II Practical Methods of Prevention
A. for Women
Sexual Reproduction
To understand the practical methods of birth-control, or the control of conception, we must first have a clear view of the processes involved when the reproductive organs are in activity, and of the nature and situation of the sexual organs themselves. The diagrams on pages 34, 35 and 36 show in general outline the reproductive organs of man and woman.
Now fertilisation does not necessarily occur whenever the male organ comes in contact with the female organ. Fertilisation occurs only when a male-cell (spermatazoon) unites with a female-cell (ovum); in other words, when the spermatazoa in the seminal fluid of a man meet and unite with the germ or ovum in the body of a woman. That is the beginning of the child. This union of the two cells need not take place during or immediately after sexual intercourse. It may occur many hours, or even two or three weeks, after connection, because the spermatazoa have motion of their own. They are tiny threadlike bodies, which may work their way towards the ovum long after they have left the body of the man and been placed in the body of the woman, and the uterus has a searching movement, and may by its pulsations draw the spermatazoa upwards. For these reasons a woman cannot be quite sure of the exact time of fertilisation, and hence cannot predict exactly the date of the child-birth. Generally the pregnancy lasts nine months, but it may last longer—say ten months on rare occasions; and it may be extended apparently by a delay in fertilisation.
Prevention of Conception
For many reasons which I need not enumerate here, the precautions against impregnation can most easily and effectively be taken by the woman, rather than by the man. She is the one fertilised, and therefore she is the one to guard herself against fertilisation.
There are two methods of preventing fertilisation:—
(1) The chemical method, that is, the destruction of the male cells (spermatazoa) by means of a suitable germicidal substance, such as many of the disinfectants; and
(2) The mechanical method, that is, the adoption of measures which keep the male and the female cells apart from one another.
Neither of these two methods in practical application by ordinary women can be said to be completely certain. Both are apt to fail at times. The chemical method, that is, the application by the woman of a suitable soluble contraceptive suppository before connection, or of a germicidal douche (such as a dilute solution of lysol) after connection, or both these measures taken consecutively, may fail because of some fault in application, or because the seminal fluid actually enters the womb during intercourse; that is to say, when emission takes place, the end of the male organ may be exactly opposite and close to the mouth of the womb, and the spermatazoa in the seminal fluid enter directly into the womb, and cannot then be removed or destroyed by douching or contraceptives of any kind. Now if the physical conformation of the reproductive organs of the husband and the wife render this event possible or probable, then soluble suppositories and contraceptive douching are alike unreliable, by themselves or in combination. On the other hand, the mechanical method, that is, the use of a rubber protector, preferably the spiral-spring occlusiveG “Dutch” pessary, by the woman may also fail, because the protector is porous or ill-fitting. But—if the two methods are combined, the chemical method and the mechanical method, then the protection against fertilisation may be regarded as almost absolute. The completeness of the protection depends, of course, upon the proper application and combination of the measures advised.
I have discussed the various measures fully with leading medical authorities in London and Paris and elsewhere during the last five years, and have gradually evolved the recommendations made here, and these recommendations have the highest medical and scientific support and approval. Other methods than those recommended are referred to in Appendix I; to enumerate here those that have been eliminated would be purposeless and confusing. We are satisfied that we have selected the least harmful and most reliable methods known to science yet. These methods and these only will be explained and recommended. Everything possible has been done to make the methods acceptable to women.
Unattainable Conditions
Before detailing these methods, I want to ask every woman to rid her mind of certain false hopes and impossible demands. It is no use asking for something which gives no trouble at all, which costs nothing, and which is at the same time absolutely certain to prevent conception. These conditions are unattainable. But almost absolute control of her reproductive functions is most certainly attainable by every careful, intelligent woman willing to spend a good deal less time and money over her sexual toilet than she now spends over the care of her teeth, for example.
Sexual Toilet Outfit
To begin with, it is necessary to obtain suitable sexual toilet outfit, and the requirements for this are as follows:—
Enamel bidet, soluble suppositories, suitable syringe, and properly-fitting rubber pessary. These are illustrated on pages 38 and 43.
General Conditions
1. Cleanliness.—Sexual control is largely a matter of sexual cleanliness. We must all learn to keep the genital passages cleansed in the same way as we keep all the other openings of the body clean. The ears, eyes, nostrils, mouth, anus, orifice to the urethra, and the vagina should be appropriately cleansed daily. The openings of the body which stand most in need of daily cleansing are the anus and the vagina, and yet many women fail to cleanse these properly at all. Every home should have a suitable bidet (preferably fitted into the bath-room, with hot and cold water attached), and every member of the family should be trained from childhood to use the bidet, night and morning, with the same care and regularity as they use their sponge or toothbrush. All over the Continent and in the United States of America this is done in well-ordered households nowadays, but hardly anywhere in the British Empire is it done at all.
2. Soluble Suppositories.—Generally speaking, the soluble quinine pessaries or suppositories which are sold in the shops are unreliable. Several brands have recently been analysed and found to contain no quinine at all—or particular pessaries have been without sufficient quinine. Quinine is fatal to the spermatazoa, and without it these pessaries are simply pieces of soluble cocoa-butter. Cocoa-butter is the substance generally chosen for cheap soluble pessaries, because it is easily obtainable, and has what is called a sharp melting point—that is, it dissolves or melts very suddenly and readily at body-heat, but is solid below that heat. Cocoa-butter in itself is quite harmless—usually non-irritating (unless it is “rancid”)—and it gives some mechanical protection, in the same way as vaseline or any kind of fat or oil would do, provided, of course, it is in the right place to catch and entangle the spermatazoa and thus prevent their uniting with the ovum. Research and experiment have proved conclusively that no spermatazoa—indeed, no microbes or germs of any kind—can pass through a film of oil. But if the protective covering of grease is incomplete at any point, it may there prove ineffective, and there is no chemical protection whatever if the particular germicide relied upon, such as quinine, has been omitted. Quinine is sometimes omitted on the ground of expense, and sometimes because it proves irritating to many women. Only really suitable suppositories, guaranteed to be made in accordance with accredited medical formulæ, should be used. These suppositories should be composed of specially selected and tested fats, should be soothing and cleansing, as well as protective; should be stainless, odourless, and quite non-irritating. If they do cause any woman discomfort temporarily, vaseline or soap-suds could be substituted, but might not be quite so certain to prevent conception.
3. Syringe.—The ordinary enema is not a particularly suitable appliance for the purpose of douching. The kind of syringe required is one which will not only flood the vaginal passage with warm water or very weak antiseptic lotion (such as dilute solution of lysol), but one which is sufficiently large for the contents on injection to distend slightly the walls of the vagina, straighten out their folds and furrows, and thus let the cleansing and protecting lotion touch every part as far as possible. A movable rubber flange is necessary to act as a stopper at the mouth of the vagina, and thus enable the woman to retain the lotion for a minute or so. Care should be taken, when filling the syringe, to express all the air from it—by filling and refilling it two or three times with the nozzle under water; otherwise the first thing put into the vagina would not be warm water or antiseptic lotion, but simply a large bubble of air.
4. Soluble Suppositories and Rubber Pessaries.—It is quite true that the use of a suitable soluble suppository alone may be sufficient to protect against impregnation, but the protection by this means does undoubtedly fail at times, and therefore, by itself, the soluble suppository is unreliable. Still it eliminates the majority of the chances of impregnation. The use of the rubber pessary is also sometimes unsuccessful because it does not fit properly, or because it is porous, or because in removing it some of the seminal fluid from the under-surface may be accidentally spilt in the vagina, and in this way the spermatazoa may later find their way upwards to an ovum. Therefore, the soluble suppository and the rubber pessary should be used in combination. A woman should first push up, as far as possible, a suitable suppository, and then insert the rubber pessary (slightly soaped—with soap-suds), so as to occlude the whole of the upper part of her genital passage and thus cover the mouth of the womb and effectively prevent entrance of the spermatazoa. The rubber pessary must in the first instance be fitted by a doctor, because if it does not fit properly it will be ineffective. The seminal fluid may pass by its loose rim and impregnation may result. If the rubber pessary has been properly fitted, and it is not porous, the protection should be complete; but if, by any accident, spermatazoa should get beyond the rubber pessary, they will be destroyed and tangled in the melted suppository—provided, of course, that a suitable suppository has been used. It is all a question of getting the right articles to begin with and using them intelligently. But there is this chance—a bare chance—of accidental impregnation, and we want to eliminate all chances, if possible. Assuming the rubber pessary fits properly, as it will if skilfully selected and applied in the first instance by a competent medical practitioner, then the seminal fluid must remain in the lower part of the vaginal passage. An hour or two after intercourse, or next morning, this seminal fluid can all be washed away by the use of syringe and bidet. It is far better to sit over the bidet and syringe in that position than to squat down over a basin—an uncomfortable and unsuitable position for douching, because the walls of the vagina in that position may be pressed hard together. The fluid should be retained in the vagina for a minute or two, by pressing the flange of syringe closely against the orifice of the vagina. After syringing, but not before, the rubber pessary should be removed (to be washed with soap and water, dried carefully, and put away till required again), and immediately after removing the rubber pessary it is a good plan to facilitate the ejection of the surplus fat of the suppository by urinating and re-syringing. It is quite easy for a woman to insert and remove these rubber pessaries for herself as occasion requires, provided that whilst inserting and removing the pessary she has placed her body in a suitable posture—say, lying on the back with knees drawn up, sitting on bidet, or standing with one foot on a chair, or whatever other position she finds suitable. A doctor’s help is needed only when first selecting the right size of pessary. The pessaries are made in ten different sizes, each size being numbered, and the right size can always be obtained on order. No harm may come from wearing the pessary for a day or two, but it is highly desirable as a matter of cleanliness and otherwise to remove the pessary in the morning when performing the sexual toilet. The pessary should, of course, never be worn during the menstrual period. A good rubber pessary should last from three to four months, and it should be tested occasionally by filling it with water to see that there is no hole in it. If it has been fitted shortly after a miscarriage or confinement, refitting is desirable at the end of a few months. But in normal circumstances refitting is not necessary.
5. Antiseptic Douching.—If antiseptics of any kind are used, such as lysol, they should always be used in very very weak solutions, and should be varied from time to time. There is no necessity ordinarily to use anything but plain warm water, with perhaps a little table-salt in it, for internal cleansing, and soap and water for external cleansing; then dry parts carefully. But some women prefer a weak antiseptic vaginal wash, as they do a weak antiseptic mouth wash. If a woman is unfortunate enough to be married to a man liable to infect her, then she should follow the same practice as detailed here (every effort, of course, being made for her husband to be cured as soon as possible), and she should use a special suppository, as prescribed by her doctor or otherwise authoritatively recommended, and should douche and urinate immediately after each sexual connection. She should also, before douching with weak disinfecting lotion, wash thoroughly—internally and externally—with suitable soap and water. This will certainly help to prevent infection in the vagina and elsewhere. The rubber pessary and the suppository will give her a very real measure of protection against the worst of all forms of infection, viz., uterine and ovarian. She can also protect herself against infection in the female urethra—that is, the passage from the bladder—by urinating immediately after each connection, as advised. A good deal of nonsense is still talked by some medical practitioners about the alleged harmfulness of douching. The same kind of distracting and misleading statements were made a few years ago regarding antiseptic mouth-washes, which were similarly condemned. Fortunately, we are passing out of these dark ages! Soon it will be regarded as quite as natural and necessary and desirable to cleanse the genital passages as to rinse out the mouth or wipe the nostrils.
It is important to remember that the “personal equation” counts for something in choosing a disinfectant, some substances suiting one person and some suiting others. “One man’s meat is another man’s poison.” It is also very desirable to “ring the changes” by using, say, lysol one day, something else the next, and so on. Using three or four simple disinfectants alternately on different days of the week tends to make the disinfectants less irritating and more efficacious, as well as adding a fresh interest to the toilet performance. On this and other points personal instruction is far the best—provided you can find a good instructor. Every man and every woman should seek an opportunity of learning, from competent authority, precisely what to do in the matter of prevention, and what it all means. Reading books is all very well, but personal tuition as well is a great advantage.
Summary
Finally, the following briefly summarises the recommendations for women:—
1. Before Intercourse, Wash and be Clean.—Insert soluble suppository, and then place rubber pessary in position, concave side downwards. This will slip up more easily if slightly soaped. No harm can possibly come either to husband or wife from these appliances, and neither party will be conscious of the presence of the occlusive rubber pessary (some other kinds of rubber pessary have not these advantages). The pessary can be inserted some hours before intercourse, and need not be removed till some hours afterwards. The rubber pessary should not be worn continuously. If you have mislaid the rubber pessary, a small sponge, a piece of clean cotton-wool, or even a piece of soft tissue paper can be used. Native women in different countries use seaweed, moss, sponge, etc., and Japanese women use rice-paper. But these articles are not so clean or effective as the occlusive rubber pessary. If sponge or cotton-wool is used, it should be saturated in contraceptive lotion or smeared with contraceptive ointment before insertion. But always remember—the rubber pessary is cleanest and safest.
2. After Intercourse.—Douche next morning (or earlier), remove rubber pessary, wash and dry it and put it away slightly powdered. Where there is any chance of venereal infection, the woman should urinate immediately after each connection, wash with soap and water, and then at once douche with weak and warm disinfecting lotion. If medically directed, she should also use a little calomel ointment for anointing parts that have been touched in any way.
3. Daily.—Cultivate in yourself and in the members of your household habits of sexual cleanliness. Wash and be clean. Apply this to all the openings of the body, but in particular to the vagina, urethra and anus, which should all be cleansed night and morning. This practice is not simply cleansing and refreshing, but it is preventive of many forms of disease, such as piles, etc., etc., and
4. Always remember that the spread of this kind of knowledge has been made possible by the long and patient efforts of hundreds of doctors, many of them unknown and forgotten, and that women will best be able to apply this knowledge efficiently by working in loyal co-operation with medical practitioners who have made a special study of these matters.H
Digest of Best Preventive Precautions
Before Connection.
1. Douche with warm water or weak antiseptic lotion (warm).
2. Insert suitable suppository.
3. Place rubber pessary in position
After Connection.
4. Douche.
5. Remove rubber pessary. (Urinate to facilitate ejection of surplus fat.)
6. Douche and dry parts.
The use of rubber pessary does not do away with desirability of douching, but it does enable the woman to douche at her own convenience with safety.
Antiseptic Lotions
Dr. K.R.D. Shaw, of 144, Harley Street, London, W.1, who has had a very wide experience of “prevention” in different parts of the world during the last twenty-five years, has named the following as suitable disinfecting lotions:—
Half a teaspoonful of Lysol in 5 pints of warm water;
or One teaspoonful of Sanitas in 5 pints of warm water;
or One quarter teaspoonful of Bacterol in 5 pints of warm water;
or 2 grains of Sulphate of Copper in 5 pints of warm water.
N.B.—Where there is grave danger of venereal infection, it is an excellent additional precaution to douche first with soap and water, and douche again with antiseptic lotion. The sooner this is done the better.
If all or most of these hygienic measures are widely made known to women, it can rightly be claimed that women have been released from the twin terrors of unwanted pregnancy and venereal infection, which are at the present time ruining their marital health and happiness in so many cases. Even if some only of these measures are adopted, the nation as a whole cannot fail to benefit mentally, morally and physically. The success of the measures, of course, depends to some extent on their being taken in time, but in this, as in many other directions, the old proverb holds good: Better late than never.