While the sexual organs of little girls rarely require such special attention as is involved in circumcision for their brothers, the corresponding operation is necessary at times and certainly not less care should be expended upon the selection of their nurses. The same pleasurable sensations which it is possible to arouse in the boy-baby’s private parts lie dormant also in his little sister’s organs, and can be called into action by an unscrupulous nurse to quiet the child, regardless of the serious consequences to the physical and moral nature which may ensue. There are foreign nurses in this country, too, who make a habit of breaking up the hymen–the “maiden-head,” or membrane that closes in the vagina–in new-born or very young girls; a practice which, of course, should be condemned.
But care must be taken to maintain perfect cleanliness about the private parts, and to avoid all such sources of irritation as are found in woollen diapers; in skin diseases due to neglected discharges upon the diapers, to ill- fitting cloths or careless washing; and in the crawling forward from the back passage of worms, in case such pests should afflict the little infant. All of these causes may contribute to derange the sexual organs of girls at a very tender age, and even in the earliest years the female sexual apparatus is of prime importance with regard to the physical well-being of the future woman.
And conversely, the general physical well-being of the girl or woman is of prime importance in the maintenance of sexual health and activity. A woman differs from a man more or less in every department of her nature, and these differences, one and all, are calculated to fit her for the special work of motherhood. Every part of her body and every faculty of her mind is in subtle communication and sympathy with the organs in which sexual life centres. General health involves sexual health; sexual disease inevitably involves general ill- health.
It follows, then, that the best foundation for sexual health will be laid by the most judicious attention to general health in those years during which sexual life is comparatively quiescent owing to the undeveloped state of the organs through which it finds expression. Encourage “tom-boy-ism” and activity by every possible means in the growing girl, and never think of finding fault with dirt or rents acquired in healthful sport. Let her join her brothers and their friends in romping out of doors, and keep her in the open air and at active sport as much and as long as possible. Be sure she has plenty of sleep and let her wake up when she will in the morning, and in general let the body and its health be the chief considerations till childhood is past.
Sexual feelings are probably less likely to be awakened in girls than in boys before puberty. In fact, it seems to be true through life that distinctively sexual desires are, on the average, less imperious in the female than in the male. At least, society is organized on this hypothesis, and it is one that seems reasonable enough from the fact that in women, no such main-spring of passion can be discovered as is found in man in the secretion of the semen and the distention of the sac in which it is stored. But on the other hand, nothing is more certain than that even very young girls do sometimes manifest decided capacity for sexual pleasure, and it therefore becomes a matter of importance that parents should be on their guard, and that young girls as well as boys should be taught the functions, and the dangers of abuse of the genitals.
Question will present themselves to the girl’s mind as to the boy’s, and she will not be behind him in seeking answers. None but honest answers will stand the test of time, and keep intact that perfect confidence in parents which is the only security for the maintenance of a wholesome parental influence. But as a matter of course it is best plan in early life to keep the mind as far from sexual subjects as possible, and to do this reliance must be placed on general instruction in delicacy and modesty, upon activity and constant employment, and upon the positive teaching that no handling or irritating of the privates, except for washing, is good for them, but that, on the contrary, it may do harm.
The exception just made is, however, one of great importance. Young girls frequently have so impressed upon them an idea of the shamefulness of touching the privates, infact in some cases almost of the disgrace of having privates at all, that cleanliness of those parts is neglected with far worse than ordinary consequences. There are glands between the inner and outer lips of the external genitals, discharging themselves into the furrow at that point, precisely as the glands under the foreskin of the male organ discharge about the head in which it terminates, and this discharge allowed to remain untouched dries out partially and becomes, in the one case as in the other, a source of persistent irritation such as may lead to disease and to bad habits. It not infrequently happens that persistent itching and discomfort, nervousness, irritability, peevish restlessness, discontent, melancholy, and even mental disturbance in girls and unmarried women who have been taught never to touch the privates, may be completely cured by simply separating the larger and smaller lips that are found on either side of the vagina, and cleaning out from the furrow between them a mass of cheesy matter, the accumulated discharge of the glands at that point. So greatly have very serious symptoms been benefited in so many cases by this simple procedure that it must be thought an important matter to instruct girls and women to separate these lips and wash between them at least once a month, and in warm weather–say from May to November–as often as once a week.
And girls should be taught before puberty what they are to expect at that time. The flow of blood coming for the first time to an uninformed girl is more than likely to frighten her into doing something to arrest the bleeding, and she may easily injure herself for the rest of life by applying or sitting in cold water, or taking some other ill-advised step. The time of puberty cannot be foretold definitely; it is usually between the twelfth and the sixteenth year in this country, and the best guide in any given case is the age at which the girl’s mother began to menstruate, or “have her courses,” as it is popularly expressed. When the epoch does arrive, however, there is precisely as much, if not more, need of full and careful sexual instruction, as in the case of the boy. Natural sexual feeling may be less in the girl and the woman than in the boy and the man, but it exists, and to it is added the regularly recurring monthly flow to which attention must be given; and it would be strange, indeed, if these two elements together did not lead many an uninformed girl into the way of temptation and even into thoughts and acts certain to be followed by disastrous consequences.
The very bad habit of exciting the sexual organs by the hand is undoubtedly one into which many girls fall, although it is not so prevalent among them as among boys. Its results, however, are somewhat similar, as it puts an exhausting drain upon nervous vitality, draws blood to the parts, by which means menstrual irregularities and local pain are brought about; and it is, in all respects, mental, moral, and physical, as disastrous as is the corresponding habit among boys. It is to be met by much the same course of diet, surroundings, social influences, moral and physical treatment, and education, as that already advised for the opposite sex.
And let no mother lull her conscience to sleep with the ideas that her daughter is above such habits, or the temptation to them which comes from natural feelings misunderstood or misguided. The girl who lacks sexual feeling is as much to be pitied, and is as truly in an abnormal condition, as the girl who lacks sight or appetite; but the girl who, having sexual feeling without knowledge of its significance or proper restraints, acquires harmful habits ignorantly, as so many do, is far more to be pited than blamed, even when she falls the victim of some designing rascal who understands her nature better than does the mother who was made her guardian and instructor by the Creator Himself. The supreme sphere and office of woman is motherhood. Attain to what she may in other directions, this must ever be her crowning glory if it be accepted and used in accordance with the divine intention. So long as this is true–and it is admitted on all sides–the importance and beauty of the organs and functions which make the office possible must be admitted. It is no shame to have organs which can house and nurture a budding human life; it is no shame to study those organs, and learn how they can best serve the new being that will be dependent upon them and their healthy condition for a fair start in the race of life. It is a shame to consider those organs either nuisance, able to put unwelcome responsibilities upon us, or mere sources of animal gratification and pleasure, either in or out of wedlock; it is a shame to neglect, trifle with, or abuse those organs, as such treatment can but interfere with their office of nesting- place for a new soul.
Let the girl be taught that every menstrual period is a new evidence of her capacity to hand down to another generation, not merely her life, but her disposition, her mental power or weakness, her ambition, her faults, and shortcomings; that it is a reminder that she is responsible to posterity for her habits, and daily behavior, and that the important relations of her sexual life to every other part of her being, show that she should never fail to consider whatever she does in the light of its possible influence upon her children. Women, as a rule, are not properly prepared for the simpler, and more easily understood duties of child-bearing and nursing. Generally, a woman is thought to be a pretty good mother if she get her children up to their tenth year without making them, or allowing them to become, nuisances to her neighbors. But rare enough are the mothers who can claim to have successfully coped with their duties toward children in their teens, and why should not this constantly recurring flow be considered as nature’s way of reminding them of their life- work, in preparing for which they cannot by any possibility spend too much time or thought? Any young girl who is taught so to look upon her menstruation and sexual organs will be in very little danger of sacrificing her health and strength to the momentary, unsatisfactory, and degrading pleasure of masturbation, or of falling a victim to vice in any form.
Menstruation, or the monthly flow of blood from the womb, usually begins somewhere between the twelfth and the sixteenth year, and continues for about thirty years, during which time its only healthy interruptions are those occasioned by pregnancy and nursing. The periods in health are regular, except for a time near the beginning, and again near the close of the reproductive portion of a woman’s life, which is that portion during which menstruation continues. But regularity with respects to the periods does not mean the same thing for every woman: for with some, two weeks is the usual interval, with others, six, while still others experience a regular return of the “courses” at almost any time between those limits. In other words, every woman is a “law unto herself,” and what is regularity for her must be determined by observing the usual interval at which this function is repeated by her body under ordinary circumstances. Health simply requires its regular performance, not its repetition at any stated time. And the same thing is true with regard to the duration of the flow. With some it is two days, with others, ten; some lose a tablespoonful of blood, others, half a pint. As an average, however, it may be said that menstruation returns once is twenty-eight days, and lasts five days.
The Derangements of Menstruation consist of irregularities in the quantity, quality, duration, or frequency of the flow, and of various symptoms associated with the function. More or less irregularity is to be expected at the establishment of the flow, and two very important things should be remembered by those who are in charge of a girl during this epoch: First, no amount of irregularity in the periods or of delay in the appearance of the flow will warrant medical interference, unless there are other symptoms indicating deranged health; and, second, the establishment of this flow is an important effort of the body, requiring all the nervous energy that can be spared from absolutely essential vital processes, and for this reason, as little as possible should be required of the girl’s mind and muscles, till the new function is thoroughly well established, and proceeding regularly and painlessly.
When a girl nears her “teens,” or comes to about the age at which her mother began to menstruate, she should be watched with extra care, and any disturbance of health should be met by prompt measures. If nature be engaged in establishing menstruation, more or less indefinite pain, languor, loss of appetite, and disinclination for society and regular employments are to be expected, and should be the signal for laying aside studies, work, and every taxing employment. Let the dictates and even the caprices of appetite have much weight in the selection of food, so long as no attempt to eat positively indigestible articles is made. If breakfast be not wanted, do not urge it–the patient has other work on hand in the body more important for the present than the digestion of food, and there is no danger of starvation before the appearance of the sense of hunger. But hold in check the ambition of the girl herself, or of her teachers, which would ignore the demands of the body for the sake of accomplishing a certain amount of study or other work in a certain time.
During the actual continuance of the first period the girl ought to lie down, and if there be any pain or disturbance of general health at subsequent periods, the same rule should be observed till the flow is well established. The relationship of this function to the whole mental, moral, and physical life of the woman is so very important that too much care can hardly be bestowed upon the girl during its establishment. All the little ailments and whims which at another time might better be repressed and ignored, should now be considered in their possible relation to derangements which, if allowed to become seated at this crisis, may result in permanent ill-health and disability. It is far better to allow nature even a year or two of entire freedom from ordinary demands at this time, that she may perfect the body and its functions on the sound basis of health, than it is to crowd studies, piano-practice, and other taxing employment at the cost of a life of invalidism. Usually between the periods the girl will feel as well as usual, and it will be sufficient to keep her at rest on the back while the flow actually continues. But if her ill-feelings demand attention at other times they should not be neglected.
If the first menses do not appear at the time they are expected, but other symptoms of general disturbance of health are present, the case demands investigation. Possibly the membrane that closes in the vagina in many (not all) women is without an opening for the escape of the blood. This is a condition that can only be discovered by local examination, and the person who should thus examine is, of course, the mother. A “maidenhead” without an opening is not difficult of recognition, and the cure for it is a surgical operation. Possibly the obstruction may be more serious and deeper, or there may be, in very rare cases, no vagina at all. Such things demand a surgeon’s attention, and if present where menstruation is attempted by the womb, will occasion heaviness, fulness, and swelling in the lower part of the abdomen, backache, nausea, swelling and tenderness of the breasts, constipation, and other symptoms requiring careful professional treatment.
When backache, “bearing-down” pains, headache, and lassitude indicate that nature is endeavoring to bring about the monthly flow, but nothing is seen of such flow, and no obstruction can be discovered, a warm foot-bath may be tried as a stimulant to the function. Let the water be at 110*F.–measured by the thermometer, and not guessed at-deep enough to come up well on the ankles, let it contain two teaspoonful of ground mustard, and let the patient sit quietly with her feet in the bath for full thirty minutes. The bath and lower part of the body should be covered by a sheet or blanket to keep in the heat and guard against draughts. Such a bath may be advised for a similar purpose at any time of life; but cold bathing of any kind should always be entirely omitted during menstruation, no matter how well and strong the patient may think herself. Baths, of whatever character, should never be taken within less than two and a half hours after a meal, and a good time for a warm foot-bath, such as just described, is immediately before retiring.
If a medicine be required for delayed or suppressed menstrual flow, either at its first establishment or later in life, Sil, or Pulsatilla will be most likely to be indicated. Silicea should be given in tablespoonful doses, morning and night, using a solution of twelve globules in half a glass of water, when the patient complains of a hot head, with pain and dizziness, backache, sweating feet, has a tendency to boils, and itching or soreness about the sexual organs. Pulsatilla should be given in similar doses, four times a day, to a patient who complains of chilliness, want of appetite, especial aversion to fat foods, pains that are constantly changing both locality and character, and who is better in the open air although, perhaps, not anxious to get out of doors. This medicine is often of service where the failure of the menses to appear can be traced to wetting the feet or to cold. Sometimes failure of the menses to appear in those who are fat and flabby, who sweat much about the head, have cold feet, are pale and lack vitality, may be corrected by giving Calcarea carb. dissolved in water, a tablespoonful four times daily.
The menses are intended to relieve the womb of a quantity of blood sent to that organ each time an egg is matured and cast off. This blood is put to other uses in case the egg is fecundated, as it is called, that is, put into condition to become a new human being; otherwise it flow off, and at times it does not escape by the usual channel, but, instead, leaves the system through the nose, lungs, or some other outlet, giving rise to a discover known as vicarious menstruation. The patient feels as if the menses were about to appear, but they do not flow, or flow very scantily, while at the same time nose-bleed, or vomiting or spitting of blood does occur. Such losses of blood do not always indicate that the organ through which the blood flows is diseased, although it does indicate a tendency that way by reason of weakness of that organ, and it makes care for the health and rest during the menses imperative. Bryonia is the best medicine in such a condition, and should be given dissolved in water, in doses of a teaspoonful every hour to two hours while the periods lasts, and in tablespoonful doses twice daily during the interval between the periods. If this medicine be not sufficient to effect a cure, the case may easily be of such gravity as to require professional treatment.
Menstruation in health should be painless as well as regular. When it is otherwise we have the disorder known as dysmenorrhoea, meaning painful or difficult menstruation. This condition may depend upon several causes, and manifests itself by many symptoms. Sometimes deformities, displacements, or obstructions in the womb itself are the cause, sometimes nervous or other diseases, sometimes it is due to cold or to imprudence or exhaustion. The pain may be a colic, a backache, headache, a “bearing-down,” or something else, local or general, may be accompanied by the discharge of a membrane from the womb, or by scanty, profuse, intermittent, or variable flow. Such a catalogue of causes and effects makes it evident enough that a full plan of treatment for difficult menstruation can have no place in a work like the present; still some suggestions can be made.
The first thing to advise when there is pain with the menses is lying down so long as it continues. Lie on side, face, or back, as is most agreeable, but horizontal, and with the head rather low. The next thing to be thought of, especially if there be backache, is the hot foment–as hot as can be borne.