Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

IMPOTENCE AND STERILITY

Evidence in relation to the above subjects may be required in actions for nullity of marriage, divorce, legitimacy, inheritance, pregnancy, and criminal assault.

Impotence.—By impotence is meant the incapacity for sexual intercourse, and applies both to the male and female; but the term is more especially used in reference to the former.

Sterility.—Sterility denotes the incapacity for procreation of children; is also applicable to both sexes, but more usually in reference to the female. A person may be impotent without being sterile, although the former is usually regarded as implying the latter. On the other hand, a person may be sterile without being impotent, the former not necessarily denoting the latter. In reference to nullity of marriage, if natural sexual relations are not and cannot be consummated, the marriage will be declared null and void, provided that such inability of consummation was unknown to the person bringing the action for nullity before marriage. Impotence is sufficient ground for bringing an action for nullity, provided it was present at the date of the marriage, that it is irremediable, and that the person bringing the action was not informed of it previously. Should, however, the marriage have been consummated and impotence develop later, there will be no grounds for such an action.

Impotence and Sterility in the Male.—This may arise from some organic defect of the organs or functional disorder. In reference to the former there are certain abnormalities of the male organs which have to be considered. Monorchids, men in whom one testis is absent from the scrotum, are not necessarily impotent or sterile; nor are cryptorchids, where both testes are undescended. In many of these cases spermatozoa are absent from the seminal fluid with consequent sterility; on the other hand, procreation has taken place, proving that cryptorchids are not necessarily sterile.

Absence of the penis may be the result of want of development, injury, disease, or operation. The penis may be present but attached in its whole length to the scrotum; this may be remedied by operation.

Epispadias, so often associated with ectopion vesicæ, as a rule renders an individual impotent and sterile. On the other hand, hypospadias does not necessarily bar procreation; it will depend largely upon the position of the urethral opening, and the possibility of its being remedied by operation.

Removal or destruction of both testes renders a man sterile eventually, but not necessarily impotent.

Functional disorder due to disease may give rise to impotence, although the organs may remain anatomically perfect. Diseases such as diabetes and influenza, neurasthenia, tabes dorsalis, myelitis, mumps, and orchitis, and injuries to the head may be causative factors in impotence.

The capacity for sexual intercourse is influenced to a varying degree by age. Sexual capacity is regarded as coincident with puberty. In judging the sexual capacity of a youth, age is of less moment than the degree of physical development. I have seen a male child of five years of age with as complete development of the sexual organs as an adult, and with a deep voice. At the other extreme of life it is impossible to lay down any definite limit to sexual capacity. Although it is regarded as diminishing with age, yet there are many instances of procreative power in men of an advanced age.

The principal points for consideration in reference to impotence and sterility in the male are: (a) Does the condition prevent the secretion of semen? (b) Does it prevent the conveyance of semen to the vagina?

Impotence and Sterility in the Female.—As in the male, these may be associated with organic defect or functional disorder. The external organs may be absent, with or without the internal. The vagina may be wanting through lack of development, or it may be obstructed by mal-development or the result of disease. Again, the external organs may be present, but the internal absent in whole or part. The hymen may be imperforate, or unusually tough. Diseases of the uterus often give rise to sterility. Vaginismus, in which attempts at coïtus cause painful spasm, may prevent intercourse. In reference to functional disorders are to be noted extreme debility, constant leucorrhœa, dysmenorrhœa, menorrhagia, and amenorrhœa, all of which may be associated with or causative factors in sterility. Emotional psychical conditions may prevent sexual intercourse in women. General diseases, however, do not necessarily prevent intercourse, as the woman may remain a passive agent, neither is bodily deformity always a barrier to the act.

The advent of sexual capacity in women is regarded as coincident with the onset of the menses, about fourteen years of age, but pregnancy has been known to take place prior to the first menstrual period. The age at which the menses first appear varies in no small degree. It has been known to occur during the first year of life, and pregnancy has been known to occur as early as the eighth year. The menopause in women is regarded as coincident with loss of procreative power. Women as a rule cease to menstruate at forty-five years of age, but in not a few the function persists until fifty, in exceptional cases to a more advanced age. It is rare for a woman to bear children after the menopause, but exceptions have been known to take place.

In the case of a husband seeking a nullity of marriage on the grounds of impotence or sterility in his wife, the question at issue is not whether she can bear children, but can she permit sexual intercourse? Many conditions which cause sterility in the woman need not render her impotent, and unless the latter obtains a nullity of marriage would not be allowed. Further, the conditions which render the woman impotent must be permanent and irremediable.