HERSELF

Before we can understand the care of anything we must have some knowledge of its structure; so I think it well, in this our first talk, that we should learn something of the structure of the female generative organs. As I have told some of you in former talks, the womb is designed as a nest for the babe during its process of development from the egg or ovule. It lies in the center of the pelvis, or lower part of the body cavity, in front of the rectum and behind and above the bladder. It is pear-shaped, with the small end downward, and is about three inches long, two inches wide and one inch thick. It consists of layers of muscles enclosing a cavity which, owing to the thickness of the walls, is comparatively small. This cavity is triangular in shape and has three openings,—one at the lower end or mouth of the womb into the vagina and one at each side, near the top, into the fallopian tubes. The womb, or uterus as it sometimes is called, is not firmly attached nor adherent to any of the bony parts. It is suspended in the pelvic cavity and kept in place by muscles and ligaments. As the muscles and ligaments are elastic, the womb slightly changes its position with different movements of the body. Normally, it is inclined forward, resting on the bladder; so you see, a full bladder will push it backward, while a full rectum and intestines tend to push it forward and downward.

The lower end or mouth of the womb opens into the vagina, a distensible and curved muscular tube, which helps to support the womb and also connects it with the external parts. The vagina is about three and a half inches long. It often is called the birth canal because the baby must pass through it on its way from the womb to the external world.

The two upper openings of the womb lead into the fallopian tubes or oviducts, which are two small muscular tubes leading from the ovaries to the womb. Each one is about four inches long, but the opening through the center in its largest portion is only about as large as a broom straw, while near the womb it narrows down until it will admit only a fine bristle. When the ovum or seed leaves the ovary it must pass through one of these tubes to reach the womb, so you see how necessary it is that they be kept in good condition.

From the end of each tube, but not directly connected with it, is suspended a small almond-shaped body called the ovary. Each ovary is similar in shape and size to an almond, measuring about one and a half inches in length, three-fourths of an inch in width and one-half an inch in thickness. The function or work of the ovaries is to produce, develop and mature the ova (eggs) and to discharge them when fully formed so they may enter the tubes and so find their way to the womb. In every ovary there are several hundred little ovules or eggs in various stages of development. At irregular intervals one of these ovules ripens and leaves the ovary. It passes along the fallopian tube to the womb. Here it remains if it is impregnated or fertilized, and develops into the babe. If not impregnated, it passes off with the menstrual flow. Every twenty-eight days large quantities of blood are sent to the womb, producing a natural congestion. The pressure of this extra blood in the tiny capillaries of the womb stretches and weakens their walls. This allows the blood, which is being sent to the womb to provide nourishment for the ovum if it be impregnated, to pass into the cavity of the womb, then out through the mouth into the vagina, thence to the external parts. This flow is called the menstrual flow. When the flow ceases the mucosa or lining assumes its former state. This process is repeated every month.

Lining the cavity of the abdomen and also folded over the womb, ovaries, tubes and other organs is a thin membrane called the peritoneum. An inflammation of this lining is called peritonitis.

All these organs I have mentioned are situated inside the body out of sight, but there are other organs that are external. You have noticed two longitudinal folds of skin extending from the anus, or external opening of the rectum, to the rounded eminence in front. Their outer surface is covered with hair and their inner surface with glands that secrete a lubricating material. These folds are called the labia majora. Within the labia majora are two smaller folds called the labia minora. These folds meet at their anterior (front) end. At the meeting point you will notice a very small structure which is called the clitoris. This clitoris is very similar in structure to the penis of the male, having a tiny prepuce or foreskin which folds over to protect the sensitive end. Sometimes the foreskin is bound down too tightly, so that instead of being a protection to the parts, it becomes a source of irritation. Then we say the clitoris is hooded and it is necessary to loosen or cut this fold of skin. The operation is similar to that of circumcision in the male.

Just back of the clitoris, within the folds of the labia, is situated the meatus urinarius, or opening leading to the bladder. This aperture does not open directly into the bladder but is connected to it by a tube, about an inch and a half long, called the urethra.

The orifice or external opening of the vagina is situated just back of the meatus urinarius, also within the folds of the labia. In the virgin it is partly closed by a membranous fold called the hymen or maidenhead. The shape and size of the hymen varies greatly in different individuals, sometimes being entirely absent. After marriage it usually persists as notched folds. The presence of an intact hymen is not necessarily a sign of virginity, nor does its absence necessarily indicate defloration. Its congenital absence or absence at the time of birth is known. It sometimes is injured, or may be destroyed by an accident, as by falling astride of an object; again violent exercise may rupture it (horseback riding). Surgical operations or vaginal examinations, roughly conducted, not infrequently cause rupture. Then, too, authentic cases are on record in which prostitutes have had perfectly preserved hymens. It is well known that the use of vaginal astringents may tone up and narrow the vagina and even restore the hymen to a great degree.

The surface between the vaginal orifice and the anus is called the perineum (Do not confuse this with the peritoneum, for they are entirely different). It is this perineum that sometimes becomes torn during childbirth. The vaginal opening does not always stretch sufficiently to allow the passage of the child's head and the great pressure being exerted on the child by the uterine and abdominal muscles pushes it through, causing the tear. (You will understand this better when I explain about the development and birth of the child.) If this tear is repaired immediately no inconvenience usually results but if it is neglected it may produce a series of complications, some of which are falling of the womb, inflammation and even sterility.

Not directly connected with any of the other organs but still associated with them are the breasts. They vary in size at different periods of life, being usually of small size when the girl is young but increasing in size as the generative organs develop. The breasts consist of fatty tissue surrounding milk glands and ducts. During pregnancy they increase in size and become filled with milk. After the menopause (change of life) they ordinarily shrink in size. The ancient Greek statues, such as the Venus de Medici, long regarded as a type of perfect beauty, the Venus of Capua, regarded as the bust of a perfect form, show that the Grecian ideal of the feminine form had small busts. The modern idea seems to have wandered far from the Grecian ideal and many women devote much time and money trying to develop their busts. Perhaps sometime we will give up trying to be so artificial and conform to Nature's ideal.

Nature has constructed the internal female organs so wisely that we seldom need give them much thought. But the external organs do need our attention every day. I told you that the labia secreted a lubricating material which kept the parts moist, but this secretion must not be allowed to accumulate. The scalp secretes an oil that is necessary to the health of the hair but if this and the perspiration are allowed to accumulate the hair has an offensive odor. So it is with the female organs, the parts must be bathed carefully every day. I have been surprised in the past to find how many intelligent women neglect these parts. Women come for an examination, their clothing is scrupulously clean, their bodies show recent care but in the folds of the labia, especially near the clitoris, I find an accumulation of a cheesy-like material which has an odor very offensive to any truly refined woman. Sometimes in public gatherings, I have been seated near a woman with this same offensive odor very noticeable, and I have longed to tell her how to avoid it, for I am sure others must notice the same odor. But even from a physician, in the privacy of the office, women resent any suggestion that they are not thorough in matters of cleanliness. Daily cleansing of these parts is a necessity. At least once a day these parts should be sponged carefully. The labia should be separated and every fold thoroughly cleansed. Occasional vaginal douches also are necessary, for the various secretions often are retained in the folds of the vagina and cause irritation. But in taking a douche one always should remember to have the water warm. Cold water may produce congestion. The virtue of douches (except when taken for medicinal purposes) lies in their cleansing properties and warm water cleanses even better than cold. Many women produce grave disorders by the use of cold douches under the mistaken notion that they are of greater value than hot ones. A douche should be taken at the close of the menstrual period especially.

These female organs should not be the source of worry but they do require as much or even more attention to cleanliness than we give to our mouths or other parts of the body.

The subject of menstruation seems to be troubling several of you. I am sorry that you did not all have the advantage of having this explained at an early age. You might have been saved a great deal of suffering and causeless worry.

By menstruation, or "the monthlies" as it sometimes is called, is meant the monthly hemorrhage that takes place in the uterus or womb during the child-bearing period of the normal woman except during pregnancy and lactation, when it nearly always is suspended. The child-bearing period commences at the age of puberty and ends with the menopause (change of life).

Puberty is the period of maturing of the sexual organs. It occurs about the age of twelve, although there may be considerable variation as to this. It extends over a period of several years. As a rule, girls mature earlier in warm climates than in cold and in cities than in country districts. The signs of the approach of this period are the growth of hair on the pubes and other parts of the body, the enlargement of the breasts, a general rounding and increased grace of the body, the development of the pelvis so that the hips become more prominent, and a change in the mental qualities of the child, the girl naturally becoming more retiring. The menstrual function usually is not established at once, there being premonitory symptoms of a vague nature. There may be, at first, only a slight discharge of mucus tinged with blood, later the normal menstrual flow will be established.

During this period of puberty there are great changes taking place in the girl's internal organs. This change and development requires considerable of the girl's strength and naturally influences her nervous system. It is for this reason that a girl at this period of her life should not be subjected to any great exertion, either physical or mental. She should have plenty of light, healthful exercise in the open air, but should not indulge in any very violent exercise. A little care at this time often will save her years of suffering. As the nervous system is greatly affected at this period there should be no great mental strain. In fact, if the girl shows many nervous symptoms, it may be wise to take her out of school for a year so that her strength may be used as Nature requires it. As a rule, too much work is required in school at this age. The school duties should be lessened and the girl allowed to rest a day or two during her menstrual period. The girl at this age should not attempt to accomplish as much work or study as the boy does. Her time at this period might better be occupied in learning the rudiments of housekeeping and home-making. Then, when her body has become developed, her strength can be spared and can be well used in the development of her mind. If the nervous strain too common at this age could be relieved we would have fewer nervous women and a healthier and happier posterity.

As puberty approaches, a mother should give her daughter adequate information so that she should not be frightened at the first appearance of the menstrual flow, nor take any risks at this period. Menstruation is the sign of the possibility of motherhood. If properly taught this fact, every girl will be glad she menstruates and will want to be careful during the period. On account of lack of early instruction, many a girl obtains wrong ideas regarding this function and it produces in her a feeling of repugnance. She should be taught the reasons for observing prudence during the menstrual period. The possible lifelong invalidism that may result should be pointed out. A woman owes it to herself to take good care of herself during her menstrual periods. For two or three days at least she should avoid any unnecessary strain, lie down and rest as much as possible and not worry over school or other duties. Especial attention should be paid to cleanliness during this period. A sponge bath taken in a warm room is not injurious and unpleasant odors can be avoided by sponging the parts with a warm antiseptic solution upon changing the cloth. Every woman should be provided with a circular girdle cut upon the bias so it may be elastic, and provided with tabs to which to pin the folded cloth. She also should have a supply of sanitary cloths made of absorbent cotton-fabric, or pads made of absorbent cotton enclosed in gauze. The latter especially are convenient for the girl who is obliged to room away from home, for they may be burned and the cost of new ones is no greater than the laundry of cloths. These pads or cloths should be changed at least twice a day. It also is necessary that one should bathe the parts in warm water with each change, as unpleasant odors can thereby be avoided. At the close of each period she should take a bath and change all clothing. One cannot be too careful about these matters so essential to cleanliness. It is surprising how many women neglect these important matters. The erroneous idea that bathing of any sort at this time may have disastrous results accounts for much of this neglect. If proper care is taken warm sponge baths cannot be injurious.

A woman in normal health should not suffer at the menstrual period. She normally will have a feeling of lassitude and disinclination for any great mental or physical work, perhaps accompanied by a slight feeling of uneasiness in the pelvic region. Because so many women do suffer at these periods it often is considered as "natural" and allowed to continue.

The phenomena often noted at the menstrual period are,—pains in various parts of the body, hot flashes, chilliness and various hysterical symptoms. A few days before menstruation commences there may be various nervous symptoms, as irritability and a disinclination for any exertion. Dark circles often appear under the eyes and the breasts become enlarged and painful. A sense of fullness and oppression may be felt in the head.

Any severe pain or profuse flow during the period or a discharge between periods indicates a weakened or diseased condition and should not be neglected, for it sooner or later will affect the whole system. A woman suffering from female diseases not only is unable to perform her work in a normal manner but the pale skin, dark circles under the eyes and drawn haggard look which accompany these conditions rob her of her charm of physical excellence.

The menstrual flow appears, as a rule, every twenty-eight days, although the length of time varies with the individual. The average duration is five days, but varies from three to seven. The flow consists of blood from the uterine mucosa (lining of the womb) together with small quantities of mucus. The color generally is dark at first while later it becomes more pale. Women in poor health often have a pale discharge. There always is a faint odor to the menstrual flow, which has been likened to the odor of marigolds. The quantity varies with the individual. Usually fleshy girls flow more than thin ones and dark complexioned ones than light ones. The average quantity is four to six fluid ounces. The time between the periods is required by the uterus or womb to first restore the lining and then prepare it for the reception of the ovum. Every month one or more ova (eggs) leave the ovary, pass to the uterus and, if not impregnated, pass off with the menstrual flow. The material prepared for the reception of the ovum is used to nourish the new life if pregnancy occurs, but when it does not, this surplus passes off in the form of the menstrual flow.