This beautiful lactation idyll or, more correctly, mammalian idyll, will not bear the test of scientific criticism. In the first place, the effect of the proposed manipulations is exceedingly dubious, and would only produce the desired result in exceptional cases; in the second place, such an artificial lactation, continued for a long period, would be extremely harmful, just as an excessive protraction of lactation after normal delivery is known to be deleterious; and in the third place, last, not least, the reputed anticonceptional effect would, in the majority of cases, fail to occur. At any rate, there appears to be no reason why pregnancy should not ensue, since the condition of the genital organs would apparently permit this, and would certainly differ from that which obtains in women who give suck in a normal manner after giving birth to a child.
2. Divergences from the Normal Mode of Coitus.—Attempts have been made to prevent fertilization by means of various modifications of the sexual act. Thus, starting from the old belief that active participation in the sexual act on the part of the woman, as well as libido and the sexual orgasm on her part, are indispensable prerequisites of the occurrence of impregnation, a more passive demeanour of the woman has been recommended—a distraction of the mind and the senses from the sexual act, after the manner of the cong-fou of the Chinese, who frequently employ this trick during intercourse. This opinion is deceptive, for, in the absence of all activity and orgasm on the part of the woman, in the most diverse conditions possible, conception may ensue.[727] Thus, in this case also we have to do with a quite untrustworthy method.
Trustworthy, on the other hand, and therefore extremely widely diffused, is the so-called coitus interruptus—interrupted intercourse, in which the penis is withdrawn from the vagina shortly before the ejaculation of the semen (so-called “withdrawal,” “Zuruckziehen,” “Sichinachtnehmen,” “fraudieren,” “congressus reservatus, onanismus conjugalis”). The views regarding the harmfulness of this method, by which pregnancy can certainly be prevented, have in recent years undergone considerable change, in so far as the disadvantages are to-day considered less serious than they formerly were. More especially, Dr. Alfred Damm, in his work “Neura,” overestimated the harmful effects of coitus interruptus, inasmuch as he attributed to it the entire degeneration of a race. These extreme views, supported by no facts whatever, of the degeneration fanatic Damm are briefly described in a little book by E. Peters, “The Sexual Life and Nervous Energy” (Cologne, 1906).[728]
It cannot be denied—and has, in fact, been maintained by other physicians such as Gaillard Thomas, Goodell, Valenta, Bergeret, Mantegazza, Payer, Mensinga, Beard, Hirt, Eulenburg, Freud, von Tschich, Gattel, and others—that the “ineffective” excitement occurring during coitus interruptus, the absence of the natural discharge of sexual tension, the voluntary postponement of ejaculation, the strain put upon the will during the sexual act, may have a transient harmful influence upon the nervous system; but, according to recent researches, it is only in those who are already neuropathic that permanent troubles result, in the form of “anxiety-neurosis” (which, as Freud[729] has proved, is actually dependent upon coitus interruptus), or in the form of other neurasthenic and hysterical troubles, and also sometimes of local irritative conditions. The harmful influence of frustrated sexual excitement is shown also by the frequency of nervous troubles during the period of engagement, which, as a witty colleague of mine remarked, must be regarded as a single, long-drawn-out coitus interruptus. But it has not been proved that in healthy individuals coitus interruptus, even when the practice is continued for a long time, gives rise to serious and permanent injuries to health. According to the experience of Fürbringer, Oppenheim, von Krafft-Ebing, Rohleder, Spener, and, above all, of L. Löwenfeld, who has instituted exceptionally exact researches into the matter, such consequences are quite exceptional. This is also true of the disorders which coitus interruptus is reputed to cause in women.
Another method for the prevention of pregnancy, which, according to Barrucco, is practised especially in Italy, is the prolongation of sexual enjoyment by means of repeated interruptions of the act, followed by renewed erections. This, naturally, is extremely harmful. Fürbringer, however, reports the case of certain frigid men who were able to extend the act of conjugal intercourse for long periods, without any disastrous effect upon their health. One of these men was able to find time during the act for smoking and reading!
3. Mechanical Means for the Prevention of Conception.—According to Kisch, in Transylvania and in France a method is in use according to which, during the sexual act, the woman, at the commencement of ejaculation in the male, presses her finger forcibly upon the root of his penis just in front of the prostate gland. In this way the passage through the urethra is temporarily occluded, and ejaculation of the semen is prevented: it regurgitates into the bladder, and is subsequently evacuated with the urine. Unquestionably this manipulation would be likely to prove exceedingly injurious to health.
In Italy and in New Guinea many women expel the semen from the vagina, as soon as coitus is completed, by means of muscular action, by vigorous movements of the perineum.
A mechanical apparatus for the prevention of conception which is unquestionably carefully thought out is the so-called occlusive pessary of Dr. Mensinga—a hemisphere of rubber surrounded by a steel ring, introduced into the vagina before coitus, and even left in situ for prolonged periods, so that the os uteri is occluded. When accurately applied, it does, in fact, definitely prevent fertilization. Various considerations, however, render its use undesirable: (1) the difficulty of the introduction, which most women are unable to master; (2) liability to displacement of the pessary during the act; (3) the occurrence of irritative conditions of various kinds (discharges, diseases of the uterine annexa, etc.), if, as often happens, the pessary is allowed to remain in the vagina for a long time. Recently a pessary has been constructed of waterproof cambric, which is said not to produce any such irritative reaction. Moreover, Mensinga himself, and Earlet, have made other improvements upon the occlusive pessary. Easier to introduce is Gall’s “balloon occlusive pessary.” In this instrument, by means of a compressible rubber ball and tubing, air is blown into the interior of a thin-walled rubber ring which surrounds a soft elastic rubber disc. A dangerous article, and one to be avoided, is Hollweg’s “obturator.” The ideal mechanical means for the prevention of pregnancy is, once more, the condom, regarding the application and qualities of which we have already said all that is necessary (vide supra, [pp. 378], [379]). Simple in its mode of application, it is, when of good quality, certain in its effect, and is relatively the most harmless of all preventive measures. When it is used, coitus runs a perfectly normal course, with the sole exception of the sensation during ejaculation. We must reject as harmful the use of the so-called “stimulant condom,” which bears a ring of spines or points, in order to increase libido in the woman.
4. Chemical Physical Preventive Measures.—To these belong, above all, douching of the vagina immediately after sexual intercourse, for which purpose cold water, solutions of alum (1 per cent.), copper sulphate (1⁄2 to 1 per cent.), sulphate of quinine (1 : 400), etc., may be used. The douching must be effected when the woman is in the recumbent posture, and the vaginal tube must be introduced deeply. This method, however, is very untrustworthy.[730]
The same is true of attempts to destroy the spermatozoa by the insufflation of chemically active powders; or by the insertion of antiseptic “security sponges,” which Rohleder has rightly named “insecurity sponges”; untrustworthy also is the combination of these with mechanical apparatus.