Chapter 14

SEXUAL HYGIENE OF THE ADOLESCENT MALE.

SEXUAL HYGIENE OF THE ADOLESCENT MALE.

No rational or acceptable system of sexual hygiene for the human male can be worked out without constant reference to the lower ranks of the mammalian class and to primitive social conditions.

In our study of the anatomy and physiology of the sexual apparatus of the human male, it must have become evident that man has many things in common with other mammals, and that no adequate knowledge of man's physical or psychical attributes can be obtained without a study of similar phases of life among related animals.

All of the changes which Nature introduced into the physical and psychical development of the adolescent male were of a character to equip the individual for the maintenance and protection of a wife and children. This development has been reached by the time the young man is twenty-one to twenty-three years of age, when, in the average case, he would be able, so far as concerns his physique and temperament, to establish and maintain a home. The fact that his adolescent development is complete by the age of twenty-five, and that he has, by the time he arrives at that age, grown into the full stature of all his physical and mental powers, may certainly be interpreted as nature's indication that his home-building should be begun not later than the twenty-fifth year. This means, then, that young men ought, if possible, to marry as young as twenty-five.

But the conditions of society at the present time are such that a large proportion of the young men, particularly those who are preparing for any of the learned professions (theology, medicine, law, pedagogy, etc.) are hardly through their professional courses by the time they reach that age, and most of them feel that they must make a start in their profession before they assume the responsibilities of supporting a home. This means that a large proportion of them marry as late as thirty years of age.

If we consider now those commercial, financial and industrial vocations which involve considerable preparation in technical institutions or a long apprenticeship (engineering, pharmacy, manufacturing chemists, banking, journalism, etc., etc.) we find that the young man is hardly able to establish such a home as most such young men feel that they must maintain on any salary that they receive before they are twenty-eight to thirty years old. This consideration applies particularly to college and university men, as, almost without exception, these men are preparing for some of the above mentioned professions or vocations.

Now the conditions of college life, the field sports and athletics, together with the social conditions, tend to develop in college circles a body of most virile young men. The problem which now confronts us is: How may these young men live a hygienic life under these unnatural circumstances?

If a man becomes able to procreate his kind at seventeen but is hardly able to marry before he is thirty he must solve the problem as to what his attitude shall be regarding matters of sex. The earlier this problem is solved the better it is for the young man. Unfortunately, a large proportion of young men do not realize that they have any problem in this field to solve until circumstances, more or less accidental, have already established in them a mental attitude and, perhaps, a habit of life that may not be either wholesome or wise.

From what has preceded, it must be evident that from the early months of the period of puberty, through the adolescent and adult period, even until some progress is made in the senile period, every normal male will experience sexual desires. It has been shown that these particular experiences are linked, more or less intimately, with the condition of the sexual apparatus; but whatever the cause, we are confronted with the question, What shall be done about it?

When a man experiences a sexual desire does it necessarily follow that the desire must be satisfied? Some have reasoned that the muscles of the arm, if not exercised, wither and become weak, therefore the sexual desires, if not exercised will become weak, and the sexual apparatus, if it does not exercise its function, must become withered and atrophied. While this course of reasoning may seem rational and the conclusion may seem tenable, it is well known to physiologists and sociologists that the reasoning is fallacious; the fallacy rests in the premises. It was assumed above that the activity of the sexual glands was comparable with that of muscles.

We must not lose sight of the fact that the male sexual glands are continuously active, and in this continuous activity get their exercise. This activity develops them and keeps them physically perfect after the onset of the period of puberty. Their activity consists very largely in the formation of an internal secretion, the office of which is to develop in the male the highest possible state of virility. Nor must we lose sight of the fact that every procreative act is performed at a sacrifice of some of this vital fluid on the part of the male. A wanton sacrifice of vital fluid either in the act of self abuse or in excessive venery is not justifiable under any consideration; nor may these acts, under any circumstances, be looked upon as sustaining to the gland a relation similar to that which muscular exercise sustains to muscle tissue.

In the light of these facts every normal man would admit that frequent masturbation or excessive sexual intercourse, in wedlock or out, should certainly not be recommended as a method of developing the sexual apparatus.

Most men, however, raise the question: "Is any indulgence or any artificial means for satisfying the sexual inclination to be discouraged?" This inclination comes to us in the course of nature. Man in the primitive state would seek a mate as soon as he felt this inclination; would fight for the possession of her as soon as he had reached a sufficient stage of muscular development, and once in possession of his mate, would take her to his perch in the trees or to his cave. In his primitive home he would follow his sexual inclination, impregnate his wife and protect her against all dangers.

Under our present social conditions the young man experiences all these desires the same as his primitive ancestor, but he may not be able to choose a mate and begin with her the building of a home for a whole decade after he experiences the desire to do so. What is the solution?

It must be evident that the solution lies in the acceptance of one or another of three alternatives--either the young man may seek illicit intercourse with women to satisfy his sexual desire, or he may adopt some artificial measure, such as masturbation (self abuse) or, finally, he may lead what is known as a continent life. By continence we mean to adopt neither one of the first two alternatives mentioned, but to leave the care of the sexual apparatus wholly with Nature.

We may now consider these three alternatives in turn.

1. ILLICIT INTERCOURSE WITH WOMEN.

By illicit intercourse with women we mean, sexual intercourse out of wedlock. The term applies either to intercourse between any man and a prostitute, between an unmarried man and a married woman, between an unmarried man and an unmarried woman or between a married man and a married woman not his wife. The term, illicit intercourse, applies to all sexual intercourse that is illegal.

In our discussion of the young man's problem, we may confine our consideration particularly to intercourse with professional prostitutes and with clandestines, or women who are willing to accept the sexual embrace for their own gratification or for money.

In this phase of sexual gratification, it is assumed that the woman has these relations with various men. We purposely eliminate from this discussion the deliberate seduction of pure girls for the purpose of sexual gratification, as such seduction is a heinous offense against the victim and against society, for which offense the man is legally responsible. We are here discussing not the crimes of men, but their vices.

The question that the young man naturally asks is--"Why should society hold these relations as a vice when the woman, who is party to the act, gives her free consent, perhaps even soliciting the relation, and has given herself up to this sort of a life, either as a sole occupation (prostitute) or as an auxiliary occupation (clandestine) to supplement a wage on which she may not be able to live in luxury?"

The answer to this question is not far to seek. Women so occupied have, as a rule, made themselves incapable of maternity. They are outcasts from society, unfortunately exerting a most harmful influence on all those who come into relation with them. Furthermore, they are centers for the dissemination of venereal diseases which wreck the health of all those who become infected. But for the uncontrolled passions of men, there would be no such women. So while we, individually, as men, may not be responsible for the ruin of any one woman, we must confess that men as a class are responsible for this condition of prostitution and clandestine intercourse. An overwhelming majority of women would, if following their inclinations, seek these relations in wedlock only and for procreation only. But many a young woman, under promise of marriage, sometimes even under a bogus marriage, is brought into a condition of hypnotism or into a mental state that puts her in the power of the man whom she loves and respects. If he deceives her and betrays her, continuing such betrayal until the victim becomes pregnant, he will, in the average case, leave her to bear her child in shame, while he slips away to other scenes of activity. We cannot wonder then, that the girl--deserted, humiliated, crushed by the one in whom she reposed absolute confidence; cast out of society, perhaps thrust from the protection of her own father's roof--gives up the struggle and says--"_What's the use?_"

A vast majority of such poor girls make their way to houses of ill fame and give themselves over to a life of prostitution. Hardly one of these women, if married by the man who brought her to this condition, would have failed to make a true and loving wife and mother. So society, while it casts these women out, has come to recognize that men are the real sinners in such cases.

It may be added here, that an occasional girl goes wrong through temperamental shortcomings within herself--perhaps she may even be a degenerate; but the proportion of women who would willingly and deliberately sacrifice their virtue is vanishingly small as compared with the proportion of young men who seem to be willing to sacrifice their virtue. This is probably in part due to their training. Mothers, as a rule, instruct their daughters carefully regarding their relations with boys and men. It is in part due to the instinctive and inherent purity of mind of the normal woman.

Nature has devised a retribution for illicit intercourse in the form of venereal disease. If the parties observe fidelity to the marriage vows venereal disease is experienced in wedlock only on very rare occasions, and then through some accidental infection, as from contact with some public utensils, as a public water closet, a public towel or drinking cup. So rare is this unfortunate accident, however, that we may say, that intercourse in undefiled wedlock results normally in pleasure and gratification to both parties, while intercourse out of wedlock, or illicit intercourse, is destined, as a rule, to be visited with retribution.

What form does this retribution that nature metes out to the vice of illicit intercourse take? Besides the various psychic punishments, the principal of which are remorse, and impure thoughts, there are physical punishments in the form of venereal diseases. So prevalent are these venereal diseases among lewd women, whether prostitutes or clandestines, that specialists in this field say that "_all lewd women are diseased part of the time and some lewd women are diseased all the time_."

These sexual diseases are contagious--that is, transmitted by contact. They are all germ diseases; one of them is practically local, one is capable of spreading the infection to contiguous organs and one is systemic.

a. =Chancroid or Soft Chancre.=--This is the least dangerous of the venereal diseases. It is a contagious disease of purely local type, usually acquired during the sexual act, the infection taking place through a break in the continuity of the mucous membrane.

Chancroid may be single, though most often is multiple. It makes its appearance in from one to five days after exposure, anywhere on the penis, but most frequently on the under side of the glans beside the frænulum as a small red spot. This rapidly takes the form of a blister containing serum and pus, and in a few days may become the size of a ten-cent piece. When the roof is removed the ulcer has the appearance of having been punched out, the floor being covered with pus. It is surrounded by a zone of inflammation and is painful.

If uncomplicated the disease runs its course in from two to five weeks. The most common complication is swollen and suppurating glands of the groin on one or both sides. This condition is termed _bubo_ or "blue ball" in common language.

Sometimes serious complications arise which may prove dangerous and require the individual to be confined to his bed for weeks.

b. =Gonorrhea.=--This is incomparably more serious than chancroid. This disease is very prevalent among the incontinent, and it is claimed by some specialists in this field that from sixty to seventy-five per cent. of men have had gonorrhea before the age of thirty.

It is a contagious disease, acquired usually during intercourse, though the individual may become infected innocently from water closets, bath tubs, etc.

To become infected it is not necessary that there be an abrasion of the mucous membrane.

The disease manifests itself in from three to seven days after exposure by swelling of the orifice of the urethra, peculiar sensations between tickling and itching, and smarting or burning during urination. The peculiar sensations fix the attention to the genitals, thus causing frequent passage of urine.

These symptoms increase for about a week, when the disease reaches its maximum degree of severity, which is maintained a variable time, the discharge from the urethra being thick, creamy and of a greenish yellow color.

In the majority of carefully treated cases, the discharge ceases in from three to six weeks with apparent recovery. Unfortunately, however, there is frequently a tendency for the disease to become chronic. The discharge becomes thin and more watery and persists for an indefinite period. This condition--chronic gonorrhea--is commonly known as "gleet."

c. =Syphilis=, popularly termed the "pox," is a constitutional affection of the type known as "blood diseases."

It is by far the most important and most greatly to be feared of the venereal diseases. No disease has been so wide-spread in its dissemination or more potent in its influence upon humanity.

It has been known for centuries, having been mentioned by Japanese historians and in Chinese writings two thousand years ago.

Syphilis is contagious and is transmitted by inoculation. The infectious material enters the broken surface of either the skin or mucous membrane, called "contact" or "acquired" syphilis. When it is transmitted by the mother to the embryo, it is called "hereditary" or "inherited" syphilis.

The disease manifests itself first in a "_primary lesion_" which is a local ulcer (hard chancre) at the point or points of inoculation at a period ranging from ten to thirty days after exposure. It may appear as an erosion or as a dry scaling and indurated papule, varying in size from a pin-head to a silver dollar. The base of the ulcer is indurated. It is oval in shape, perhaps somewhat irregular, with a raw surface and red colored base devoid of pus.

Immediately following the appearance of the chancre, the glands in direct connection with it become enlarged, hard and rarely painful, but they have no tendency to suppurate like the enlarged glands of chancroid.

The chancre disappears in a few weeks and then there is a period when the individual has no outward manifestations of the disease. In about six weeks after the chancre the so-called _secondary symptoms_ make their appearance. They are heralded by headache, pains in the limbs and back, nausea, sleeplessness and nervous irritability and fever, followed by the appearance of a rash upon the face and body, falling out of the hair, sore throat and mouth. These symptoms disappear to be again followed by a period free from symptoms. After a longer or shorter time the so-called _tertiary symptoms_ make their appearance, which are many and varied.

The disease presents a succession of morbid constitutional disturbances, appearing at variable intervals, and pursues a chronic course.

This disease remains in the body for years and affects the most vital organs, particularly the brain and spinal cord.

When one is infected with this disease he should seek the services of a reputable physician. The treatment of this extends over a long period, usually about three years, and must be strictly and conscientiously carried out. Marriage upon the part of an individual once infected should be only upon the approval of a physician.

After having detailed, as above, the terrible consequences of the venereal diseases, it is hardly necessary to add that the young man who deliberately seeks any of the usual chances for illicit intercourse, is more than taking his life in his hands. If infection with a venereal disease meant simply the death of the infected individual, it would really be very much less deleterious to society than is the present condition. When the young man "sows wild oats" and catches incidently gonorrhea, that twenty years ago was considered a sort of a "good joke," he will, in a large proportion of cases, lay the foundation for broken health and will run a serious risk of transmitting the disease to an innocent, pure wife.

When a woman catches this disease, particularly from her husband, she is very likely to interpret the discharge as a leucorrhea, may say nothing about it to her husband or her physician, but adopt simple home treatment with antiseptic and astringent douches. Such treatment will usually result in allaying the inflammation in the superficial organs, but will not eradicate it from the deeper organs. It spreads to the uterus, Fallopian tubes and ovaries and may even affect peritoneal tissues, first of the pelvis, then of the abdomen--may even finally affect the heart and joints. Of course, these are rather the extreme limit, but they are not at all rare cases. Once this terrible disease gets into a woman's organs, it is very likely to lead to a sojourn in a hospital where she loses some portion of her body as a sacrifice to this mogul of gonorrhea.

It is claimed by specialists in this field that at least sixty-five per cent. of the operations that women are subjected to in the hospitals for diseases of the pelvic organs are the results of gonorrheal infection. Besides the cases that require operation, a large proportion of cases of sterility is due to gonorrheal infection, either in the man or woman, or both.

If we consider the revolting sequences of syphilis with its train of operations, and progeny of scrofulous children, it would seem to make the natural retribution for illicit intercourse infinitely outweigh any brief pleasures derived from the enjoyment of the stolen fruits.

It hardly seems possible that any young man who knows the whole truth about these venereal diseases and their terrible after-effects could be tempted to indulge in illicit intercourse.

2. MASTURBATION.

The vice of masturbation or self-abuse is very likely to be learned in boyhood, perhaps even by boys of six or eight years of age through their associations with obscene playmates. It not infrequently happens, however, that the habit is learned independent of these evil associations. It has been explained above that secretions frequently accumulate under the prepuce and accumulating there serve as a local irritation, causing itching of the organ. This local irritation leads the boy to attempt to allay the irritation through rubbing. Such manipulation of the organ is very likely to excite it and to lead to the discovery on the part of the boy that such local manipulation may lead to pleasurable sensations of momentary duration. If he has not been instructed by his parents that these organs are sacred to the uses of manhood and that they will be injured if handled during childhood, he is very likely to repeat this act until it becomes a more or less fixed habit.

While it must be admitted that anything short of extreme excess in this habit among little boys will not be permanently injurious if the habit is stopped at puberty, it must be perfectly evident that if a boy enters puberty with this habit, the psychical and physical conditions of puberty are such as to make the habit very difficult to stop. If it is not stopped a serious injury may result. So the necessity hardly need be further urged for explaining to young boys that these organs should not be handled.

After the boy enters puberty, the habit of masturbation either acquired during puberty or carried into that stage from early boyhood, begins to have a distinctly deleterious effect.

Let us now consider just what is the character of this deleterious effect. From what we know of the physiology of the sexual apparatus, it must be evident that a sexual orgasm could be produced during waking hours only through strong stimulation of the activity of the testes, accompanied by liberation of spermatozoa and of the other elements of the vital fluid. Let us not forget in this connection, the statement made above: that the testis produces two forms of secretion, the internal secretion and the external secretion, the internal secretion being absorbed, produces those male characteristics which we group together under virility, while the external secretion is used for procreation. Spermatozoa do not make any part of the internal secretion. One reason for this must be evident, i.e., that being cellular elements, they could not pass through the vessel walls and be absorbed into the blood current, and if they could, by some special adaptation, get into the blood current, there is no conceivable action which they could perform in the body. We must then look upon the internal secretion as composed of the liquid elements of the testicular secretion.

So far as physiologists know at present, the external secretion differs from the internal secretion only in possessing spermatozoa. When we say that the testes form their external secretion under sexual excitement only, we simply mean that they liberate or release spermatozoa under sexual excitement. The spermatozoa must be looked upon as the fertilizing element of the semen, while the liquid portion of the semen probably contains that mysterious element which, absorbed into the body, produces virility and which, passed out with the spermatozoa, may have an important role to perform in the fertilizing function.

If the adolescent young man is leading a continent life, we may assume that from time to time he is subjected to conditions which serve as strong sexual stimuli, arousing in him a definite desire for sexual intercourse; but leading a continent life, he curbs his desire and fixes his thoughts upon other subjects. In this way, though the sexual excitement is brought quickly under abeyance, we can rest assured that a certain number of spermatozoa have been released from the testes; and that the other secretions have been increased in volume. The excitement may be sufficient even to cause an erection, and produce a few drops of the secretion of Cowper's glands. The spermatozoa, together with a small amount of the liquid secretion, will make their way gradually along the vasa deferentia and collect in the ampullæ. The bulk of the liquid secretion, however, will, in the course of the following hours or days, be reabsorbed, thus making for virility. The small advance guard of spermatozoa that may have made their way to the ampullæ will undergo a gradual decrease of their nascent activity, as the days go by. On the occasion of the next nocturnal emission the ampullæ will empty along with the seminal vesicles and these spermatozoa pass out. If they be examined under the microscope as a part of a normal nocturnal emission, they will be found to be almost motionless or very greatly lacking in typical spermatozoon activity.

Now let us suppose that the young man, instead of curbing his sexual appetite, resorts, after a season of erotic imaginations, to the act of masturbation. We may picture the seminal ducts, vasa deferentia and ampullæ as being gorged with the secretion of the testes, including, of course, myriads of just released and nascent spermatozoa, together with several cubic centimeters of the liquid portion of the testicular secretion. The act of masturbation causes an orgasm and leads to a complete emptying of all these ducts. Thus we note that in this case the virile fluid is wasted, not being used in the procreative act or reabsorbed to exert its influence on virility. Nature's ends have been defeated. The system suffers a certain degree of depletion from which it recovers only after hours or even days. It must be evident from this picture of the processes that go on in the male sexual apparatus incident to the act of masturbation that the act cannot be performed repeatedly, as it naturally is when it becomes a habit, without interfering with the virility of the adolescent male.

In the study of a large number of cases the author has found that the principal _physical_ changes that occur in a young man as the result of this habit are, flabbiness of muscle and clamminess of hands. The really virile man possesses firm muscles and clear, direct eyes and a strong grip; usually also a warm grip.

It has been thought by some that pimples on the face are a sign of masturbation in the youth, but such is not the case. They are a sign of lack of elimination through the kidneys and bowels and are not to be interpreted as having any essential relation to masturbation. There may possibly be an incidental relation growing out of the fact that in some cases of masturbation that habit seems to affect the nutrition and that in turn may cause the appearance of pimples on the face of the adolescent. However, one must be very slow to pass judgment in these cases.

Not the least important among the results of masturbation is the attitude of the victim to society in general. This _psychical_ change is noticed in immoderate cases of masturbation and takes the form of disinclination to enter into any physical contests, or games; and disinclination to cultivate the society of the opposite sex. Here again one must be conservative in his judgment, because there are individuals who possess a very retiring temperament naturally, and who may become so engrossed in study or productive work that they take little share in the society of either sex, so that individuals who may be wholly innocent of any abuse of their sexual apparatus would suffer a very grave injustice if they were classed among the masturbators. So allow the author at this place to emphasize the importance of never passing judgment on anybody in these matters on circumstantial evidence.

While the damage that one may do to his system through the practice of masturbation may not be very serious, in many cases that have come under the author's observation in which the habit has reached extreme limits, very serious, sometimes irretrievable damage has been done, yet the encouraging feature of this whole matter is, that if the adolescent youth, who is practicing this habit, is warned of its danger and stops at once absolutely, nature comes to his rescue, and gradually, step by step, but surely, rebuilds the whole fabric of his virility, bringing back gradually the flush of perfect health into his cheek, the light of perfect manhood into his eye and the tone of perfect virility into his muscles.

This change can be wrought in from one to three years of absolute continence. Nature, like a loving mother, heals the wounds of her child with a kiss.

3. CONTINENCE.

Such frequent reference has been made above to continence in antithesis to illicit intercourse and masturbation that little need be said in addition to that which has preceded. The young man who holds before his mental vision an ideal of the home he hopes some day to establish--in which a pure wife reigns as queen, sovereign of his life, and gently hovers over a brood of lusty boys and fair girls--cannot for a moment consider as a sane solution of his sexual problem, periodic visits to the house of ill fame or the periodic lapse into illicit intercourse with clandestines; nor can he expect to develop his powers, physically or intellectually to the highest possible degree if he permits himself to contract that habit [masturbation] which, step by step, undermines his development. There is open to the young man only one of the three alternatives mentioned above, i.e., TO LEAD THE "CONTINENT LIFE."

The continent life is a goal which every healthy young man should strive to reach. To arrive at a goal that is before us and above us requires sacrifice and brings compensation. The sacrifice takes the form of the exertion of the whole will power of the man and the painstaking observance of those rules of hygiene which make continent living more easily attainable. The compensations of continence are those that come from the assurance that the young man has of his virility, of his worthiness to take the hand of a pure wife in wedlock, of the consciousness of his ability to establish and maintain a home, and to protect this home against all dangers.