The genitals are not fully developed :it puberty, and the -uterus especi ally is not of full size until the twenty-first year. If now it is somewhat backward, it may well be that it is yet unfit for the reception of the ovum. And it is very certain that the earlier menstrual congestions lead simply to enlargement of the Graafian follicles, the later ones only caus ing a dehiscence. These two causes, incomplete development of the uterus and of the ovarian follicles, will indeed explain the retarded con ception, but they will not account for the complete sterility which is so frequently seen. It may possibly be that the want of proportion between the membrum virile and the imperfectly developed female genitals, may set up catarrhal and inflammatory changes in these organs and neighbor ing parts, which may lead to permanent obstacles to coneept ion.
In this connection it is well to note that cattle-breeders and veterina rians have long known that if young cows are permitted to become preg nant as soon as the rut appears, their further development is checked, they become weak and sickly, and especially, they lose the power of repro duction early.
In the same manner it may be statistic,ally proven that female fruitful ness, which reaches ita highest point at from the twentieth to the twenty fifth year, decreases after that time and diminishes rapidly as the climacteric is approached. The fact that the number of births diminishes as the fortieth year is reached is no proof, and women who marry late in life as a rule marry elderly men, whose capacity for procreation is doubt ful. But even when there is no disproportion as to age, sterility in women who marry late is relatively very frequent, and it has been claimed with considerable show of evidence that ovulation ceases in very many women at the fortieth year, though the menstrual hemorrhages may persist from habit for years, until the real menopause is reached.
The rule holds good in women as in animals. Advanced age is unfav orable to fecundity, and sterile marriages are very common under these circumstances.
Abnormal Sexual Sensations.—Irregularities in the nervous pheno mena which regularly accompany female sexual life, have been frequently pointed out as causes of sterility. Our opinions will vary as we regard these sensations as necessary factors in cohabitation, or as unimportant accompaniments of the act. We can distinguish three varieties of sexual feelings--sexual desire, sexual pleasure, and sexual satisfaction. These may be irregular either from deficiency or from excess. The following
conclusions are based upon most reliable statements from married men. and from facts furnished by women as far removed from frivolity a,s front prudery.
Not infrequently wo find in women a deficiency or absence of sexual desire (appetit renerien), and a partial or coniplete absence of pleasurable sensations during intercourse. Some women have no more sexual desires than have children. The influence of relatives, custom, and example, induce them to marry, and they regard the state as one of friendship at the most. They clo not enjoy sexual intercourse—they submit to it as a duty, and they cannot comprehend the pleasure which their female friends find therein. Or again, desire may be absent, but a small amount of pleasurable sensation be developed intra coitnm. In others the sensations are present in small degree at first, but they soon diminish after repeated childbirths, and have ceased long before the climacterium. In some cases a single even normal delivery suffices to destroy all feeling. Rarely the capacity to enjoy intercourse is abrogated by gravidity; I have met with but a single case. And it is not uncommonly observed that wkile there may be great sexual excitement (luring intercourse, the woman experi ences none of the feelings of satisfaction.
I do not share the opinion that sexual passion is awakened in women only by the first cohabitation, and progressively increases, though this idea has been promulgated to explain late conception. It may possibly occur in very young newly-married people, and the idea has probably arisen from the unskillful manipulation and the injuries incidental to a first intercourse.
But the want of sexual feeling may amount to an actual repugnance to the act, and the pleasurable sensations be replaced by discomfort and annoyance or actual pain. In this latter case we must not lose sight of the fact that sexual diseases or a disproportion between the membrum virile and the female parts, or both, may be present.
Imperfectly developed sexual sensations may, as is well known, be heightened by external and psychical stimuli, but periodic changes between normal sensation and absolute want of it must be extremely rare.
This abnormal state of sensibility has been called dyspareunia, and is very frequent in its various forms and grades. It is a frequent cause of discontent on the part of the man and of jealousy on the part of the woman. They not infrequently call upon the physician for aid.