Onanism, according to _Eulenburg_, is the cause of sexual neurasthenia in women as well as in men. If, however, among the relatively very large number of women addicted to masturbation, there appears to be such a very small proportion of instances of sexual neurasthenia, this depends on the fact that from the nature of onanism in women the physical and also as a rule the psychical consequences are as a whole apt to be much less severe than those arising from similar practices in men; but it depends also on the circumstances that neuromental abnormalities of other kinds and denoted by other names, such as dyspareunia, vaginismus, sexual hysteria, nymphomania, feminine sadism, and tribadism, are apt to arise in consequence of onanism. As regards onanism, so also may it be in regard to sexual excesses and aberrations in general; they may be on the one hand causes, but on the other symptoms and sequelæ, of sexual neurasthenia. Early-acquired or inherited homosexual tendencies and habits may, as _Eulenburg_ further points out, lead to sexual neurasthenia only, but then very easily, when such individuals have allowed themselves, against their nature but in obedience to conventional points of view and to the advice of the relatives, to be persuaded into marriage. That sexual abstinence alone is competent to induce sexual neurasthenia must be dismissed as a fable.
By the term _menacme_ I designate the culmination of the sexual development of woman, during which the processes of reproduction, copulation, conception, pregnancy, parturition, and lactation occur.
The processes of puberty in woman are fully completed at the age of from eighteen to twenty years, so that from this time forward she is fully equipped for the performance of her sexual duties. The first act in the fulfilment of these duties is copulation, which in civilized countries is in the great majority of women first undertaken at the commencement of married life. The average age at marriage in the women of this part of the world is 22; but marriages at an earlier age are very common, and in many circles of society the average age is as low as 20. The fullest maturity of sexual activity in women occurs, however, in the thirty-second year of life, this being the year in which on the average the maximum fertility is attained.