Wise Parenthood (15th edition)/Chapter 5

THE shutting away of the sperm from the womb can be as completely achieved by covering the male organ as it can by covering the mouth of the womb by the rubber cap, as has just been described. This method is perhaps the best known of all in current use, and sheaths under various names, formed either from rubber, skin, or treated silk, are sold in a variety of qualities and designs. They are alike, however, in the essential, namely, that they enclose the male organ, completely preventing the sperm from escaping into the vagina.

These are certainly among the most "harmless" of the methods recommended by many people, and, where a pair has used them with satisfaction, there is no essential need to dis​card them. In my opinion, however, there are objections to them which are sufficiently serious to make the use of a sheath, except under special conditions, inadvisable.

A serious objection is that the sheath prevents the seminal fluid reaching the woman, a subject I have gone into more fully in my book, "Contraception: Its Theory, History and Practice." I have maintained that there is a physiological advantage to the woman in the partial absorption of the man's secretions, which must take place through the permeable wall of the vaginal canal, quite apart from the separate and distinct act of fertilisation. If, as physiology has proved is the case, the internal absorption of secretions from the sex organs plays so large a part in determining the health and character of remote parts of the body, it is extremely likely that the highly-stimulating secretion of man's seminal fluid can and does penetrate and affect the woman's whole organism. Actual experiment has shown that iodine and other substances placed in the vagina in solution are so quickly absorbed that in less than an hour they have penetrated the system and are being excreted. Extended experience only increases my certainty of the beneficial effect of coitus, and the conviction that some subtle substances are mutually absorbed to the benefit of both parties, as they can be when the cap is used.

​A further objection to the use of the sheath is that it reduces the closeness of contact and thus destroys the sense of complete union which is not only pleasurable, but is definitely soothing to the nerves and physiologically and spiritually advantageous in every way.

A minor, but nevertheless important, objection is an æsthetic one—the putting on of a sheath, the feel of its texture, and the consciousness that it is there, destroy the spontaneous beauty of what should be the natural development of mutual feeling.

If, however, it is absolutely essential that no risk should be run of the wife becoming pregnant (if, for instance, it would kill her to have another child), then perhaps the sheath may be used in addition to the method taken by the wife, because no one method gives absolute security by itself, though it may give 9,999 chances of security to one of danger. But for normal healthy people I do not recommend the sheath.

Advice is often given about washing and disinfecting the sheath so that it can be used again. But this is not really a wise procedure, for few private people are likely to be sufficiently careful to make such disinfection complete. Preferably the sheath should be destroyed and a fresh one used each time.

The method perhaps most widely in use of all, and which appeals to many people because it requires no special appliance or chemicals, is withdrawal, or coitus interruptus. Many who are inclined, without sufficient knowledge, to condemn other methods, consider that this must be entirely harmless, because nothing is involved which they consider "unnatural," and it is even miscalled self-control, and thus surrounded by an odour of approval and sanctity very misleading to those who do not probe into realities. The same misnomer is also applied to absolute continence (see page 12). Nevertheless, this method has without doubt done an incredible amount of harm, not directly, but through its reactions on the nervous systems of both man and woman. Many doctors, now that the subject has been opened, have communicated with me confirming this statement from their experience. To a medical correspondent I am indebted for the interesting observation that "coitus interruptus" is not a certain method of controlling conception, owing to the presence of active sperm cells in the beads of clear secretion which are often present on the male organ during erection and before ejaculation has taken place. This doctor has seen under the microscope in his own case active sperm in ​such drops. This fact may be the reason behind those fairly frequent cases where undesired conception has taken place and both parties unite in declaring that none of the ejaculation touched the woman. There are a few arguments in favour of withdrawal which make some people regret its condemnation, the chief of these arguments being that it requires no outlay of money and that it is available at any time and place. Individuals who have particularly strong muscular and nervous systems may go through life using this method and feel from it no ill-effects. Their advocacy, however, should not blind the greater number of people to its dangers. Some men are strong enough to feel no evil effects even from its constant practice; but others who do not trace it directly to this are, nevertheless, sufferers through their nerves, and consequently through their digestions and power of sleep (ills which a competent observer can trace to this procedure); and some men are acutely conscious of its ill-effects.

The great majority of women whose husbands practise this method suffer very fundamentally as a result of the reiterated stirring-up of local nervous excitement which is deprived of its natural physiological resolution. Of the far-reaching effects on the woman's entire organism of the lack of a proper orgasm, which is generally a result of this method, this is not ​the place to speak, and the reader is referred to "Married Love," where various aspects of the subject are more fully considered. Some women whose husbands are among those capable of using this method without apparent ill-effect, maintain that the husband can, and always should, control his reaction sufficiently long to give the wife her complete orgasm before his withdrawal. Such power on the part of the average man, however, does not seem very common. Where it exists, it does undoubtedly remove the objection to withdrawal indicated in the preceding passage, but even in the best of circumstances the following specific objections exist. The local support and nerve-soothing contact which are supplied mutually to both when the act is completed normally are destroyed. The man, instead of allowing himself the normal ease and relaxation of attention which should be the concomitant of the act, has to keep a strain upon his attention in order to withdraw at exactly the right second; he is thus straining not only his local nervous system, but his central nervous system.

The woman, even when she has the good fortune to have a husband with exceptional powers of control, is always in a state of anxiety in case the withdrawal should not be rightly timed, or that some of the fluid should accidentally touch her. In either case pregnancy is possible; so that her central system, as well ​as her local nervous system, is also strained. The act, therefore, cannot have the soothing and healing power which it normally should have, and is, moreover, resolved into its lowest terms—merely physical "relief" for the man.

In addition to this, if there is the slightest delay in withdrawal or any carelessness, the woman has immediately to arise from the warm bed and douche, in the anxious hope that she may be in time. (Concerning douching, see what I have to say below, p. 66.)

Except for cases of emergency or in circumstances involving accidental lack of other means, or by exceptional people who have become specially adapted to this malpractice, withdrawal should never be used. Most unfortunately, by a certain "virtuous" type of person this method is described as self-restraint," and so has been surrounded with an aura of approval, and thus the incalculable harm it does is increased.

Another practice which is sometimes advocated as a method of control of conception is in some ways a further extension of the power to withdraw at will. It is, in truth, a real form of self-restraint, though it is not the restraint of abstinence from all connection. This method consists in a strong mental control exerted by the man after his entry, a control which differs from that in the practice of withdrawal in that ​it aims at avoiding any ejaculation whatsoever, while at the same time retaining erection and remaining as long as possible in the closest union with the beloved. This controlled restraint appears to be possible to a certain type of man, and it has been studied and has formed the subject both of experiment and published statements for nearly a century. The mental attitude of those who adopt it can be essentially summed up in a few words: Union for the mutual spiritual and physical sense of joy and comradeship, kept distinct from the procreative act by the strongest possible guidance and control by the will, so that the procreative act or ejaculation does not take place at all. Those who practise this method speak with enthusiasm in its favour. I find, however, most medical men in this country, who are cognisant of it, are very strongly against it, and from general deductions I think it is safe to assume that it is not particularly suited to the average Englishman's temperament and powers, and indeed might very well be detrimental to his health. Although this book is essentially addressed to the average, the advanced and the more spiritually minded as well as the "intellectual" and under-sexed types should not be ignored, and for all such there is no doubt that this method would appear to avoid many of the drawbacks and objections to mechanical methods of preventing ​conception. Though I must disclaim any expression of opinion in its favour, if it proves valuable and health-giving to some and highly detrimental to others, data collected on this point may throw light on still further fundamental divergencies in human needs and construction, and be of great social interest and value.

Various instruments, some of metal, have been made and from time to time recommended for the internal use of women. They should in any circumstance only be used after the fullest and most competent medical examination and must be fitted by a doctor. For some unfortunate women who have been damaged by child-birth, and whose organs are no longer normally placed, they may be necessary. For normal women they are generally to be condemned.

The method most widely practised by women, and which is recommended as not only "harmless" but by many as positively beneficial, is douching. About this method there is much to say.

​In the first place, in the nature of things the douching must come after the act of union. As sometimes the sperm may be ejected actually into the womb itself, douching after the event may be quite futile. But even where this has not happened, and the sperms are still in the vaginal canal, it resolves itself into a race between the plasmolising fluid and the sperms; and the sperms, having already got something of a start, may win the race and penetrate the womb. In that event douching may be entirely too late. There is, therefore, no certainty whatever in the method of douching, though as a result of the shock and general discomfort entailed it may very often inhibit conception.

The objections to it, even if it were, what it is not, a safe method, are twofold: æsthetic and physiological. The æsthetic objection is by no means to be despised, for the effect both on man and wife of having immediately to rise from a warm embrace and come down to the crudest material facts of douches and chemicals at the moment when the whole relation should be one of tenderest mutual feeling and repose, is desolatingly disillusioning to a romantic man or woman. In not a few instances it has broken up sex relations entirely by destroying the man's sense of romance, so that he is no longer capable of physically loving his wife, while there are wives who refuse all sex ​relations to their husbands on the ground that the douching involved is intolerable.

The man, however, is often saved the disadvantages by the natural sleep which follows his completed act. It is the woman who chiefly suffers by this method. Physical reactions on the woman are of two principal kinds: the first, subtler, and generally overlooked, is that her inclination to sleep (if she has been fortunate enough to have had the completed act) is thwarted if not entirely destroyed. The tendency of this is to make her nervous, and, if she is highly strung, to induce chronic sleeplessness. On the other hand, she also suffers from the local chill of getting up out of a warm bed and moving about the room, unless she is one of the very few fortunate ones who can afford a fire in a bedroom and a maid to prepare the warm douche. Most women have to do these things themselves, and even douching with warm water does not eliminate the general chill.

There is, however, another and more serious objection against the douching which is so widely advocated. It washes out and destroys the bacterial inhabitants of the vaginal canal. People insufficiently acquainted with science have jumped to the conclusion that this is a good thing, because some bacteria are known to them to be enemies of mankind. They think it therefore an act of cleanliness to wash ​out the vaginal canal, and they even go so far as to compare it with brushing the teeth and rinsing the mouth.

Some people, observing the "dirty" little nodules on the root of the pea plant, and being told that they contain bacteria, would be impelled to pinch them off—thereby depriving the plant of its most valuable allies—the bacteria which "fix" the nitrogen from the air and which consequently place the pea plant in a more advantageous position than most of the members of the vegetable kingdom. It is true that doctors have not yet thoroughly examined or discovered exactly what part the bacteria in the vagina play in the internal economy of the woman, but sufficient evidence has accumulated to show the folly of destroying them and at the same time affecting the lining of the vaginal canal. For some years I had been against douching, save in emergencies, and shortly before I wrote this book a definite denunciation of douching was published in the British Medical Journal of April 20, 1918, by Dr. Fothergill. This article is, of course, by no means final, any more than are my own private views on the matter, but it deserves the careful attention of the many people who indulge in or recommend the frequent use of the douche of all kinds.

Nevertheless, there are occasions when douching may be necessary, and when it is ​only used infrequently it can do no harm if the proper solutions are used.

Regarding the solutions which should be employed when a douche seems advisable, a large number of substances, all of which are soluble or mixable with water, have been recommended by various people. It is to be remembered that at present I am recommending only those suitable for normal healthy people. Specific diseases, of course, require specific treatment.

Many of the so-called "harmless" substances used for the douche are very far from being entirely harmless. Such a chemical as corrosive sublimate, for instance, which has often been recommended, ought not to be placed in the hands of the private individual haphazard, and, moreover, though but few serious cases are on record against it, when one realises that the vaginal walls may absorb part at least of the fluid, its use is to be entirely deprecated save for specific diseases.

Lysol, carbolic acid and other such strong fluids, though "harmless" if diluted sufficiently, are, nevertheless, destructive rather than healing in their action, and if by accident used too strong, or even if used frequently by a sensitive subject, are very apt to lead to sores or even partial destruction of the tissues.

Only the simplest and most wholesome substances, therefore, are to be recommended ​for general use. For the purpose of douching to plasmolise the sperms, either vinegar and water or common salt and water could scarcely be bettered. If vinegar and water are used, it should be in about two parts of warm water to one of vinegar. A stronger solution would do no harm if used infrequently, but would tend to harden the vaginal walls if used regularly. Common salt should be made into a strong solution, and about two tablespoonfuls of salt to a pint of water. These solutions are quite sufficient to incapacitate any sperm, and at the same time they contain no substance in the slightest degree deleterious or even very foreign to the system if partly absorbed.

People have for too long coupled normal prevention for quite healthy people with disinfection of one or other of the pair where disease exists or is suspected. In this book I am not dealing with cases of the diseased or the medically unfit in any way. They may, under doctor's orders, have to use strong, even perhaps dangerous chemicals. I am now only advising the perfectly normal and healthy what to use to keep themselves normal and healthy, for I think it is time to disentangle simple control of conception by healthy people from the covert attempts to stay the progress of racial disease.

It will be seen from the above, therefore, that on the whole I strongly deprecate douching ​as a regular practice, but should advise every woman to have a douche available for infrequent use on occasions, when she should employ simple salt and water, or vinegar and water, in making up the douche.

Many people are under the impression that if the act of union is confined to certain days, they are then quite safe, and that conception will not occur. The dates vary slightly, depending on the exit of the unfertilised egg cell; but, on an average, from the fourth or fifth day after menstruation for about a fortnight a woman is said to be unable to conceive. This may be true for some individuals, whose reproductive vitality is not very acute, but it is extremely unreliable, and in many instances is quite deceptive. The reason for this is obvious to those who know the structure of the parts. Male sperm can live, if it is vital and healthy to begin with, for eight or ten days: during any time throughout this period one deposited days before may emerge from some crevice in the skin of the vaginal canal in which it has lain concealed and swim into the womb and ultimately effect conception, though it is true that the chance of this taking place is not so great as the chance of conception following an active orgasm. Nevertheless, cases ​are on record when a sperm has made its adventurous journey not merely from the vagina into the womb, but from the outside organs of a virgin girl.

Some people, therefore, to whom it is not a financial disaster when a child is born, may find the comparative security of a "safe period" sufficient. But I am inclined to advise against its observance, because the "safe period" is obviously the time when the woman has less physiological benefit from the sex act, and also because I think that so important and fundamental a need as the act of married union should not be thwarted by waiting for dates on the calendar, when it could be so much better fulfilled at the normal time of desire if the woman is protected in the way which I have recommended on page 35.

Another "method," often advised by well-meaning people and sometimes by nurses and even by doctors, is for the woman to feel safe while she is nursing her child. Prominence has been given to this advice by the fact that there is a very proper movement on foot at present to encourage so far as is possible the nursing of infants by their own mothers. One fears sometimes that well-meaning but insufficiently instructed people unconsciously urge as an ​advantage which may accrue from such nursing that security from too rapid pregnancy which is so pathetically desired by the poorer working women. It is true that very generally a nursing mother does not become pregnant, but too many instances are known to me, when even in the early months of nursing pregnancy has begun, for me to feel that the advice should ever be given without qualification. The security offered is as unreliable as that of the "safe" period. Those interested in that point should read my evidence before the Birth Rate Commission, published in 1920, p. 242, of "Problems of Population and Parenthood."

Another danger of such advice is that the poorer and more ignorant women are tempted to continue to nurse an infant long after the milk has lost its nourishing quality, in the hope of delaying so long as is possible the time when they are liable once more to become burdened with yet another unprovided-for child. So long as the flow of milk remains, it is far too easy for the assumption to be made that the child is having all that it required, whereas this may be very far from the truth, and the infant may be on the highway to rickets and many other forms of general weakness, while the system of the mother is also drained and she is weakened and exhausted needlessly. Every encouragement and inducement should be given to women to nurse their own babies, ​when they have suitably nutritious milk. Yet one cannot too strongly deprecate the confusion of thought which coincidently urges the nursing period as the "safe" period, although, alas, this is often done by otherwise estimable people.

Of the many other varieties of methods and substances recommended and in use, I do not propose to speak. In addition to direct contraceptives there are a variety of malpractices in use which are most harmful. There is no necessity to specify or to condemn them more explicitly. Those who have read the present pages with attention will be able to appreciate for themselves arguments against their use. Many of them are the sources of the erroneous idea that "all birth control methods are harmful." The ideal method is not yet discovered, although those described on p. 35 et seq. are absolutely harmless, and generally reliable and satisfactory. If anyone knows of any method better than are now suggested, I sincerely hope that he or she will publish it or will communicate it to me, in care of my publisher.