Sex and the Love-Life/Chapter 4
CHAPTER IV
WOMAN'S SEXUAL NATURE
Sexual Instinct in Woman—Woman's Sexual Organization More Complex Than Man's—Feminine Eroticism More Highly Ramified—Woman's Emotional Nature—Strength of Sexual Impulse—Woman Sexually Conservative—Variations in Sexual Impulse—Sexual Desire outlasts the Reproductive Life—Anatomy and Physiology of Female Organs—The Ovaries—Graafian Follicles—Process of Ovulation—Fallopian Tubes—Salpingitis—The Uterus (Womb)—The Vagina—The Hymen—The Vulva—Bartholin Glands—The Pelvis—The Mammary Glands—The Internal Secretions—Normal Effects at Puberty—Effects of Deficient Secretions—Menstruation—Symptoms of Initial Appearance—Hygiene of Menstruation—Disorders Due to Constipation—Re-establishing Menstruation When Prematurely Checked–The Menopause.
Sex Instinct in Woman. In the previous chapter, we have observed that the sexual impulses are normally more powerful in man than in woman. On the other hand, woman's sexual nature, because of her biological function of motherhood (nature, of course, makes no distinction between the actual and potential) is more diversified in its manifestations. It is less dominated by a powerful urge that seeks specific expression, less centered upon the immediate goal of concrete sexual experience. It is, however, instinctively more concerned with the mate as a companion and protector, with children as "flesh of her flesh and blood of her blood," and with the feelings that are bound up in these relationships.
The tendency in this direction is not a question of choice or will, but is due to the character of woman's physiological being, with its highly organized nervous system. The particular development of her visceral organization, which is responsible for her more sensitive emotional nature, also governs the general character of her erotic life.
In other words, her physiological structure and biological functions are responsible for the typical psychological reactions peculiar to woman. It is inevitable that this should be so. Sexual conservatism and quiescence—i. e., relative passiveness—are demanded by the responsibilities of motherhood, whether actual or potential. Of course, as our social environment is far from a natural state, there are many modifications in sexual conduct in all its phases. Fundamentally, however, woman is sexually conservative, comparatively passive, but nevertheless possesses an erotic and emotional organization more highly ramified than that of man, and with different reactions and different ways of manifesting itself.
Man's sexual nature is more centered upon the love-object from the standpoint of sexual experience, more ego-centric, more dynamic.
This quality of differentiation of sexual temperament in the two sexes is not peculiar to the human race, but extends throughout the animal kingdom. It is summed up in the axiom that among all organized beings, the male as a rule pursues the female of its choice.
Certain cases, as in some pathological and hysterical types of women, and to an extent in incorrigible flirts, may seem to contradict this contention. But these are exceptions, represented by abnormal types. In this connection, Clouston states that hysteria tends to prove absence of control of the superior centers which rule the sexual instinct. Hysterical eroticism, therefore, indicates a lack of sexual control, and where the intense sensuality gets out of bounds, criminal tendencies often make their appearance, as has been evidenced in the case of many famous voluptuaries of modern times and as reported in history.
Those instances, not infrequently noted, where women are said to "pursue the man," often in high social circles, are not so much natural examples of the biological impulse in action as they are examples of the economic motive or social ambition-i. e., seeking to marry for position, money or domestic security.
Woman's Emotional Nature. It has not been sufficiently emphasized that in woman the involuntary (sympathetic) nervous system which controls the organism is more extensive and intricate than in man. This is a physiological necessity, as woman has additional organs—the breasts, womb, ovaries, etc.—with their functional capacity of ovulation, menstruation and gestation.
As woman has more organs concealed in the pelvis, with a greater complexity of function, her sympathetic nervous system is necessarily more complicated.
It is mainly due to this elaborate sympathetic system that the emotional side of life is more evidenced and expressive in women. They are more subject to fear, shock and fright, and more easily aroused to joy or sorrow. Their affections, if not deeper, are more demonstrative.
The sympathetic nervous system which controls the sexual life of woman, as well as the visceral functions generally, also regulates the tears that are shed in grief, the salivary and gastric secretions that are checked in fright, as well as the milk-flow that is stopped, or increased, respectively, under the influence of terror, or maternal well-being as the case may be.
The ancients attributed hysteria—a functional neurosis of abnormal sensations, emotions or paroxysms—to causes within the womb. There is unquestionably a connection; not that the disorder is actually seated in the pelvic regions, but these organs form part of a reflex arc to the brain centers through the sympathetic nervous system. In hysteria, the system is probably in a state of hyperesthesia, or over-sensitiveness.
Strength of Sexual Impulse. While the strength of the sexual impulse in woman is subject to a wide range of variation, there is no doubt in the mind of the serious student of sexual phenomena that its normal manifestation is quite invariably a factor to be reckoned with.
In modern times, quite down to the present, outside of a comparatively limited circle that has had the advantages of rational sex understanding, the notion has prevailed that the sex impulse in woman, at least in "good" or "respectable" women, is a negligible quantity. She was never supposed to evidence any sexual feeling, erotic interest or passion.
In the Middle Ages, the sexual impulse normal to womanhood was perhaps better appreciated than it has been in later times. Luther gave utterance to an opinion not without currency in his day when he wrote: "It is just as impossible for a woman to do without man as for a man to do without woman." He also sums up most excellently the natural aspect of sex in the following words: "He who wishes to restrain the impulse of nature and not allow it free play, as nature will and must, what does he do but this: to insist that nature shall not be nature, that fire shall not burn, that water shall not be wet, that man shall neither eat, drink, nor sleep."
Mantegazza stresses the point that in the female, sexual desire is very rarely accompanied by pains analogous to those which occur in man, in whom sexual excitement manifests itself in painful tension of the testicles and the seminal vesicles, or in spasmodic, long-continued priapism.
Considering woman's function in the realm of sex, her relative conservatism is based on very fundamental grounds. As Professor Erb has pointed out, woman is the principal sufferer in the process of reproduction. For the most part, with a cruelty that baffles the processes of the rational or philosophic mind, nature has condemned woman to a far more difficult position than man in the intercourse of the sexes and in the preservation of the species. In her biologic rôle, she has been over-powered and forced by man. She is always compelled to make the most severe sacrifices for the sake of the new generation, first when the new being is germinating within her body, later in the throes of parturition, and finally when the helpless mite of humanity is entrusted to her maternal care. And only too often she fails to receive the respect and protection due to her for the performance of these difficult functions. When everything is considered, it is fortunate that as a rule the young woman who has never come into intimate contact with the male appears to be endowed with a relatively weak sexual urge.
The sexual impulse in normally constituted individuals is by no means constant in its intensity. Apart from the temporary indifference resulting from gratification, and apart from the decline in the impulse that sometimes occurs after prolonged continence, the mode of life is a factor of great importance. The urbanite who is continually reminded of sexual matters and subjected to greater erotic stimuli, is quite inevitably more disposed than the countryman to sexual excitement. A sedentary and sheltered mode of life, a diet composed too largely of animal food and highly seasoned condiments, have a stimulating influence on the sexual organs.
In woman, the sexual impulse is stronger just before and after menstruation, and during the period it may also be more than usually pronounced. In neuropathic women, this increase in excitement may occur in a pronounced degree.
Sexual desire in woman, it is generally agreed, outlasts the active reproductive life. That is, the erotic impulse continues to manifest itself after the cessation of menstrual activity, when the possibility of conception has passed. It appears, therefore, that sexual desire is not necessarily dependent upon ovulation.
Probably no other individual has written so extensively and at the same time so wisely of sex matters as Havelock Ellis,[1] who speaks of the differential characters of the sexual impulse in the female as follows:
"In courtship woman plays a more passive part than man; in woman the physiological mechanism of the sexual processes is more complicated, the organism develops more deliberately; the sexual impulse in woman needs more frequently to be actively stimulated; the culmination of sexual activity is attained later in life than in man; the strength of sexual desire in woman becomes greater after she has entered upon regular sexual intercourse. Women bear sexual excesses better than men; the sexual sphere is larger and more widely diffused in women than in men; finally, in woman the sexual impulse exhibits a distinct tendency to periodic exacerbations (increased severity of symptoms), and it is in any case much more variable than in man."
Ellis further maintains that the source of erotic pleasure in the case of the male lies in activity, but in the female in the passive state, in the experience of loving compulsion, as it were, and he holds that sexual subordination is a necessary element in the sexual enjoyment of women.
ANATOMY AND PHYSIOLOGY OF THE FEMALE ORGANS
Whereas the male reproductive organs are for the most part located outside the body, the female organs of generation are situated mostly within the body, in the pelvic cavity between the two principal organs of elimination—the bladder and the large intestine.
The generative system of woman is composed of the following important units:
a. Two glands—the ovaries—which produce, develop and discharge the ova, or eggs, when fully formed. These glands also produce an internal secretion (the sexual hormone), which exercises a remarkable influence over the development of the body as a whole from the time of puberty, controlling what is known as the secondary sexual characteristics of the individual.
b. Two ducts, the Fallopian tubes, or oviducts, which convey the ova or eggs from the ovaries to the uterus (womb).
c. The uterus, or womb, where the ovum, when fertilized by the male element, the spermatozoon, develops into a new being.
d. The vagina, the canal leading from the uterus which receives the male organ in copulation.
e. The vulva, the external parts in which are located the outlet of the vagina, and of the urethra—outlet of the bladder.
f. The mammary glands (mammæ)—the breasts—also properly form a part of the female reproductive system.
The Ovaries. The ovaries of the female—the egg- or ova-producing glands—correspond to the testicles of the male. In the adult woman, they are about the size of an almond shell, being approximately 1½ inches long, ¾ of an inch wide and ⅓ of an inch thick, and weigh from ⅛ to ¼ of an ounce.
They are situated in the upper part of the pelvic cavity, one on each side of the uterus. They are more or less enclosed within the fringed extremities of the Fallopian tubes, and are held in place principally by the broad ligament of the uterus, which folds around them.
As in the case of the testicles of the male, they are first formed higher up in the abdomen—just below the kidneys—but before birth descend to their normal position.
The ovaries are already filled with undeveloped eggs at birth—estimated at about 100,000 in number, but in the course of their development, there are left only about 30,000 at puberty. The balance have been used up as nourishment for those that remain. But of these many thousands, only a few hundred ever become ripe and capable of growing into a new life. One ovum for every 28 days during the normal reproductive life of a woman—about thirty years—would be approximately 400 in all. The ovum was first discovered in 1827.
The ovary has a double structure, of which the central part is reddish in color, and soft and spongy in texture, consisting chiefly of blood vessels. The cortex or outer layer is gray in color and of firm texture, being composed of connective tissue. This is the essential part, as the ovisacs, or Graafian follicles are located in it. Each of these ovisacs, which are in various stages of development, contains an ovule, as the unfertilized ovum is specifically termed.
The follicles were first described by De Graaf, a Delft physician, in 1672, from whom they derive their name. Until the time of puberty, the Graafian follicles, with their tiny ova, are in practically a dormant condition. But with the beginning of puberty, when the sexual organization turns from a latent to an active state, the ovaries become correspondingly active.
Ovulation consists in the bifortnightly maturation and expulsion of a ripe ovum. Each ovum measures from one two hundred and fortieth to one one-hundred and twentieth of an inch in diameter, and is a potential life, requiring only contact with the male sperm cell in the proper environment to quicken it into being. The outer transparent wall of the cell covers the inner protoplasm, or yoke. Imbedded in the substance of the yoke is a nucleus called the germinal vesicle. This contains a minute substance termed the germinal spot, which is the life producing element of the ovum.
Another process connected with the reproductive life of woman, also takes place once a month, or more accurately, every twenty-eight days, namely, menstruation. While the latter is closely associated with ovulation, it is not a part of the identical process. The function of menstruation is important enough to receive special attention. This will be taken up later in the present chapter.
Fallopian Tubes. The Fallopian tubes, or oviducts, are two small muscular tubes which lead, one from each ovary to the respective upper, opposite sides of the womb. They are about four inches in length, with a very tiny passage-way, which at its largest diameter is only about the size of a broom straw, while near the womb, it narrows down until the opening is only about the size of a fine bristle.
To guard against the ova's going astray, the end of each tube, near the ovary, becomes larger, with a trumpet-shaped, fringed, extremity. The fringes are called the fimbria.
As the channel of these tubes is very fine, measuring not over one-sixteenth of an inch at the largest diameter, it will be seen that an inflammation or diseased condition will readily clog it up. If there is a stoppage in these tubes, the eggs cannot pass down into the uterus, and the woman is therefore barren, or incapable of bearing children.
The Greek name for the Fallopian tube is "salpinx." This word means "tube." Inflammation of the Fallopian tube, is therefore, called salpingitis. Salpingectomy is a surgical operation for cutting away the whole or part of the Fallopian tube. It corresponds to vasectomy (excision of a portion of the vas deferens), in the male.
The Uterus. The uterus (Latin) or womb (Anglo Saxon) is a pear-shaped muscular organ, with the small end down-ward, situated in the middle of the pelvis. It is about three inches long, two inches wide and one inch thick, and weighs from one ounce to an ounce and a half.
The muscular walls of the uterus are thick and the cavity is comparatively small. It contains three openings—two from the Fallopian tubes, one on each of the two upper corners, and one in the lower end, being the mouth (os) of the womb, opening into the vagina.
The uterus is not firmly attached to any of the bony parts of the pelvic cavity. It is suspended in its position by a number of muscles and ligaments. It therefore slightly changes its position with different movements of the body, and during gestation increases in size to accommodate the new being growing within it, and gradually rises out of the pelvic cavity, as more space is required for growth, into the abdominal region.
Its normal position is inclined forward, resting against the bladder. A full bladder will push it backward and downward. The stretching of the sustaining ligaments, through lifting heavy weights, or excessive physical labor, may cause the uterus to sink down into the vagina—a condition known as prolapse, or falling of the womb. There are a number of other more or less common displacements of the womb, when the organ becomes flexed or bent in one of several directions. These conditions will be referred to in Chapter XI.
The upper and larger portion of the uterus is called the body, or fundus; the lower and smaller part is called the neck or cervix. The uterus is a very remarkable organ, with a muscular structure that is capable of immense enlargement. In pregnancy, it distends from ten to fifteen times its normal length and many times its normal breadth.
There is an abundant supply of blood vessels to the uterus, which is not merely for nutrition, but to provide for the demands of menstruation and pregnancy. The internal mucous lining of the uterus is smooth and pink in color, except during menstruation, when it is red, and swollen to double its normal thickness.
The Vagina. The vagina (Latin, meaning a sheath) is the tube or canal which serves as an outlet from the uterus to the vulva, or external parts. It is a distensible and curved, a muscular tube which helps to support the uterus, as well as serving as its outlet. It is about three and a half inches long, and is often called the "birth canal," because the baby must pass through it on its way from the womb in the process of birth.
The upper end of the vagina is more spacious, where it surrounds the uterus, than at its external opening. The latter portion is somewhat contracted, and in the virgin is partly closed by a fold of membrane called the hymen, or "maidenhead," which extends forward from the posterior wall to the opening.
This thin membrane is usually ruptured at the time of the first sexual intercourse; consequently its presence has been considered by many, especially in the past, as an infallible sign of virginity. It is now generally recognized, however, that no definite interpretation can be placed upon the presence or absence of the hymen. It may be ruptured in early childhood by injury, surgically removed as an hygienic expedient, or otherwise eliminated. On the other hand, even after sexual experience, it may be stretched instead of ruptured, and present some of the appearance of virginity. In rare instances, it may form a circular wall closing the passage way into the vagina, thus preventing the discharge of the menstrual flow. Cases of this kind should without delay undergo the slight surgical procedure of having the hymen pierced to permit menstruation and assume a healthy, hygienic condition.
The Vulva. The vulva is a collective name for the external sexual organs of the female. There are two openings into the vulva, the smaller one being the outlet of the bladder. This opening, the terminus of the urethra, is called the meatus urinarius. The length of the female urethra is about an inch and a half long. The main aperture, however, is the vagina, already described.
The most prominent portions of the vulva are the two longitudinal folds of skin, extending downward from the rounded eminence above the organ, the mons veneris (Venus's mountain). These folds, called the labia majora (large lips) are covered with hair on their outer surface. The inner side is lined with mucous membrane.
Within the labia majora are two smaller folds called the labia minora (small lips) which meet at the front of the vulva. At this meeting point, there is a small erectile structure called the clitoris, about one-half to three-quarters of an inch in length. It is plentifully supplied with nerves and is the principal point of excitation in the female genitals. The extremity of this little, highly sensitive structure, is called the glans clitoris. It corresponds to the penis of the male, and is supplied with a tiny foreskin or prepuce, the purpose of which is to fold over and protect the sensitive tissue of this organ.
When the foreskin is too tight, however, it becomes a source of irritation, instead of a protection. The clitoris is then said to be hooded, and it is desirable to cut this fold of skin—a very slight and painless procedure in the hands of a surgeon or gynecologist. The operation has a similar purpose to circumcision in the male. If this condition is neglected it is sure to cause nervous irritability or abnormal sexual stimulation, and is a cause of excessive masturbation among girls.
The labia minora are formed of a peculiar kind of skin-tissue, in which are numerous sebaceous glands producing a whitish secretion with a penetrating odor. It is the function of these secretions to keep the tissue moist and supple, and also to destroy foreign substances which may enter the vulva, so that they will not get into the womb and cause injury to that delicate organ.
The vulvo-vaginal glands, or glands of Bartholin, are reddish-yellow bodies about the size of an apricot stone, situated on either side of the entrance to the vagina. They open by a long, single duct on the inner side of the labia minora, just outside of the hymen. Bartholin's glands correspond to Cowper's glands in the male. They secrete a clear fluid which is discharged during sexual excitement. This secretion is of acid reaction, and is the only ejaculation of the woman.
The Pelvis. All the genital organs proper, which have been described, are situated in the pelvis (meaning basin), also called the pelvic arch or girdle. It is made up of three bones, the two hip-bones, and the sacrum. The latter is a wedge-shaped bone, formed by a fusion of five vertebræ, therefore constituting a part of the vertebral column. Below this solid portion of the vertebræ is the coccyx, consisting of three rudimentary vertebræ—the vestige of the missing link—the tail, which the progenitors of mankind lost somewhere in the long biological climb. The hip-bones are joined with the sacrum at each side in an immovable joint.
The inner surface of the hip-bones in the normal, upright position of the woman, make, together with the sacrum, a basin-shaped and almost circular bony foundation for the generative organs to rest upon. In front, the two hip-bones meet in an immovable junction—the symphysis pubis.
There is considerable difference between the male and female pelvis. The latter is shallower and wider and less massive. The margin of the bones are more widely separated, giving greater prominence to the hips, which is a very noticeable female characteristic, and contributes much to the grace and physical charm of femininity.
The biological reason for this, however, is to permit the child's head to pass through the pelvis at birth. If the female pelvis were patterned exactly after the male pelvis, it would be impossible for a full-term living baby to pass through it. Women with an extremely small, or deformed pelvis, are not fitted to bear children.
The Mammary Glands. The mammary glands, or breasts, are accessory organs of the female reproductive system. They are rudimentary before puberty, being practically the same as in boys. But beginning with puberty, they undergo the quick transformation characteristic of the sexual organs at this period, and increase in size. They grow larger during pregnancy, and are largest during the nursing period. Among civilized races, the shape is hemispherical, but among savages it is more conical, or pointed.
The increased size at this time is due principally to the growth of the tissue which secretes the milk, but there is also a marked increase of fat. It is a common occurrence for the left breast to be somewhat larger.
A little below the center of each mammary gland is a small conical eminence, the nipple, which is surrounded by an area of somewhat wrinkled skin, having a colored tint. The wrinkles are due to the presence of sebaceous glands which secrete a fatty substance for the protection of this organ during the nursing period. In the young woman this area is usually either pink or crimson, and darker tinted in brunettes than in blondes. With the beginning of pregnancy, the tinted surface enlarges and deepens in color, becoming brownish, which remains permanent after the birth of the child.
The structure of each breast is made up of fifteen or twenty lobes or divisions, separated by partitions. Each lobe is a distinct milk-producing unit, and has a tube going direct to the nipple which acts as the outlet for the milk secreted in the individual lobe.
THE INTERNAL SECRETIONS
In the previous chapter, reference was made to the secretions of the endocrine or ductless glands in men. The system as a whole, excepting only the sexual unit, is quite identical in the two sexes. The internal secretion of the male's sexual glands (testes) has its analogy in the female in the internal secretion of the ovaries.
The ovaries, in addition to their procreative function which has been described, produce an hormone, or internal secretion, which directly enters the blood stream, and in this way exercises a profound influence over the whole organism. As a matter of fact, this internal secretion is more vital, at least to the individual, than the external secretion, or the process of ovulation.
A woman may be barren—that is, incapable of bearing children—from various causes, so that the process of ovulation is interfered with or does not take place, and still be a fine physical and mental type of womanhood.
When a woman, however, lacks the internal sexual secretion, whether congenitally, or through disease or deprivation by surgical means, she tends to lose the distinctive attributes of physical womanhood, and those psychic qualities that are characteristic of femininity.
Experiments on animals and birds first proved the nature and functions of the internal sexual secretion in influencing the complete development of the individual. If the ovaries of the female are removed—called "spaying"—when the animal is young, thereby depriving it of the sexual hormone when the time comes for this substance to be produced, the secondary sexual characteristics of the animal do not develop.
When the ovaries of a woman have not properly developed in her youth, or when they have been atrophied by disease, or surgically removed, so that the internal secretion is not supplied as is normally the case, she will be lacking in the characteristic development—the secondary sexual traits—that gives beauty to woman.
The girl from the time of puberty evidences development of the feminine characteristics, due to this internal chemical activity. Her figure, previously little differentiated from that of the boy, undergoes marked changes. Her breasts round out. Her arms and legs become more shapely; the hips enlarge and she otherwise gives evidence of the physical charm and gracefulness of young womanhood.
The mental and psychic traits which develop through the influence of the sexual hormone are no less notable. It is the time of the birth of new emotions—ambitions, hopes, fears, desires, doubts, and the awakening of those subtle qualities that constitute love. During adolescence, the girl begins to take a new, or different kind of interest, in boys. Up to this time they may have been desired as playmates, but now a new emotional element—new feelings—enter into the relationship. Consequently, the girl takes a greater interest in her personal appearance, with a tendency to self-consciousness.
MENSTRUATION
Perhaps the principal phenomenon of adolescence to the young woman is the beginning of menstruation, commonly called the "periods," "the monthlies," etc. This is a discharge composed chiefly of blood and mucus from the generative organs. It is a perfectly normal function, and therefore should be accepted as a natural process, and not be considered a trial or burden imposed upon womankind by a malevolent act of nature. It occurs, normally, every twenty-eight days, and lasts from three to five days, during the woman's child-bearing period of about thirty years.
The greatest amount of blood is usually passed during the first two days. It has been estimated that the quantity of blood expelled during a menstrual period averages from one and one-half to three ounces.[2] In very full-blooded women, it may be considerably more.
There are commonly various depressing symptoms preceding and accompanying the initial appearance of menstruation, due to the organism adjusting itself to a new stage of life. It is a mistake, however, to begin the practice of looking upon the menstrual periods as the regular recurrence of a condition of semi-invalidism lasting for several days each month.
There is a relationship of the menses to the psychic and nervous organization of woman that warrants a word of comment. Menstruation is a physiological function involving quite a complicated chain of events in the organism. It is, therefore, naturally accompanied by certain general, as well as local, reactions.
For two or three days before the menses, the girl or woman is apt to feel a particular sensitiveness and nervous excitation, perhaps accompanied by a feeling of fullness in the abdomen. These symptoms are usually relieved at the beginning of the flow.
A healthy woman will not suffer distress from the periods when the proper attitude is assumed toward the condition. Over-emphasis on the part of the mother or other elder, of the supposed distressing nature of the event, has started many a girl off with an exaggerated notion of the ordeal. As a consequence, the anticipated "sick spells," "cramps" and other foreboding experiences have been to some extent realized by the very process of mentally encouraging them and giving them a psychological reality.
As has been stated the function is a perfectly normal one, and while slight nervous and emotional reactions are to be expected, it is well to bear in mind that one should not cultivate them as pet idiosyncrasies. When a woman is aware of just what is happening in the complex structure of her organism, and what nervous and emotional reactions she may expect at this time, she will understand their true significance. A sensible, intelligent attitude on these occasions will do much to avoid periodical moods; which if encouraged by indulgence in them, may act as an incentive to irritation and unpleasantness in the daily life.
Hygiene of Menstruation. While the misconception that menstruation means illness is an old-fashioned idea that should be discarded, it is the part of commonsense to use some judgment in one's activities and mode of life during these periods. Of course, violent exercise at this time is decidedly unwise, but continuing one's usual activities in moderation benefits the circulation, and keeps the mind from dwelling on the subject of depressing symptoms, or anticipating them.
Congestion of the uterus is intensified by standing, and it is advisable, if possible, for women to sit at least part of the time during menstruation while continuing their regular work.
Exposure to cold, dampness or rain, is to be avoided at this time, as a chill upsets the physiological processes, and may bring about a premature cessation of the flow. When this occurs, it should be re-established, if possible, by a hot foot bath, drinking hot water, and obtaining complete relaxation in a warm bed where rest and perspiration should be helpful in bringing about the desired result.
Always during these periods avoid chilling the body, avoid cold tub baths and swimming, as these experiences are apt to be injurious and may lead to serious results. It is also better to postpone a hot tub bath until the menstrual flow has ceased.
Constipation is another cause of distressful menstruation. If the bowels are not evacuated regularly—that is, daily—the accumulation in the large intestine and rectum will tend to press upon the nerves supplying the generative organs and produce more or less congestion.
From every standpoint of health, the question of bowel regularity is an important one. The habit of using laxatives and purges is an unfortunate one, and makes the condition worse in the end, because the normal peristaltic action of the intestines is weakened.
The treatment for constipation should therefore be a general one, involving attention to diet, exercise and the cultivation of the regular daily habit of evacuating the bowels. The best time for this is immediately after breakfast. The habit should be formed early in life, but if neglected at that time, the adolescent may, by diligent attention to this need, acquire regularity.
The diet should contain a sufficient amount of coarse foods, such as whole wheat or graham bread, oatmeal, cornmeal, green vegetables and fresh fruits, to stimulate the activity of the intestines in a normal way. Of the fruits, prunes, figs, dates, apples, oranges, peaches, plums, pears and grapes are especially valuable. Water should be drunk frequently. A glass of cool water about a half-hour before breakfast is particularly effective, in conjunction with the other measures recommended.
The disorders of menstruation, and some other of its peculiarities, will be referred to in Chapter XI, under Sexual Disorders of Women.
THE MENOPAUSE
The menopause (climacteric), or "change of life," denotes the end of the reproductive period in woman's life. While the principal phenomenon is the permanent cessation of the menstrual flow, there are usually general disturbances, and nervous reactions. It is a period of readjustment in which the organism adapts itself to new conditions in the cycle of life. Among the general symptoms are flushings, also giddiness, headaches, faintness and pains in the back. Probably many of the bad results could be avoided and the inconveniences minimized if a more rational viewpoint prevailed upon the nature of the change.
After all it is a perfectly natural course and if accepted as we should accept any normal course of life, with equanimity, understanding and courage, the process of adjustment would be much easier, and many of the really serious results now attributed to "change of life" would unquestionably prove avoidable excrescences resulting from ignorance, misunderstanding and worry.
The flow may stop rather suddenly at this time, the amount growing less and less, until absolute stoppage. As a rule, however, the climacteric extends over a course of several months up to a year or two or three years. There may be considerable irregularity in the periods, a slight flow alternating with a profuse one, and the intervals between successive flows may become longer, as from six to eight weeks.
The importance of the menopause in the life of woman warrants more extended comment, which will be taken up in Chapter X.