Part 7

In the further course of development of the graafian follicles at this period, the most advanced now reapproach the surface of the ovary, so that a fully-matured follicle comes to occupy almost the entire thickness of the cortical substance, and may even give rise to a localized bulging of the surface of the organ. In such a mature follicle, which has attained nearly the size of a pea, we recognize an outermost connective-tissue investment (_theca folliculi_), consisting of condensed ovarian stroma, in which two layers are distinguished, sometimes called simply _outer tunic_ and _inner tunic_, sometimes known by the names of _tunica fibrosa_ (outer) and _tunica propria_ (inner), respectively; within this is the cellular layer known as the _membrana granulosa_ (or _stratum granulosum_), the portion of which, now greatly enlarged, immediately surrounding the ovum is known as the _discus proligerus_ (or _cumulus oöphorus_); the interspace between the _discus proligerus_ and the membrana granulosa is filled with a clear fluid, the _liquor folliculi_. In consequence of the continued increase in its fluid contents, the graafian follicle ultimately bursts along the most prominent portion of the superficial wall, and the ovum passes out through the rupture, finding its way under normal conditions into the Fallopian tube and through this into the uterus. The follicle itself then undergoes a regressive metamorphosis, forming the _corpus luteum_, the rent in the envelope of which, after the absorption of the yellowish semi-fluid contents, undergoes cicatrization. Contemporaneously with this development at puberty of the process of ovulation, menstruation also for the first time makes its appearance, recurring thenceforward at four-weekly intervals as the regular catamenial discharge.

We append the account given by _Pfannenstiel_ regarding the ovarian follicles. He writes: “In correspondence with the especial function of the female reproductive gland, which is to bring to maturity and to evacuate only after the lapse of a considerable period and at successive intervals, the ova which it has contained from the very outset, we find that primitive follicles continue to exist in the ovary up to the very end of the period of sexual activity, though naturally in diminishing numbers; and the size and shape of these primitive follicles remain nearly identical throughout the various periods of life. As the follicle ripens, the epithelium grows, the cells becoming cubical with a rounded nucleus, and increasing in number by cell-division, so that several layers are formed. As soon as these layers are three or four in number, a space, at first slit-shaped, forms in the epithelium on the peripheral surface of the ovum; this space is filled with fluid, known as the liquor folliculi; the peripheral layer of cells, the membrana granulosa, is thus separated from the mass of epithelial cells immediately enveloping the ovum, the discus proligerus, which is situate in the side of the follicle adjacent to the hilum of the ovary. By the increase of the liquor folliculi the graafian follicle is formed, a vesicle the envelope of which is formed by the multilaminar membrana granulosa, whilst in the pole of the vesicle directed toward the hilum ovarii is the ovum imbedded in the mass of cells forming the discus proligerus, a mass which has the form of a truncated cone. The liquor folliculi is formed by the epithelium, the nuclei of which disappear by chromatolysis or by simple atrophy whilst the cell-bodies liquefy in consequence of albuminous, not fatty, degeneration (_Schottländer_). Within the epithelium of the follicle we find the faintly glistening epithelial vacuoles of _Fleming_, likewise cells which liquefy and assist in increasing the bulk of the liquor folliculi. This liquor is a thin, serous fluid, and contains albumin. * * * Every graafian follicle has a bilaminar investing membrane, which is formed by the ovarian stroma. * * * The ovum of the growing follicle increases in size very slowly indeed, attaining on the average, according to _Nagel_, a diameter of 165 to 170 µ, it retains its zona pellucida, the greater part of the protoplasm of the cell is transformed into deutoplasm (food-yolk, or yolk-granules), the nucleus assumes an eccentric position. Between the zona pellucida and the cell-body a narrow perivitelline space appears. The ovum is then full-grown, but not yet fully prepared for fertilization; for this, maturation is required, certain changes in the germinal vesicle, which occur after the bursting of the follicle. * * * As a rule each follicle contains a single ovum. But two and even three ova have beyond doubt been observed in one follicle.”

According to _Waldeyer_, the bursting of the follicle is not to be regarded as dependent upon a sudden rise of pressure in its interior, but as the result of a gradual ripening process. At the deepest pole of the follicle, which in the course of its development has now approached the surface of the ovary, an exuberant growth takes place in the internal layer (tunica propria) of the theca folliculi, with a profuse formation of new vessels. Here numerous “epithelioid” cells, the “lutein-cells,” make their appearance. In consequence of this proliferation of the lutein-cells, the contents of the follicle are gradually pressed toward the “stigma,” the superficial pole of the follicle, and the follicle itself is pushed toward the surface until it finally comes into contact with the germinal epithelium. Meanwhile the follicular epithelium undergoes fatty degeneration, alike in the membrana granulosa and in the discus proligerus. In consequence of the proliferation of the lutein-cells, on the one hand, and the fatty degeneration of the epithelium, on the other, the follicle opens at its weakest point, the stigma, and the ovum is extruded, with the liquor folliculi, and a number of cells belonging to the follicular epithelium. (To illustrate these changes we have borrowed FIGS. 15, 16, and 17 from the monograph, by _Pfannenstiel_ on _Diseases of the Ovary_, in _J. Veits’ Handbook of Gynecology_.)

The ovaries, which in the new-born female infant are flattened, ribbon-like bodies one-half to one centimeter (0.2 to 0.4″) in length, and in childhood are cylindrical, with a perfectly smooth surface, assume at the time of puberty a more or less flattened form. During the menarche they have an elongated oval shape, flattened from side to side, their average length being 2.5 to 5.0 centimetres (1 to 2″), width 1.5 to 3.0 centimetres (0.59 to 1.18″), thickness 0.6 to 1.4 centimetres (0.24 to 0.55″), weight 5 to 8 grammes (77 to 123 grains). After the repeated occurrence of ovulation, the surface of the ovary becomes more and more uneven, being thickly covered with fossæ or scar-like fissures.

[Illustration:

FIG. 16.—Ripening follicles. ]

The vagina during virgin girlhood is narrow, and its mucous surface is beset with numerous rugæ, which may be plainly felt as well as seen. The calibre of the vagina is proportionately less the younger the girl. The examining finger is gripped by the vaginal wall as by an india-rubber tube (_Maschka_). The vaginal portion of the cervix is felt in the form of a truncated cone, with a smooth surface, rather dense in consistence; the external os opens at the bottom of a small depression on its surface, in the form of a short oval, the long axis of which is transversely directed. Shortly before the menarche, Bartholin’s glands become noticeable on either side of the lower end of the vagina between the sphincter muscles.

The clitoris in many cases attains a very large size, and this is apt to lead to sexual malpractices. According to _Hyrtl_, in southern countries the clitoris is larger than in temperate and cold climates. In the women of Abyssinia and among the Mandingoes and the Ibboes, the size is portentous, and amongst the first-named, circumcision of females is a customary operation. It is said that female slaves belonging to these races are greatly esteemed by the ladies of the harem, and are eagerly sought for. In the anatomicopathological museum at Prague there is a preparation of the female genital organs with a clitoris as large as the penis of a full-grown man.

[Illustration:

FIG. 17.—Graafian follicles. ]

_Sonini_ describes “as peculiar to women of Egyptian or Koptic descent, the presence of a thick, fleshy, but soft and pendent outgrowth in the pubic region, completely covered with hair,” which he compares to the hanging caruncle on the bill of the male turkey. This appendage becomes thicker and longer with advancing years. Sonini found such an appendage one-half inch in length in a girl of eight years, one of more than four inches in a woman of twenty to twenty-five years. Circumcision in girls consists in the removal of this outgrowth, which hinders copulation; in that part of the world the operation is usually effected in the seventh or eighth year, just before puberty.

The circumcision of girls as practiced by Mahommedan peoples in Africa is said by _Ploss_ and _Bartels_ to consist in abscission of the labia minora, the clitoris, and the præputium clitoridis. _Brehm_ is of opinion that the object of the operation is to diminish the intensity of the sexual impulse, so overpowering among these races; but others believe that the great enlargement of the clitoris and the labia minora usual in those countries is regarded as a serious defect in beauty, a defect removed by the operation; whilst others again hold that the circumcision is required for the removal of the hindrance to copulation presented by the abnormally large clitoris. Closely related to the operation of circumcision in females, according to _Ploss_ and _Bartels_, is the custom peculiar to Africa of infibulation, wherein, after a preliminary cutting operation like that for circumcision, the fresh wound surfaces are brought into accurate opposition, either by sutures or by appropriate bandages, so that when cicatrization occurs the vulval cleft is closed except for a very small aperture. The object of infibulation is to enforce on girls complete abstinence from sexual intercourse. (Before marriage, the vulval cleft is reopened to an extent corresponding with the size of the genital organs of the future husband; and when pregnancy occurs, the opening is still further enlarged before parturition; but after that event, the wound surfaces are refreshed, and the whole opening is once more closed). On the other hand, in many savage tribes, elongation of the labia minora and the clitoris is artificially undertaken from the earliest years of girlhood, this elongation being regarded as a beauty.

The parts of the external reproductive organs of the female concerned in sexual sensation, first described as such by _Kobelt_, are already fully developed at the time of the menarche. Of these parts a small portion only, the glans clitoridis, is visible externally, surrounded by the præputium clitoridis, a prolongation of the labia minora, which passes round the front of the clitoris, and sends from each side a fine process behind the glans to become attached to its under surface, forming the frænum of the clitoris. The erectile apparatus of the external genitals is formed by the corpora cavernosa clitoridis. As two delicately constructed trabecular masses of erectile tissue, the crura of the clitoris, these are attached on either side to the inferior or descending rami of the pubic bones; at first passing upwards parallel to the bones, they subsequently curve downward as they converge and unite to form the body of the clitoris; these masses of erectile tissue embrace the sides and the front of the lower extremity of the vagina. This erectile apparatus, when the supply of arterial blood is greatly accelerated and at the same time the outflow of venous blood is diminished, becomes distended with blood, enlarged and stiffened; the process of erection plays an important part, as we shall explain more fully later, in the production of sexual excitement and sexual pleasure during the act of copulation.

In the virgin and in the earlier phases of the sexual life, the hymen is so characteristic an organ that its more minute description would seem desirable.

The hymen, a fold of mucous membrane, springing from the periphery of the vaginal orifice, separates as a perforated diaphragm the vagina from the vulva. Between the two epithelial layers of which, as a fold of mucous membrane, the hymen consists, is a supporting layer of connective tissue of variable strength; in other respects the mucous membrane of the hymen has the same structure as the mucous membrane of the vagina. On its inner surface the rugæ and folds of the vaginal mucous membrane are prolonged. The shape of the hymen is very variable; most commonly its aperture is more or less central, so that the hymen has a ringed or semilunar shape.

[Illustration:

FIG. 18.—Annular Hymen. ]

[Illustration:

FIG. 19.—Annular Hymen. ]

In the new-born female infant, the hymen has the appearance of a tubular stopper closing the lower end of the vagina; according to _Dohrn_ it exhibits as a rule one of three typical forms: _Hymen annularis_, _denticulatus_, _et linguiformis_; the _annular_, the _denticulate_, and the _linguiform_ (or _linguliform_) _hymen_. The transverse ridges on the inner surface of the hymen, prolongations of the rugose columns of the vagina, are strongly developed. During the girl’s further growth, in association with the enlargement of the vagina, the hymen undergoes important changes in form and structure. Its border becomes thinner and more tense; and in the virgin at the time of the menarche, the annular hymen is the fundamental type, subject, however, to extensive variations. In most cases, at any rate, the aperture in the hymen is more or less centrally situated; very commonly, however, this opening is crescentic, when we have a semilunar hymen, the height of the border posteriorly being much greater than anteriorly. The consistency of the hymen, its extensibility, and its thickness, are as variable as its shape.

[Illustration:

FIG. 20.—Semilunar Hymen. ]

[Illustration:

FIG. 21.—Annular Hymen with congenital Symmetrical Indentations. ]

[Illustration:

FIG. 22.—Fimbriate Hymen. ]

[Illustration:

FIG. 23.—Deflorated Fimbriate Hymen. ]

In the normal position of the reproductive organs the hymen has very rarely the appearance of a tense membrane; as a rule it is folded up, and becomes plainly manifest only when the genital organs are stretched. The margin of the hymeneal aperture, as a close examination shows, is sometimes sharp and regular, sometimes lobulated, with small congenital notches. These congenital notches are to be distinguished from the lacerations resulting from defloration by the fact that the former have a smooth border, which is of the same consistency as the general substance of the hymen. In some instances the border of the aperture in the hymen is beset with small, fine villi (villous hymen).

The common varieties of the hymen are thus classified by _Maschka_:

1. The _annular hymen_, in which the membrane when stretched is seen to have a rounded aperture, which may be central or eccentric; very often, indeed, the aperture is more toward the upper half of the hymen, in which case it is not always circular, but frequently rather ovoid in shape.

2. The _semilunar_ or _crescentic hymen_, in which the aperture is eccentrically placed in the upper half of the membrane, in such a manner that the hymen exhibits a wide surface below the aperture, which surface narrows at either side as it passes upwards until it disappears, the two sides failing to reunite above the aperture.

3. The _heart-shaped_ or _cordiform hymen_, the general shape of which may be circular, ovoid, or even semilunar, but in which from the middle of the upper or lower margin a three-cornered tongue projects across the aperture, which is thus given the form of the conventional heart of a pack of cards.

4. _The infundibuliform hymen_ has the form of a small projecting funnel resembling in appearance the invaginated end of the finger of a glove.

_Maschka_ refers also to the rare condition in which the hymen is sometimes said to be absent. As a matter of fact, however, in such cases, it is represented by a very narrow annular eminence, the genitals being in other respects normal. The smooth character of the eminence will serve to differentiate it from the remains of a destroyed hymen. Other rare forms are:

1. The _imperforate hymen_, an occlusive membrane, entirely blocking the vaginal orifice. In some cases, however, the hymen is not absolutely imperforate, a very small, punctiform aperture being present.

2. The _cribriform hymen_, a hymen which is “imperforate” in the sense that there is no opening of a size approaching the normal, but in which several minute apertures are present.

3. The _septate_, _bridged_ or _divided hymen_ (_hymen bifenestratus_, etc.), exhibits a strip of mucous membrane, most commonly running directly from before backward, occasionally, however, somewhat obliquely, across the aperture in the membrane, which is thus divided into two equal or unequal parts. In some instances the process that bridges the aperture of the hymen is expanded in the vertical plane to form a septum which projects for some distance into the vagina.

[Illustration:

FIG. 24.—Septate Annular Hymen. ]

[Illustration:

FIG. 25.—Septate Semilunar Hymen. ]

[Illustration:

FIG. 26.—Extremely tough Annular Hymen, with an obliquely disposed Septum. ]

[Illustration:

FIG. 27.—Septate Hymen with Apertures of unequal size. ]

4. The _lobate_, _lobulated_, or _labiate hymen_, which consists of several (two to four) lobes on either side, each overlapping the next like the tiles in a roof, whilst the aperture between the two sides has the form of an antero-posterior slit (FIG. 37); in some cases the lobes of a lobulated hymen are so disposed that the membrane has the appearance of a fold of mucous membrane with a central furrow.

[Illustration:

FIG. 28.—Septate Hymen with Apertures of unequal size. ]

[Illustration:

FIG. 29.—Hymen with rudimentary Septum. ]

[Illustration:

FIG. 30.—Hymen with posterior rudimentary Septum. ]

[Illustration:

FIG. 31.—Labiate Hymen with posterior rudimentary Septum. ]

It is obvious that an imperforate or cribriform hymen, by the hindrance it offers to the passage of the menstrual discharge, is liable at the time of the menarche, and as soon as menstruation begins, to give rise to serious disorder and to pathological states.

[Illustration:

FIG. 32.—Hymen with anterior rudimentary Septum. ]

[Illustration:

FIG. 33.—Hymen with anterior rudimentary Septum projecting in a opiniform Manner. ]

[Illustration:

FIG. 34.—Hymen with anterior and posterior rudimentary Septa. ]

[Illustration:

FIG. 35.—Hymen with filiform process projecting from the anterior margin. ]

[Illustration:

FIG. 36.—Hymen in which there are two symmetrically disposed thinned areas. The left of these is perforated. ]

The illustrations we append, showing the various forms of the hymen, are taken from _von Hoffmann’s Handbook of Medical Jurisprudence_. (FIGS. 18–45.)

[Illustration:

FIG. 37.—Very unusual form of Hymen. ]

[Illustration:

FIG. 38.—Semilunar Hymen with cicatrized Lacerations in its Border. ]

[Illustration:

FIG. 39.—Deflorated Semilunar Hymen with laterally disposed Symmetrical Lacerations. ]

[Illustration:

FIG. 40.—Deflorated Annular Hymen with several cicatrized Lacerations. ]

[Illustration:

FIG. 41.—A. Septate Hymen in which Defloration has been effected through one of the Apertures. U. Urethra. Cl. Clitoris. H. Cicatrized margin. C. Septum. B. Lateral View of Septum. ]

In some cases the hymen is exceedingly thin and delicate, so that it is liable to be torn if handled at all roughly; in other cases, on the contrary, it may be very firm, thick, and fleshy, interlaced with strands of connective tissue and muscle, so that it forms a veritable cuirass for the protection of physical virginity.

[Illustration:

FIG. 42.—Deflorated Septate Hymen. ]

[Illustration:

FIG. 43.—Hymen with larger anterior and smaller posterior Apertures. ]

[Illustration:

FIG. 44.—Carunculæ Myrtiformes in a Primipara. ]

[Illustration:

FIG. 45.—Vaginal Inlet of a Multipara, without Carunculæ Myrtiformes. Slight Prolapse of anterior and posterior Vaginal Walls. ]

As signs of virginity in the female, a knowledge of which is required, not only for the purposes of medical jurisprudence, but for various other reasons, we may enumerate the following anatomical characteristics of the genital organs. The labia majora are elastic in consistence and are in close apposition with one another; the labia minora or nymphæ are covered by the labia majora and are but little pigmented; the vestibule and the vaginal orifice are narrow, and the vagina itself is narrow, tense, and markedly rugose; the hymen is normal and uninjured (this, of course, is the most trustworthy of all the signs of virginity); the breasts have the virgin conformation. In opposition to the plea that the hymen can be destroyed by other causes than defloration, as by a fall, especially a fall which brings the external genitals in contact with some hard body, or by diphtheritic, variolous, or syphilitic ulceration, _Maschka_ maintains that such occurrences are among the greatest rarities.

On the other hand it is sufficiently well known that the presence of an uninjured hymen affords no certain assurance of actual virginity. Cases enough are recorded, both in older and more recent medical literature, in which even pregnancy occurred in women in whom the hymen had remained intact, the explanation being that during copulation penetration of the penis had failed to occur, the semen being ejaculated on the vulva. _Scanzoni_ and _Zweifel_ have recorded cases in which the intact hymen offered a hindrance to parturition. The first-named author explains these occurrences by the assumption that the hymen was so stout that the penis was unable to rupture it. _Veit_ remarks that both male and female youth, in these days of the continued advance of knowledge, are well acquainted with _coitus sine immissione penis_, and that very frequently a woman who is informed that she is pregnant makes answer that this is impossible, her paramour having assured her that pregnancy could not occur. On the other hand, cases are met with in which the aperture in the hymen is a very large one, so large that the penis can penetrate to the vagina without lacerating the membrane.

_Broudardel_ reports a case of rape in which the lacerated hymen healed so completely that an expert maintained the integrity of the membrane, until another pointed out the fine scar.

In general, that we may be assured of the existence of virginity, we must find the hymen uninjured; and, on the other hand, we must regard the laceration of the membrane, unless known to be the result of gynecological examination or other manipulation, as a proof of defloration.

In ancient times among savage races the integrity of the hymen was prized as a proof of virginity, and in the Bible also great stress is laid on this sign in connection with defloration, and its absence was even regarded as a ground for the death punishment (Deut. xxii, 21). But amongst other races the hymen was held in no particular esteem as a token of virginity.

[Illustration:

FIG. 46.—Mamma, the breast of a virgin aged eighteen years. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.) ]

In ancient times, and even at the present day in the Philippine Islands, the Ladrone Islands, and certain other islands of the Polynesian Archipelago, also among many African tribes, the right of defloration belonged, not to the bridegroom, but to every man belonging to the same tribe; sometimes on the bridal night all the men of the tribe had access to the bride, the bridegroom coming last, but thenceforward having undisputed possession of his wife. Amongst certain other tribes a similar custom prevails, differing however in this respect, that the rite of defloration is performed by a priest or by one of the chiefs of the tribe. In mediæval Europe, again, the great landed proprietors exercised the well-known _jus primae noctis_ or _droit du seigneur_.

In girls at the time of the menarche who have long practiced masturbation, some of the following indications of the habit will be found: Elongation, redness, and general enlargement of the clitoris; elongation and thickening of the nymphæ, which are also of a tough consistency and deeply pigmented; flaccidity of the labia majora; redness of the vaginal orifice; flaccidity of the hymen, which also may exhibit lacerations, caused by the forcible introduction of the finger or of some hard foreign body.