Contraception/Chapter 2

THE all too prevalent idea that in coitus woman a passive instrument and the man guilty of "self-indulgence" or "allowing relief to his baser nature" is wrong. This false and foul-minded idea is the source of an incalculable amount of racial injury.

It is essential first to be explicit about the fact that the coital act is an extremely complex social function in which the woman (as well as the man) is an active partner, and from which both derive physical, mental, and spiritual benefit if this act is fully and correctly performed.

The realization that the woman should be an active and joyous partner in the act may be thought by some to require demonstration, as even by medical practitioners this has often been denied. That a normally healthy woman has an active sex life with spontaneous requirements different from, yet ​not entirely incompatible with, those of her male partner, must be accepted as an axiom before contraceptives can be intelligently discussed. Some aspects of this fact are given in "Married Love,"^[1] to which readers should refer. In that book for the first time were published charts of woman's spontaneous rhythm of sex desire, and about this demonstration Dr. Havelock Ellis, the great sexologist, wrote in the Medical Review of Reviews, bringing contributory evidence^[2] from two other aspects of woman's sex life to indicate the correctness of the Stopes curve in having two wave crests of spontaneous desire in each menstrual month. Ellis concluded his account of his independent lines of evidence by saying, "It is remarkable that they should both confirm what we must regard as the two essential points in Dr. Stopes' teaching: (1) the regular existence in women of a menstrual wave of sexual desire, and (2) the occurrence in that wave of two crests. This seems to represent the most notable advance made during recent years in the ​knowledge of women's psycho-physiological life."

Accepting then as one axiom that normal women do have spontaneous sex desires, the second axiom I would have you accept before we investigate contraceptives, is that the best times for the coital act are those when both the husband and the wife have mutual desire. Then only is the act perfectly performed and of fullest physiological and psychological benefit.

Hence the proper form of contraceptive must be one available at any time by the pair: and so the "safe period" often advocated by those who pose as moralists is not satisfactory (see also p. 84). The proper contraceptive must also be one which permits the natural and complete contact between the tumescent sex organs; hence from the nature of things all sheaths and coverings worn by the man have serious disadvantages (see also p. 125).

Finally, the theoretically perfect contraceptive should be so unobtrusive as not to obtrude on the consciousness of either party during or immediately after the coital act. In my opinion, in coitus, any mental or psychical injury is quite as harmful as any physical one.

What then have we at the present time ​in the way of methods to achieve control over conception during a fully and properly performed coital act by normal and fertile people?

It may be briefly stated at the outset that the absolutely ideal (as considered from the point of view of strictly scientific perfection) method of contraception has not yet been devised, although one or two humanly satisfactory methods are in use to which little objection can be taken, as they very nearly conform to the theoretical requirements.

In the great variety of contraceptives in use or which could be imagined, one or other of three essential characteristics are necessarily involved:—

1. That the ovum itself is rendered irresponsive or incapable of fusing with the sperm.
2. That the sperm is prevented from meeting with the ovum.
3. That the contraceptive renders the ejaculated sperm infertile.

Theoretically, it is perfectly possible to imagine some injection, serum, toxin, or internal secretion, which might render the ovum or the sperm respectively incapable of playing its part in fertilization. Such a contraceptive may appear to have many ​desirable characteristics. Its existence, however, is purely theoretical, and will remain so until research on this every abstruse and difficult theme has been accomplished.

The second of the three alternatives mentioned above may be achieved in a variety of different ways, the commonest and best known being by the use of the condom (vulgarly called the "French letter") which by enclosing all the ejaculated sperms in the membrane of the condom, prevents them from reaching the ovum. Were the seminal fluid a simple procreative substance only, with no other accessory qualities, characteristics or potentialities, this method might appear to be theoretically perfect. The fact, however, is otherwise, as will be elaborated on later pages (pp. 76, 208), depending partly on the existence of valuable accessory characteristics of the seminal emission, and partly on account of unsatisfactory features involved in the use of the condom itself.

The separation of the sperm from the potentially fertilizable ovum may also be accomplished by the internal cap or pessary used by the woman. This does not intervene between the seminal emission and its contact with the vaginal walls, and there​fore avoids one of the objections to the sheath, while it does stand on guard between the ovum and the motile spermatozoon.

While the main object, that is the prevention of the sperm from reaching the ovum, may appear to be equally accomplished by both of these methods, the subsidiary uses of the coital act are not interfered with in the latter procedure in the way they are by the use of the condom, and, therefore, the pessary approaches the theoretically perfect standard method much more nearly than does the condom.

The accessory values of properly completed coitus are too frequently ignored in general practice, and much marital unhappiness can be traced to the widespread ignorance among the lay public of the essential facts of coitus and the benefits to be derived from it. In illustration of this theme (which, for the purpose of this book, must be treated as axiomatic), one or two references may be mentioned. For instance: Havelock Ellis^[3] notes the experience of an Austrian gynecologist that of every hundred women who came to him with uterine troubles, seventy suffered from congestion ​of the womb due to incomplete coitus (see also p. 69).

Such incomplete coitus may, of course, be due to a variety of procedures on the part of the married pair, but though sometimes mere ignorance of normal procedure is the cause, this is relatively rare. The incomplete coitus in one form or another is generally due to mistaken and incorrect attempts at controlling conception.

Nyström^[4] pointed out long ago that the so-called "sex coldness" of women would not exist if they were correctly and ardently wooed, and if those who did not desire children used sensible contraceptive measures instead of coitus interruptus.

McDonagh^[5] goes so far as to say, "Another very common cause of sexual neurasthenia is coitus interruptus, a continued practice of which may even lead to dementia."

This subject is treated more fully on pp. 69 et seq.

It should not be forgotten that in normal coitus properly performed, the orgasm of the woman is of direct assistance toward ​achieving the result of conception, though the necessity for orgasm to ensure conception varies greatly with different women. It is on record that women can conceive when in a state of narcosis, and many a fertile mother has never felt an orgasm in her life yet, on the other hand, many sensitive women only conceive as a result of a fully completed orgasm.

Thirdly, after ejaculation into the vagina, the living spermatozoa may be demolished easily by a great variety of chemical substances also placed in the vagina. These may act as simple plasmolizers or definite poisons to the spermatozoon.

It should here be emphasized that the true contraceptive (as distinct from the sterilizer) should have only an effect applicable at will to one coital act, and should not have any permanent effect on the individual using it.

We may take it then that the contraceptive which approximately conforms to the theoretical demands should accomplish the following:—

It should either shut away the sperm from the ovum completely and securely (and without at the same time depriving the partner's vagina of contact with the seminal fluid) or it should completely and reliably ​destroy the life and activities of the spermatozoa in the semen without in any way injuring or destroying the accessory substances in the seminal fluid and without injuring the lining or the bacterial inhabitants of the vagina.

Theoretically, the second result should be as easy to obtain as the farmer, but in practice it has not yet been ascertained what substances, if any, are in practice available. for use to deal with the spermatozoa effectively without having some effect on any other cells or tissues. Quinine, which is widely and beneficially used at present, has certain detrimental effects on a small number of people, and does not, therefore, conform to 'the theoretically perfect contraceptive. substance. Other theoretically better substances depart still more from the desirable standard owing to difficulties of application.

The internal cervical cap or small occlusive pessary if properly adjusted by the woman over the cervix so that it closes the entrance of the os, but does not cover, or intercept contact between the penis and the vaginal walls, offers no chemical or destructive action to either the sperm or the vaginal capacity to absorb. After insertion it is entirely unobtrusive. It is considered more in detail on p. 138.

​If there be any truth in the assertion recently made^[6] and at once challenged^[7] the small cap only deprives the woman of a fraction of the benefit to be derived from complete coitus, for the main benefit of coitus is not dependent on the entry of the sperm to the uterus itself, but is achieved through the venereal orgasm together with the effects of absorption through the vagina. This is clear from the large number of women who find coitus with the use of the cap entirely satisfactory and extremely beneficial.

If a spermaticide is decided upon as theoretically the most desirable form of contraceptive, there then appears to be no reason why the other requirements of the system of the individual patient involved should not be taken into consideration, and in my opinion, the use of a spermaticide offers an interesting opportunity for the ingestion of some substance useful to the whole system. A certain number of women do undoubtedly benefit by the absorption of quinine which naturally results when using quinine as the spermaticide; others, ​on the other hand, suffer detrimental effects from quinine (see p. 110).

Wherever abnormalities of any sort are present (and how often, alas, that is true!) special considerations must come into play, and in specific cases the more advisable method might be quite other than that which would be the best for a normal and healthy woman. Considerations of some such special cases are indicated on pp. 183 et seq.

As the act of coitus is not solely a physiological process, but one which, particularly in our later civilizations, is so complex and so involved with sentiment and spiritualized feeling, the ideal contraceptive must be one the use of which is sufficiently simple and easily adjustable not to interfere with the sentimental and psychological reactions of the act. For this reason the practice of douching, not uncommon (see p. 116), is thoroughly unsuitable, even if it were satisfactory in other respects, which incidentally it is not.

Once contraceptives are studied adequately they might be so planned as to combine their function with that of a tonic or other substance likely to benefit the individual case. Theoretically, however, as I have persistently maintained, contraception should ​be treated primarily as a problem for the perfectly healthy woman, and, therefore, should not be complicated by any accessory requirements. Wholesome contraception is a valuable tool in the hands of those who work toward elevating our sex knowledge in the way urged by Professor Bayliss.^[8] The main and most legitimate objects of a true contraceptive are to permit of the full benefits of coitus, the complete absorption of all that can naturally be absorbed and used from the seminal fluid, and the prevention of the union of the spermatozoa with the ovum,

This seems a very simple requirement, but partly owing to the prudery which has surrounded and kept the subject from being studied properly, and partly from the complexity of the psychological reactions involved in the act of coitus, even yet, after many centuries of use, we are far from a complete knowledge of contraceptives. So far as I can discover nothing better for the perfectly normal woman exists than the internal cap, which will be described and dealt with on p. 140.