The most frequent causes of sterility in women are inflammation of the lining membrane of the uterus, or of the neck of the uterus, or of both.  The source of this condition in women who have had children is most frequently due to parturition or abortion.  In the newly married it may be due to a previously existing slight uterine catarrh in a displaced uterus, or it may be a manifestation of a run-down state of the system.  In a majority of the newly married, however, the inflammation of the endometrium is probably due to the first efforts at conjugal approach.  Many young women as the result of the preparation of the trosseau, augmented by a round of gaities at the time of marriage, enter the married state in a condition bordering on physical and nervous exhaustion; and then begin engorgements and inflammations which lead to future suffering and to sterility.  Displacements and flexions of the uterus also cause sterility.  Such displacements of the neck of the uterus may occur that, instead of lying in a pool of semen, as it should, it is above, in front of, or away from it, and this may prevent conception.

Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue shortness of the vagina, unless great care is exercised by the husband, will induce painful coitus, and may bring about sterility by favoring the formation of a copulation sac outside of the axis of the uterine canal, and consequently misdirection of the semen.

Scrofula, probably by its effects on the general condition, leading to deficient development of the whole body, the genital organs included, may be productive of sterility.

The female being less passionate than the male, the orgasm comes on later with her, or the male orgasm occurs so soon that she may not reach that stage at all.  If both were simultaneous, it is reasonable to suppose that conception would be more likely to occur.

Ovulation is doubtless more frequently performed in some women than in others.  Some women conceive with more or less regularity every fifteen or eighteen months, and others at intervals of several years.

The effect of repeated coition, provided that impregnation does not take place at once, is to engorge the uterine vessels, to alter the nature of the glandular secretions, to cause profound reflex disturbances, and thus to produce such changes in the endometrium as to lead to local inflammation and to general nervous exhaustion.  Backache, leucorrhea, and irritable bladder are the first symptoms of this disorder; but frequently there are added to these, headache, indigestion, rectal tenesmus, painful and profuse menstruation.  In many cases the disease continues in a mild catarrhal form, giving the woman little inconvenience besides the slight leucorrheal discharge which stains her clothing; but often this is indicative of such a change of the lining membrane of the uterus as to render it unfit for the fixation and development of the ovum, even should impregnation take place.