of religion is a similar remolding of nature, a repression of natural impulses, an effort to turn them into new channels. Prohibition of intercourse during menstruation is a fundamental element of savage ritual, an element which is universal merely because the conditions which caused it are universal, and because—as is now beginning to be generally recognized—the causes of human psychic evolution are everywhere the same. A strictly analogous phenomenon, in the sexual sphere itself, is the opposed attitude in barbarism and civilization toward the sexual organs. Under barbaric conditions and among savages, when no magico-religious ideas intervene, the sexual organs are beautiful and pleasurable objects. Under modern conditions this is not so. This difference of attitude is reflected in sculpture. In savage and barbaric carvings of human beings, the sexual organs of both sexes are often enormously exaggerated. This is true of the archaic European figures on which Salomon Reinach has thrown so much light, but in modern sculpture, from the time when it reached its perfection in Greece onward, the sexual regions in both men and women are systematically minimized.[[103]]
With advancing culture—as again we shall see later—there is a conflict of claims, and certain considerations are regarded as "higher" and more potent than merely "natural" claims. Nakedness is more natural than clothing, and on many grounds more desirable under the average circumstances of life, yet, everywhere, under the stress of what are regarded as higher considerations, there is a tendency for all races to add more and more to the burden of clothes. In the same way it happens that the tendency of the female to sexual intercourse during menstruation[[104]] has everywhere been overlaid by the ideas of a culture which has insisted on regarding menstruation as a supernatural phenomenon which, for the protection of everybody, must be strictly tabooed.[[105]] This tendency is reinforced, and in high civilization replaced, by the claims of an æsthetic regard for concealment and reserve during this period. Such facts are significant for the early history of culture, but they must not blind us to the real analogy between heat and menstruation, an analogy or even identity which may be said to be accepted now by most careful investigators.[[106]]
If it is, perhaps, somewhat excessive to declare, with Johnstone, that "woman is the only animal in which rut is omnipresent," we must admit that the two groups of phenomena merge into or replace each other, that their object is identical, that they involve similar psychic conditions. Here, also, we see a striking example of the way in which women preserve a primitive phenomenon which earlier in the zoölogical series was common to both sexes, but which man has now lost. Heat and menstruation, with whatever difference of detail, are practically the same phenomenon. We cannot understand menstruation unless we bear this in mind.
On the psychic side the chief normal and primitive characteristic of the menstrual state is the more predominant presence of the sexual impulse. There are other mental and emotional signs of irritability and instability which tend to slightly impair complete mental integrity, and to render, in some unbalanced individuals explosions of anger or depression, in rarer cases crime, more common;[[107]] but the heightening of the sexual impulse, languor, shyness, and caprice are the more human manifestations of an emotional state which in some of the lower female animals during heat may produce a state of fury.
The actual period of the menstrual flow, at all events the first two or three days, does not, among European women, usually appear to show any heightening of sexual emotion.[[108]] This heightening occurs usually a few days before, and especially during, the latter part of the flow, and immediately after it ceases.[[109]] I have, however, convinced myself by inquiry that this absence of sexual feeling during the height of the flow is, in large part, apparent only. No doubt, the onset of the flow, often producing a general depression of vitality, may tend directly to depress the emotions, which are heightened by the general emotional state and local congestion of the days immediately preceding; but among some women, at all events, who are normal and in good health, I find that the period of menstruation itself is covered by the period of the climax of sexual feeling. Thus, a married lady writes: "My feelings are always very strong, not only just before and after, but during the period; very unfortunately, as, of course, they cannot then be gratified"; while a refined girl of 19, living a chaste life, without either coitus or masturbation, which she has never practiced, habitually feels very strong sexual excitement about the time of menstruation, and more especially during the period; this desire torments her life, prevents her from sleeping at these times, and she looks upon it as a kind of illness.[[110]] I could quote many other similar and equally emphatic statements, and the fact that so cardinal a relationship of the sexual life of women should be ignored or denied by most writers on this matter, is a curious proof of the prevailing ignorance.[[111]]
This ignorance has been fostered by the fact that women, often disguise even to themselves the real state of their feelings. One lady remarks that while she would be very ready for coitus during menstruation, the thought that it is impossible during that time makes her put the idea of it out of her mind. I have reason to think that this statement may be taken to represent the real feelings of very many women. The aversion to coitus is real, but it is often due, not to failure of sexual desire, but to the inhibitory action of powerful extraneous causes. The absence of active sexual desire in women during the height of the flow may thus be regarded as, in part, a physiological fact, following from the correspondence of the actual menstrual flow to the period of pro-œstrum, and in part, a psychological fact due to the æsthetic repugnance to union when in such a condition, and to the unquestioned acceptance of the general belief that at such a period intercourse is out of the question. Some of the strongest factors of modesty, especially the fear of causing disgust and the sense of the demands of ceremonial ritual, would thus help to hold in check the sexual emotions during this period, and when, under the influence of insanity, these motives are in abeyance, the coincidence of sexual desire with the menstrual flow often becomes more obvious.[[112]]