Addition 4 (to page 85)

Owing partly to the incredible ignorance of our bodily structure in which it is possible for a grown man or woman not only to enter marriage but to be married for years, sometimes apparently childless unions are not in any sense due to the incapacity of either partner for parenthood, but are due sometimes to trifling impediments which can easily be removed, or to trifling peculiarities of construction which can very simply be overcome.

While the great majority of married couples are actually suffering, or would suffer, without the exertion of definite control, from too many pregnancies there are still—particularly in the middle and upper classes—many would-be parents who long for children but seem to be mysteriously deprived of them. Doctors may have examined both the man and the woman, and pronounced them perfectly normal, perfectly healthy, and perfectly capable of having children together, and yet children do not come. Sometimes this is caused by an undue activity of a slightly acid secretion on the part of the woman, a secretion doing her no harm and of which she is quite unconscious, but which may be sufficient to render the active sperm impotent. Sometimes, therefore, it is sufficient to ensure conception for the woman to syringe the vagina with a little weak neutralising solution such as sodium carbonate shortly before sex union. Another cause which sometimes operates against the vital sperm penetrating to the waiting ovum is an excess of mucus at the mouth of the womb. In such a case it is important that a really complete and muscularly energetic orgasm should be achieved by the woman, not before but coincident with or after the sperm has been ejaculated. It is often argued that it makes no difference whether or not the woman has a complete orgasm, for so many cases are recorded in which women who have never experienced an orgasm have had many children; but it is generally forgotten that women are of many different types, and while one type of woman, the very fruitful mother with a wide vagina and but slight internal mucus, may conceive a dozen times without an orgasm, the more highly nervous, equally perfect, woman may only conceive on the occasion when she experiences an orgasm whilst the sperm are actually in the vagina.

Another slight obstacle to conception on the part of a woman which is not infrequent is the position of the mouth of the womb and the relation of the vaginal canal, which may be such that the spermatic fluid tends to be lost without any of it penetrating the orifice of the womb itself. To overcome this it is often sufficient for the woman to turn over directly the act of union is complete and lie face downwards for a few hours.

Without any question, all women have times of greater or less reproductive vitality, but in some women this is less marked than in others, and with some conception may take place at almost any date in the menstrual month; but with other women there is a group of days ranging from three or four to a dozen or more, in which conception seems to be impossible; while, on the other side of this group of neutral days, the days grade upwards towards a date of greater reproductive potency. Therefore, a woman and her husband who desire children, but have not after some years of marriage had the good fortune to attain parenthood, should choose for their acts of union those days on which conception is most likely. It is generally found that the most certain date for conception is—with very few exceptions—about the last day of the monthly period, or the day or two immediately after it; so that the husband who ardently desires his wife to conceive should, with her consent, concentrate their unions so far as possible on such dates.

On the other hand, it must not be forgotten that the effect on the whole nervous system of the desire to conceive is very great. A too frantic desire, which leads to too frequently repeated unions, will probably defeat itself, because it is not the mere coalescence of the sperm with the ovum which completes conception, it is also the attachment of that impregnated ovum to the wall of the womb, and intense nervous excitement may prevent that. Indeed, it has been stated by a medical man of considerable weight in the last century that there are women among those races to whom sex-knowledge is not taboo who can voluntarily control conception at will and consciously expel an impregnated ovum by mere exercise of nervous force. A woman in modern society who is in a highly nervous condition, which may find expression in her constant need of cigarettes or excitement, may be (though this is by no means universally true) frequently impregnated and at the same time continually throwing off the impregnated ovum before the settling down of that ovum, which results in true conception, can take place. If, therefore, the woman who urgently desires to be a mother finds herself continuously smoking, or notes in herself any other indication of a lack of placidity in her nerves, she would do well—not merely to restrict her smoking, which is nothing but a symptom of a deeper need—but she would do well to restore so far as possible a calm poise to her whole system by longer sleep, more country air, plenty of fresh butter, or whatever simple remedy it may be that will supply her nerves with something lacking, and for which she is unconsciously craving.

Although to many it may seem incredible, yet it is not so rare as might be supposed, that the adult pair may be married for years, and the wife still physically a virgin owing to neither of the pair knowing that penetration must be effected. Amazing as it may seem, four or five such cases, all of intelligent apparently average people, have come to my direct knowledge in the course of one year alone. Another cause, less extreme, is due to the woman making full entry difficult or impossible by not taking up a proper position during union. (See also p. 114.) In such cases a knowledge of the true details involved may speedily bring the desired conception.

These very simple suggestions are of the kind often overlooked by the medical specialist, to whom a woman goes tremblingly asking if she is abnormally formed in any way, because she does not get the children she so much longs for. Such advice, of course, will apply only to people who are essentially normal and without deformity. For more serious obstructions to parenthood, the pair, and not the woman only, should seek medical advice.