SEXUAL PSYCHOSES AND NEUROSES 213 



may be secondary, but — unless there be mental disease Primary 

 associated with such lesions, and, of course, apart from guffid^ncy" 

 primary menopausal atrophy — no positive mental dis- 

 turbances are ever seen. Negative mental anomalies, 

 such as aversion from sexual intercourse and child- 

 bearing, are, however, not uncommon — the stimulus 

 from the ovaries, which normally excites reproductive 

 instincts, is absent. 



At the menopause there is a more or less severe Menopausal 

 disturbance of the metabolism dependent chiefly on the P s y choses - 

 degree of activity that previously existed in the ovaries. 

 Many sexually apathetic women — that is, women with 

 not very active ovaries — pass through the menopausal 

 period with very little disturbance ; while women who 

 have been sexually active often have the ' change of 

 life ' late, and suffer from violent derangements of the 

 metabolism. These sexually active women may at this 

 period of life be subject to increased and almost in- 

 satiable sexual desire — probably due to the irregular 

 output of the ovarian stimuli. 



The ' change of life' is anticipated by a majority 

 of women with fear. In the first place they look upon 

 this period as synchronous with the disappearance of 

 their feminine attractions : youth, beauty and charm, 

 and all that makes them desirable to men. We need 

 not here discuss how far this may be true ; it is sufficient 

 to know that this idea presents itself to most women as 

 the time draws near. 



With an artificial or sudden natural menopause the 

 patient, if she were previously sexually active, may 

 suffer with melancholia : the rapid removal of the 

 ovarian secretion, which previously moulded her tem- 

 perament, and directed her pursuits and pleasures, 

 involves the loss of the guiding force of her existence ; 

 consequently depression, if y not melancholia, may 

 supervene. 



Moreover, many women are under the impression 

 that insanity is a frequent concomitant of the meno- 

 pause. This idea naturally tends to disturb the patient, 



