As I exposed in my book "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology"), one of the main problems of female nature is the instinctive duality between the attitude of not wanting to become pregnant ( that is, the rejection of pregnancy ) and that of desiring to become pregnant. The way women relate themselves to this question is extremely ambiguous, and here we arrive at the point in which the female nature "divides" itself in two "halves": one remains more linked to Eros ( the aphrodisiac side of women ), and the other to the so-called maternal instinct ( the demetric side of women ). In other words, one is related to the archetypal image of the "seductive woman", and the other to the archetypal image of the mother.

Here somebody could argue that motherhood is a consequence of Eros ; however, it is well known that this condition, as a primary biological phenomenon, can occur even without the development of the aspect related to Eros. A woman can be a mother even without having developed adequately the aphrodisiac side of her nature, and there is an enormous number of cases that clearly demonstrate this fact.

I believe it is valid to consider the existence of these two principles of a diverse nature in the female sex, in spite of the fact that they can eventually integrate and even complete themselves. There are women who give more value to the aphrodisiac side of their nature, while others give more value to the maternal one. We can observe that the majority of modern women only desire to become pregnant and have children, as they really do, in a few moments of their whole lives and that, most of the time, pregnancy is undesired and avoided. When gestation occurs by accident or negligence, it is almost always voluntarily interrupted by an abortion.

This means that, in a general way, in the most sophisticated and modern women the erotic and aphrodisiac side predominates over the maternal one during the greatest part of their fertile years. Nevertheless, there are those women who deviate almost all their libido to motherhood, and fulfill themselves mainly in this way, giving very little value to their aphrodisiac side. To the other extreme, there are those who do not have any maternal instinct, and never desire to have children.

With regard to the woman's instinctive duality between the aphrodisiac and the maternal sides, it is important to point out that eroticism in the female sex is, to a great extent, a self-eroticism related to women's own bodies and to their aesthetics, and that the maternal instinct demands, in order to be satisfied, a considerable sacrifice on the part of the female body. In my opinion, this is the principal basis for women's ambiguity relative to their reproductive capability.

For centuries, our culture has fallen into the mistake of considering reproduction as the main purpose of sexuality. This misconception has many origins, from religious ideas to the exclusively biological "scientific" view of the human being. However, it is obvious that, in human beings, reproduction, psychologically and existentially, is not in any way the main purpose of sexual desire. Human sexuality has its own reasons for being completely independent of reproduction. Reproduction became only one more fact, one more potentiality, in the very complex and vast field of the human sexual activity. On a great number of occasions, it is even an accident related to sexuality.

Specifically concerning women, the fact that they possess a genital apparatus and a physiology which, besides characterizing them physically as women and allowing a typical form of sexual activity, also have a reproductive purpose, does not authorize us to consider this reproductive finality as the principal one. All form and all human constitution by far transcend, from the existential point of view, their apparent original biological purposes. The human being is a biological and psychical wholeness and, because he/she possesses self-consciousness, his/her psychological side has developed far beyond the biological one. Thus, the human mind is not always in entire agreement with some biological determinisms, and also gives new and peculiar values to other features of the nature of women and men.

The error of considering reproduction as the main purpose of sexuality in human beings has influenced many areas. There is a tendency in our culture to excessively glorify motherhood, considering it as "the supreme female achievement", and deducing in a very tendentious way that women are mainly destined to become pregnant, give birth and rear children. This distorted idea has been transmitted to girls since childhood and exerts a considerable influence. There is, often, a subtle social pressure over couples, demanding sons and daughters from them. Women who have not developed the maternal instinct and, once married, decide not to have children, can even suffer some recrimination, though made in a subliminal way.

As our socio-cultural context has traditionally repressed sexuality ( in spite of the remarkable changes that have occurred in the last decades ), it has strongly emphasized the reproductive aspect of sex and, consequently, the maternal side of women. This attitude has had a great influence even on Female Medicine, creating an archaic and distorted standpoint which I call "the obstetric view of women". This misconception implies the existence of a considerable obstetric domination over Gynecology, as a consequence of which Gynecology also became "impregnated" with an "obstetric attitude of mind". This is also due, in part, to the fact that Gynecology has been traditionally practiced mostly by physicians who have a basically obstetric background. In my opinion, this situation creates extremely serious problems for Gynecology.

As I am accustomed to say, women possess the "erotic body" and, therefore, their psychology has, as a remarkable feature, a strong narcissist component related to the aesthetics and the good shape of their own bodies. At the same time, these bodies are capable of generating and giving birth to other human beings and, consequently, the female psychology is also orientated in this way. However, in order to satisfy their maternal instinct, women have to sacrifice their bodies in variable degrees and intensities, creating a conflict with their effort to preserve the aesthetics, the good shape, the comfort and even the health of their bodies.

The fact is that pregnancy and parturition impose great sacrifices on the female body, causing a considerable physiological overcharge as well as intense distortions and stretching of tissues not always entirely reversible to the previous state. Regrettably however our culture is inclined to see and exalt only the positive aspects of motherhood, trying to "hide" or not talk about the negative ones - purposely "forgetting" that everything in life has its positive and negative sides.

All of us, gynecologists, are very much aware of many sequelae that frequently result from pregnancy and/or parturition : lacerations of the uterine cervix, perineal ruptures, episiotomy scars, loss of strength of the structures of the pelvic floor, cystoceles, breast and abdominal flaccidity ( flabbiness ) and/or skin stretch marks, appearance of varicose veins, weight increase, etc. If a caesarian section is performed, parturition traumas are avoided, but surgical scars remain. It is obvious that women are also very much aware of these sequelae. Their major or minor occurrence ( as well as their intensity ) will depend on the specific conditions of each woman, on the minor or major resistance and elasticity of her tissues, on the conditions of each pregnancy and parturition and, to a minor degree, on the obstetric care that is provided.

In my opinion, it is this great sacrifice that pregnancy and parturition impose on the female body that, over and above all other reasons, gives women the perfect and entire right to abortion in cases of undesired pregnancies. A woman needs to desire too much to be a mother, so that she can be able to willingly tolerate the sacrifices, discomforts and risks that result from gestation and childbirth.

As I said, women also are very much aware of both the positive and negative aspects of becoming pregnant and having children - by personal experience and/or observation of other women. In spite of this, due to the cultural pressures that mythicize the "wonders" of motherhood, many women often have a tendency to repress the feelings considered as "negative" in relation to pregnancy. This fact generates guilt complexes with all of the consequent psychological problems. With regard to the female psychism, there is always an instinctive dualism between avoiding and desiring to become pregnant. The predominance of one side or the other, relative or absolute, is that usually varies depending on the several phases in the lives of the majority of women.

There is, however, a fact relatively easy to perceive : during the greatest part of the fertile years of most women, pregnancy is undesired and avoided ( many times even regarded with terror ). Regardless of this, they like to know that they are potentially fertile, that is, capable of becoming pregnant - but only when they desire, and if they so desire.

Sometimes, in gynecologic practice, we can observe that some women "neglect" the use of contraceptive methods, and become pregnant by "accident". Once pregnancy is confirmed and consequently their fertility is proved, they decide to have an abortion after which they return to the correct use of contraceptives. This somewhat irrational and complicated way of proving fertility almost always occurs subconsciously or unconsciously.

The female state of being is not an easy one, as it is always involved with very complex problems and situations characterized by ambiguities. The activity of Eros almost always creates a risk of pregnancy ; if this condition is undesired, it becomes necessary to use contraceptive methods in order to avoid pregnancy or to reduce this risk to a minimum. Consequently, the worry to avoid pregnancy creates another worry concerning the different contraceptive methods, as the hormonal contraceptives, the intrauterine device, etc.

When an undesired gestation occurs by accident or negligence, the solution is an abortion. When pregnancy is desired, it is necessary to tolerate the physical sacrifices inherent to gestation and childbirth in order to satisfy the maternal instinct. All of these facts have great implications in the female psychism and life, and it is fundamental that Gynecology be attentive to the psychological dynamics of these processes.

Note: See also "Undesired Pregnancies and Women's Right to Abortion".

Nelson Soucasaux is a gynecologist dedicated to Clinical, Preventive and Psychosomatic Gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, he is the author of several articles published in medical journals, and of the books Novas Perspectivas em Ginecologia (New Perspectives in Gynecology) and Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo (The Female Sexual Organs: Shape, Function, Symbol and Archetype), published by Imago Editora, Rio de Janeiro, 1990, 1993.

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Email: nelsons@nelsonginecologia.med.br