When one lip of the cervix is considerably elongated, covering apron-like the external os, the spermatozoa will not be able to enter the cervix, and sterility will result. Sterility is also found in the obliteration of the cervical canal, produced by caustics or scars after tears during confinements and after curettings. Ectropion, stenosis of the external or internal os of the cervical canal, endocervicitis, causing an increased cervical secretion, and the swelling of the plicae palmatae may prevent the entrance of semen into the uterus and thus cause impotence of propagation.
The anomalies of the uterus are also sometimes responsible for sterility. Uterus foetalis and obliterations of the lumen of the uterus will result in absolute sterility. Uterus infantilis, hypoplasia of the uterus, atresia of the uterus or polypi, hypertrophic chronic metritis, degeneration of the uterus or uterine deviations may often be the cause of sterility.
The anomalies of the tubes which cause sterility are absence of the tubes, rudimentary tubes, total or even partial obliteration of their lumen, as in salpingitis nodosa, closing of the ends of the tubes in bilateral salpingitis, and adherences of the tubes to the neighboring parts, as found in pelviperitonitis, perimetritis, perisalpingitis, and perioöphoritis.
The anomalies of the ovaries, causing impotence of procreation, are absence of the ovaries, hypoplasia of the parenchymatous tissue of the ovaries, fibrous degeneration of the ovaries, alteration of their position, as extreme prolapsus and hernia of the ovaries.
All these anomalies may produce either absolute or relative sterility. In regard to frequency they are of slight significance in comparison with endometritis and pelviperitonitis after gonorrhoea. The gonorrheic infection is, therefore, the cause par excellence of the impotence of procreation in women as in men.
Impotence of libido.—While in men the common form of impotence is inability of conjugation, the common form of impotence in women is failure to experience the orgasm, or the impotence of libido. In this anomaly two grades may be distinguished, total anaesthesia and partial anaesthesia or orgasmus retardatus.
In absolute anaesthesia there is not even a vestige of a libidinous sensation during intercourse. The woman likes caressing, hugging, kissing, etc., because the potency of voluptas is intact. But there is no vestige even of the fore-pleasure, or the ant-orgastic libido. The woman is devoid of sexual sensation, her genitals have no more excitability for pleasurable sensations than her fingers. Hence no desire for coition exists. On the contrary, there is, as a rule, a pronounced disinclination to the act. Where there is complete absence of pleasurable feelings, the act becomes naturally loathsome to the individual. If coition is granted it is done either from a sense of duty or for gain.
Physiological anaesthesia exists in children until puberty, and in adults in old age. Even after menstruation has set in, the girl is, as a rule, anaesthetic in regard to libido, although she may be erotic. “The girl has to be kissed into a woman.” After the climacterium the woman generally becomes again more or less anaesthetic. Some women may continue to experience libido years after this period, and may manifest symptoms of great sexual excitement as seen in the following case:
Mrs. X., married to an elderly man, looked upon the marital relations more as a duty than as a pleasure during her entire married life. But since the climacterium has set in, the rare approaches of her husband are impatiently awaited and they cause her great sexual excitement and satisfaction, never experienced before during the entire period of her active sexual life.
Such cases are extremely rare. Generally there is a close connection between the activity of the generative glands and the degree of libido.