The Age of Despair

The sexual question in woman... this is the general study which Dr. Philip A. Ashkar is treating in the pages of this magazine. In this issue he passes to a new subject, concerning woman in her fifth decade, and it aims to bring woman to see forty as an age of hopes, not an age of despair, as she has been accustomed to see it.

They say: the diplomat is he who remembers a woman's birthday and forgets her age. By the fifth decade is not meant the years that have passed since a lady's birth, for these, however many they be, cannot trace a single line upon her radiant brow, nor weigh down her shoulders with the pains and hopes they carry. It is rather nature, which holds absolute sway over the physiology of the body, weakening some of its organs with the passage of time and stopping others from their work altogether. Among the organs whose work ceases in the fifth decade of a woman's life are her reproductive organs.

The function of reproduction in living bodies is the secret of their survival on the face of the earth, and in the higher animals it rests upon male and female; yet the importance of the female, even in mankind, is many times that of the male. From the biological standpoint, the man is an individual factor and the woman a factor of the species and the race: she is root and he is branch, she is foundation and he is accident. The sexual function in the man is a surface matter; in the woman, its driving force is the instinct of motherhood, and this feeling is part of her very life — she nourishes it with her blood, and it fills every part of her inward being. Woman, whatever her color, whatever her social position, whatever sciences she may acquire, and however far she may go in imitating man, whether in his works or his dress or his habits — addiction to drink, or smoking, or sport — the sexual factor remains dominant over her, master of her mentality and her psychology. If she marries, motherhood is the center of the circle of her being; and if she does not marry, the physiology of her reproductive organs reminds her, at fixed and regular times, of her femininity.

This phenomenon in woman's physiology lasts, on the average, about forty years, beginning at the age of adolescence and ending at the start of the fifth decade. And if the onset of the menses in the girl is a cause of joy to her and to her family, as a sign of the completion of her womanhood, their cessation brings gloom and vexation — and for that reason it has been named the age of despair. Nor is this strange: the sexual function is, in woman's eyes, a part of herself and a thing necessary to her life. If she is married and her menses cease, she feels that she has become barren, and that there remains no one in her hands to nourish with her love and encircle with her tenderness. If she is single, she feels that a magic power has been lost to her which can never be recovered. And woman, married or single, holds sacred her youth and her beauty, and so imagines that with the cessation of her menses the sun of her young womanhood sets, the warmth of her youth dies down, the magic of her eyes fades, and the roses of her cheeks wither. What increases her mental disturbance in this period of her life is her own ignorance, and the ignorance of her family, of the physiology of menstruation and its relation to her life, and the sayings and strange opinions that strike her ears from mothers and neighbors, advisers and friends. So it is that when the age of despair draws near, she often complains of symptoms beyond counting and beyond describing.

Yet there are many women through whom the age of despair passes without their being affected by it. Every age, in their eyes, has its beauty; they are like the evergreen tree which, when its blossoms have dried, keeps its luster and its perfection: many take shade beneath it, and the young of the birds sing among its branches. And between these two extremes lie conditions of every variety, no one of them resembling another.

Among the symptoms of which a woman may complain at the cessation of her menses, and which may last several weeks or a few months, are symptoms more psychological than pathological; their occurrence is in proportion to the woman's nervous and psychological condition, and they are the result of a lack of balance among the endocrine glands in the performance of their functions. These glands are what govern the reproductive system in its entirety, and this imbalance may lie in the quantity of hormones which one gland secretes in relation to the others.

The imbalance causes local symptoms and general symptoms. The local symptoms are confined to irregularity in

the amount of the menses and in the succeeding intervals, which may lengthen to several weeks or months; the menses then appear again in a quantity that may be less or more than what she has been used to.

As for the general symptoms, they are the facial flushing that comes without warning, accompanied by an outpouring of sweat and a tightness of breath. This feeling of suffocation was, in the view of the ancients, caused by the rising of the womb to the diaphragm and its gripping of the principal organs. These symptoms may recur several times in the day; then their severity eases and their number lessens after a few months.

The woman may also be afflicted with a skin eruption, with pains in the joints, most often in the knees, with disturbance of the digestive system, and with a rise in the blood pressure. All these symptoms are short-lived, and soon pass; and once they have gone, they leave no trace whatever behind them.

If, however, the woman is of nervous temperament, her nervous system is acutely affected in this period: she becomes quick to take offense and to flare up, intense in jealousy and envy, inclined to solitude and seclusion to the point of melancholia, and becomes one of the patients of the hospitals for mental diseases.

In recent times a great fear of the disease of cancer has taken hold of women. Whenever a woman feels some pain, or some irregularity comes over her menses, whether in the quantity or in the interval between periods, she supposes she has cancer, especially as she draws near the age of despair. If this fear is a motive for consulting the doctor at fixed times, then it is welcome; but if it is a cause of her misery and her despair, then she is mistaken in her supposition.

Cancer of the womb is an external growth that can be diagnosed early; early diagnosis draws early treatment after it, and early treatment leads to complete cure. So instead of letting fear master her, let the woman consult the doctor at fixed intervals, even if there are no symptoms that call for it. The doctor today has means at his disposal that enable him to diagnose the malady at its very beginning; and if the woman keeps always to the rule of consulting the doctor, and if the doctor is exacting in his examination and in his search for whatever points to the presence of cancer, there will remain in woman's life no problem called the problem of cancer of the womb.