Permanent azoospermia is, as a rule, caused by inflammations of the testicles or of the epididymis. These bilateral inflammations of the testicles or of the vasa epididymis are almost always the result of gonorrhoea. The vasa deferentia are obliterated and impervious. The ejaculated semen consists only of the secretions of the seminal vesicles, of the prostatic glands and of the urethral glands.
The spermatozoa being absent, the sperma is much thinner than in the normal state. The absence of the spermatozoa and their movements is also the cause why the Boettcher’s crystals usually form much earlier; they appear within half an hour after ejaculation and in a considerable amount. They often cover almost the entire microscopical field. In the normal semen the movement of the spermatozoa prevents the early formation of the crystals; they appear after several hours’ standing and are fewer in number. The thin azoospermatic semen is more transparent and watery and contains more epithelia and fat than normal semen.
The patient is, as a rule, unaware of his anomaly. It is often discovered after his wife has undergone innumerable treatments for her supposed sterility. If the anomaly has been caused by gonorrhoea with the accompanying inflammation of the testicles, epididymitis, or spermatic funiculitis, the loss is almost irremediable. The revelation to the couple of their doom to childlessness is one of the many tragedies played in the doctor’s office.
Impotence of copulation.—The anomaly, most complained of, which drives the patient to seek medical help is the impotence of copulation. It is the anomaly which strikes the hardest blow to masculine vanity. It is a psychological fact that most men are proud of their potency of copulation and feel greatly humiliated when the same is impeded. A woman will not seldom discuss with her friends the double ovariotomy performed upon her, but the man deprived of his testicles will never mention the fact of his castration to his closest friends.
The impotence of copulation is best divided into four types:
1) Organic impotence.
2) Symptomatic, or paralytic impotence.
3) Psychic, a) transitory, b) relative, c) temporary impotence.
4) Atonic impotence.
Organic impotence may be congenital or acquired. Among the congenital forms are total absence of the penis. Smallness of the penis may also be the cause of impotence, although this cause has been somewhat exaggerated by most writers. The male generative organs on the Greek statues are in comparison with the size of the other parts quite small. Still, if the smallness goes beyond a certain degree it will cause impotence. In the same way enlargement of the penis beyond a certain degree will also result in impotence. Adhesions of the penis to the neighboring parts or torsion of the penis will render intromission impossible. Congenital absence of the testicles is always accompanied by loss of power.
Among the acquired deformities are counted neoplasms of the penis, elephantiasis, and the destruction of the penis through ulceration. Syphilis and tuberculosis of the testicles are generally destructive to virility. Removal of the testicles, even if operated later in life, is, after a certain time, followed by atrophy of the penis and impotence. Indurations and ossifications of the cavernous bodies lead, as a rule, to impotence.
Symptomatic impotence.—The organic type of impotence is relatively very rare. The other type, symptomatic impotence, is oftener met with. It is found in cerebral diseases, diabetes, tabes dorsalis, chronic nephritis, extreme obesitas, chronic rheumatism, chronic alcoholism and in the cachexies of anaemia, cholaemia and uraemia. But since the desire fails with the failure of power, such patients rarely seek medical aid for this anomaly. They consult the physician for their original ailment which is of far greater importance to them than the loss of power. They mention this anomaly only in the course of the anamnesis.
Symptomatic impotence is, as a rule, paralytic in form. Libido is more or less absent, and if emissions ever occur they take place without erection or pleasure. In the paralytic form of impotence nocturnal erections are absent, nor do erections occur at any other time. This sign is almost pathognomonic of this type. If the vagina is very wide, and intromission with semi-erection should be effected, ejaculation does not come in jets but slowly. The function of the bulbo-cavernosus muscle is impaired, hence no ejaculation with force in a jet is possible, but a slow dribbling from the meatus takes place.