IMPOTENCE, FRIGIDITY AND STERILITY

IMPOTENCE, FRIGIDITY AND STERILITY

These conditions are getting increasing legal importances in our society. Before discussing these conditions, for better understanding an expressable conception of sexual intercourse or coitus should be there.

Sexual intercourse or coitus consists of a chain of events, the usual stages being, 1. Sexual drive, 2. Sexual arousal, 3. Genital union, 4. Orgasm in the female and orgasm and ejaculation in the male, 5. Resolution. Sexual drive is mostly psychologically controlled and is an effort to materialise a desire of sexual performance. Depending on the degree of sexual drive, some persons are termed “oversexed” and some “undersexed”, majority being taken “normal” being in between these two conditions. However, the terms oversexed and undersexed should not be given absolute status, should rather be considered in relative terms. A so called oversexed male husband will find an oversexed wife to be normal but a “normal” wife to be undersexed. Similarly, a so called undersexed spouse may find the “undersexed” partner as normal, but the so called “normal” partner may appear to him “oversexed”. Satyriasis is the term used for oversexed males having high drive and nymphomania is the corresponding term for a female. Sexual arousal may occur due to various stimuli in either sex, which may be similar or different in nature in both sexes and may include vision of specific body parts, dress, particular posture or hearing some words or phrase or actual bodily touch. With arousal there is penile erection in males and erection of clitoris with congestion of neighbouring structures in females. Generally speaking, arousal time required for female is more than in male. It is also argued that distension of seminal vesicle with semen causes arousal in male and a female may have easy arousal during any time of her menstrual cycle, which is specific for each particular woman. Genital union consists of intermission of the erected penis inside the female vagina and its rhythmic manipulation till orgasm and ejaculation occurs. In orgasm in male, there is spasmodic contraction of penis, seminal vesicles with contraction of the allied structures with ejaculation and contraction of all the body muscles in general. In female orgasm, there is contraction of the fallopian tubes, uterus, vagina, clitoris and the neighbouring structures and also the whole body musculature, with secretion from the paraurethral glands. Resolution consists of a calmness and relaxation following orgasm with flaccidity of penis and clitoris, followed by lethargy and sleep in suitable circumstance. However, some may continue in the active phase during the period after orgasm. Some women may have repeated orgasm before resolution.

IMPOTENCE, FRIGIDITY AND STERILITYPotency, impotence and frigidity are defined, described and explained on the background of the above chain of phenomena involved in coitus. But sterility is totally a different physiological abnormality, having different legal implications in different circumstances. Thus,

Potency means, ability to perform sexual intercourse and to achieve gratification.

Impotence means inability to perform sexual intercourse and achieve gratification. In males it also essentially includes failure to have adequate erection of penis and ejaculation. Dictionary meaning of ‘impotent’ is, ‘a person who is unable to copulate’. Frigidity refers to women who are sexually cold. Some consider it as absence of desire for sexual intercourse, others consider it as incapacity of an woman to achieve vaginal orgasm and yet another group likes the term frigidity to represent psychosexual defect in women which may include any or more of the conditions which include lack of sexual interest, inability to experience pleasure during intercourse and inability to achieve orgasm terminally. Dictionary meaning of frigidity is, abnormal aversion to sexual intercourse. Sterility means inability to procreate, which for women means inability to conceive during child bearing age and for men means inability to make a woman of child bearing age, to conceive.

A sterile person may or may not be impotent or frigid and similarly an impotent or frigid person may or may not be sterile.

Permanent impotence or frigidity is a ground for nullity of marriage or divorce. But sterility is not a ground for the same. This is so because, legally the purpose of marriage is consumation of the same by sexual intercourse but not essentially to beget a child.

Legal issues involved with sterility, impotence and frigidity—

Civil issues – Nullity of marriage; Divorce; Legitimacy; disputed paternity, compensation cases due to loss of sexual function.

Criminal issues – Rape, other sex offences, adultery, blackmailing, breach of promise of marriage, criminal slander and defamation cases.

In relation to the above cases, often a male and sometimes a female is sent to the doctor to ascertain sterility, impotence and frigidity. This is not an easy job in most of the cases. In males, all cases of impotence are conditionally sterile as they cannot pour semen in the vagina, except in cases of premature ejaculation when seminal fluid may be discharged inside the vagina without erection of the penis being maintained till the female gets orgasm. In addition to the other conditions of impotence, a male may be sterile due to some other pathology in him. In such cases, for this reason, where the male can deposit semen in the vagina, the same should be subjected to laboratory investigation for knowing the percentage of motile normal spermatozoa in the semen and period of their motility. Some other investigations are also recommended in specific cases. In any case, the students should be well conversed with the causes of sterility and impotence and frigidity in males and females.

Causes of impotence and sterility in males —

1. Age – Before puberty a boy is usually impotent and sterile. But in many cases, erection of penis occurs with discharge of semen with presence of spermatozoa, much before usual pubertal age is attained and other signs of puberty appear. Such boys may be both potent and fertile before puberty. In old ages the virility of a man decreases but he is not essentially either impotent or sterile.

2. Local Developmental anomalies – Absence of penis, infantile and non-erectable perils, intersexuality and adherence of penis with the scrotum cause impotence. Absence or abnormality of both testicles or cryptorchidism from childhood (i.e., before puberty) may result in impotence. These conditions may also lead to sterility. Temporary sterility may also occur in case of hypospadias and epispadias, as in these conditions the male cannot pour the semen inside the vagina. However, these are correctable. Similarly, phimosis and paraphimosis may be the cause of temporary impotence and hence temporary sterility, so long the condition is not surgically corrected.

3. Local acquired abnormalities – Amputation of the penis may cause impotence depending on the extent of amputation, but not sterility. Castration before puberty will cause both impotence and sterility. Castration of both sides after puberty will cause sterility but not impotence. Vasectomy operation will cause sterility but not impotence.

4. Local abnormalities due to diseases – Elephantiasis and, hydrocele may cause impotence but not sterility. Syphilitic chancre or sore may also cause impotence but not sterility. However, gonorrhoeal infection or syphilis of testes and epididymis may cause sterility but not impotence. Similar is the case with new growth of these organs. Mumps may cause sterility but not impotence. In the same way other infective conditions like tuberculosis of testes and epididymis may have similar effect. Radiation exposure or repeated exposure of the gonads to X’ray may also cause sterility.

5. General diseases –

(a) General infective conditions – Tuberculosis, nephritis or other chronic infective conditions may cause temporary impotence and also sterility.
(b) Metabolic disorder like diabetes may also be the cause of both impotence and sterility.
(c) Hormonal disorders particularly with sex linked hormones may lead to azospermia, leading to sterility and may also reduce virility leading to impotence.
(d) Neurogenic causes – G.P.I., tabes dorsalis, paraplegia, hemiplegia, syringomyelia, injury to the spinal cord, all may lead to impotence and consequential effective sterility.

6. Indulgence to drugs – Indulgence to psychotropic or psychodelic drugs like alcohol, morphine, heroin and cannabis or hormonal preparation over a prolong period may cause impotence and sometime sterility.

7. Chronic exposure to certain poisons like, lead, arsenic or prolonged use of so called aphrodisiac agents may also lead to both impotence and/or sterility.

8. Psychological causes – These causes are most frequent, though mostly transient in nature. Worry and mental depression is the most common cause of impotence for the period of worry or depression. Fear of inability to complete the act of intercourse may actually lead to such condition like non-erection, early flaccidity of the erected penis and premature ejaculation. Similar outcome may be there due to shyness, timidity, guilt sense, overindulgence to sex or even excessive sexual desire or passion. A man may be particularly averse to a particular woman and may find himself impotent with her but not with others (impotence quode hanc). A man may be potent only in some specific anvironmental conditions or personal effects of the woman and in other circumstances he may find himself impotent. Psychological causes outnumber all other causes, but the effects are mostly temporary and are overcome with adjustment and time. Psychological factors are not usually expected to cause sterility in male.

Causes of impotence and sterility in females –

1. As women are passive partners in sexual intercourse, so far impotence is concerned, theoretically no age in a woman’s life is bar from sexual intercourse. However full penetration is not possible in very young girls, in whom the vagina is not well developed and capacious and in whom the introitus is very narrow. A woman is of course sterile in the extremes of her ages (beyond child bearing age i.e., before attainment of puberty and after menopause). It is however not always true. A woman may be pregnant even before the age of usual attainment of puberty and after the attainment of menopause.

2. Local developmental anomalies – Absence of vagina, narrow infantile vagina and tough and imperforated hymen cause proper intercourse impossible. Absence of vagina, imperforated hymen, absence or otherwise congenital defects of uterus (septate, infantile) and fallopian tube (lack of patency) and ovary (cystic or fibrous with absence of primordial follicles) are the causes of sterility.

3. Acquired defects or abnormalities – Injury or operation of vagina or the introitus may lead to inability to sexual intercourse. Hysterectomy, tubectomy and ovariectomy leads to sterility but not impotence.

4. Local diseases – Bartholin cyst, gross ulceration or chancre of vulva, stricture due to perineal tear during previous pregnancy, prolapse of uterus or urinary bladder, kraurosis vulva with constriction of vagina and dyspareunia of any other origin cause impotence but not sterility. Tumor of the uterus, endometritis, blockage of fallopian tube due to any infective condition will cause sterility but not impotence.

5. General diseased conditions – general infective, metabolic, and hormonal conditions may cause sterility but not impotence.

6. Drug indulgence may or may not cause sterility but does not cause impotence.

7. Chronic poisoning with lead, arsenic or some other agents may also cause sterility but not impotence.

8. Psychological cause – Fear of pain or apprehension tor sexual Intercourse (usually from the experience of a previous painful sexual intercourse) may, during an attempt of sexual intercourse give rise to a condition known as vaginismus with severe contraction of paravaginal muscles including levator ani and adductor femoris muscle leading to a state when widening of the thighs and approach to the vagina and intercourse become impossible. It is more a psychological problem. Vaginismus has been compared with such mental apprehensions on the part of the woman as is seen in forceful blinking of the eyelids in a person when a finger is aimed towards the eye of a person.

In addition to the above factors, a woman may be cold, disinterested or repulsive towards sexual intercourse, which is described below under the heading frigidity.

Frigidity in women and its causes-

1. Sedatives or depressant drugs are said to lower sexual drive and response in females, as they do so in males.

2. Due to local conditions – Conditions which give rise to dyspareunia may ultimately cause loss of sexual interest in a woman.

3. Systemic diseases – Acute or chronic systemic diseases inhibit the sexual desire and drive. In females, hypothyroidism is particularly thought to be a cause of frigidity.

4. Neurological factor – It possibly does not have anything much to do with frigidity of a woman. However, sexual drive originated in a female from higher centre or by local nervous stimuli like, touch or manipulation of the private parts may be grossly interfered with, due to neurological causes. Such a woman may eventually suffer from sexual inhibition or repression.

5. Menopause – Contrary to causing frigidity, menopause may increase sexual desire and drive in a woman due to being free from fear of getting pregnant.

6. Psychological causes – Psychological causes outnumber other causes of frigidity in women. However women being passive partner, it may be difficult to assess by the male partner, the lack of desire for sex act by the woman partner. Unsuccessful intercourse where the woman never gets orgasm may be an important cause of sexual avulsion. Apart from that, a woman may have repulsion to a particular man for whom she may be totally cold, but she may have desire or even nore than normal sexual drive and response for another man. Here, the behaviour, appearance, personality, psycho-socio-economic and educational status of the male may play important role. Vaginismus is a condition which lead to sexual avulsion in a few women. Homosexuals (lesbian girls) may have general apathy towards the opposite sex.

In assessing the degree of frigidity, the following factors should be given due consideration. Time required for the woman for optimum arousal, period of genital union (to give consideration on the point whether the woman gets orgasm or not), whether she is selectively frigid, to some particular man or she is absolutely frigid under all circumstances to any male partner and whether the condition is apparently temporary or permanent. It is to be kept in mind that, as partner, a woman can successfully suppress frigidity even upto the extent of pretending of having orgasm.

SOCIO-FAMILIAL AND LEGAL ASPECTS OF STERILISATION

Sterilisation is the process to cause a person sterile without affecting his or her potency or sexual functions.

Types –

1. Intentional – when a person is rendered sterile purposefully with some positive steps.
2. Therapeutic – When sterilisation is not the primary intention but a person becomes sterile as a result of some medical (ex. due to use of radiotherapy), surgical (following some therapeutic surgery) or therapeutic removal of testicles.
3. Accidental – Accidental injury to both the testes, or sterility due to some poison or drug.

Intentional sterilisation may again be of the following categories.

1. Voluntary – Sterilisation may be performed with free, voluntary consent of the husband or the wife on the following grounds –

(a) As a contraceptive step to keep the size of the family limited (as a family planning measure).
(b) For therapeutic purpose – Sterilisation may be performed, particularly on a wife, when it is feared that further pregnancy may involve risk to her life or health. This condition should not be confused with therapeutic sterilisation mentioned above where primary object is not sterilisation but treatment of some other ailment.
(c) When there is risk that, the offspring may be physically or mentally a detective one, then sterilisation may be performed on either partner with consent from both.

2. Compulsory sterilisation – This is effective in some countries where a mentally or physically defective person who is liable to transmit a disease to his offspring or a person who has committed some specific type of offence (say sex offence) may be sterilised even without his or her consent. This provision has no approval of Indian legislation.

Methods –

Permanent –

1. In males

(a) Vasectomy – The vas is cut and the cut ends are tied. Though a permanent method, future surgery can offer fertility to a certain percentage of vasectomised subjects.

(b) Deep X’ray exposure of the testicles – The person cannot be made fertile in future even if it is required. This method is not recommended.

2. In females –

(a) Tubectomy – Repair is possible in a good percentage of cases in future.
(b) Deep X’ray method – As in deep X’ray procedure followed in cases of males, here the ovaries are given the exposure.

Temporary methods –

1. Observation of safe period – Intercourse is avoided around the period of expected ovulation.
2. Coitus interruptus – Ejaculation is done after withdrawing the penis from the vagina.
3. Prevention of the spermatozoa entering the uterus by use of diaphragm in female, outside the os and use of condom by males (most popular).
4. Use of spermicidal jellies or foam tablets.
5. Use of intra-uterine contraceptive devices (loop) – also quite popular.

Medicolegal aspects –

1. Failure of contraceptive measure adapted by males may be a cause to suspect the wife to have sexual relationship with any other man which may initiate litigacies like – divorce, legitimacy, disputed paternity.

2. The doctor may be implicated if he performs sterilisation without consent and proper indication.

3. Healthy unmarried persons or healthy married persons without any issue should not be permanently sterilised, even if they volunteer for the same.

ARTIFICIAL INSEMINATION

When the husband is sterile or cannot pour semen in the vagina, when living motile normal spermatozoa cannot enter the uterus, when a widow or unmarried woman wants to have a child, pregnancy may be attempted by introducing semen, from a healthy selective male, inside the uterus or near the os with the help of a syringe. There is no specific provision for or against artificial insemination in Indian law.

Types —

1. A.I.H. or artificial insemination homologus – When the husband’s semen is biologically normal but he either cannot pour the same in the wife’s vagina by way of intercourse or due to some defect with the cervical opening of the wife or condition in the vagina, living sperms cannot enter inside the uterus, semen from the husband is collected by way of masturbation and pushed inside the uterus.

2. A.l.D. or artificial insemination donor – When the defect is in the seminal fluid of the husband then, semen from another healthy suitable male is used and introduced inside the vagina or the uterus of the wife.

3. A mixture of husband’s semen as well as that of a donor is used in cases where the motile spermatozoa count in the husband’s semen is poor though present in the semen. The advantage of this method is that both the husband and the wife may like to believe that, the husband’s spermatozoa which being less in count could not by themselves fertilize the ovum but might have so done, being assisted by the spermatozoa of the donor and the child thus might have been the product of the husband.

Indications of artificial insemination –

1. When the husband is sterile.
2. When the husband cannot discharge the semen in the vagina. It may be remembered here that, in such circumstances when the semen is discharged at the vulval zone, pregnancy has occurred in some cases due to the passage of the motile sperms through the length of the vagina, to the uterus, a condition known as fecundation ab extra. However if cannot be taken as a common event.
3. When the husband is impotent in other senses.
4. When some disease is likely to be transmitted from the father to the offspring.
5. Widows and unmarried women desiring for children.
6. In special circumstances, Rh incompatibility may be considered as an indication.

Possible legal and social complications of artificial insemination-

1. Artificial insemination is as such not a ground for nullity of marriage, but it is a ground for divorce if it was done without the consent of the husband. In such a case the doctor also gets implicated with legal complexities.

2. In case of widow or unmarried woman and in case of a married woman when the husband does not adapt the child, the child remains illegitimate.

3. Artificial insemination inherits a remote chance of incestual relationship between the offsprings of the donor from his wife’s side and the recipients side, as the identity of the donor being the father of the offspring of the recipient, remains secret.

4. Family problem including mental trauma of the husband of the recipient wife is possible, even though he gives consent for artificial insemination of his wife.

Recommended guidelines for artificial insemination –

As has already been mentioned that, there is no specific law in India regarding artificial insemination, legal problems may arise on the allied aspects of the procedure adapted for the purpose. To avoid the possible problems, certain procedural precautions are recommended.

1. The donor should not have any physical or mental disease which may be transmitted to the child.
2. Consent of both the recipient wife and her husband is necessary.
3. Similarly, consent of the donor and his wife is also necessary.
4. The donor should have his own child.
5. There should be parity of race, religion and as much as possible, the morphological appearance between the donor and the husband of the recipient woman.
6. The donor must not be a relative of either the recipient or her husband.
7. The donor should not know the identity of the recipient and the recipient also should not know the identity of the donor.
8. The donor should not know the outcome of donation of semen.
9. The donor should give a written declaration that he will not prefer parenthood claim for any child on the ground of donation of semen.
10. A female attendant must be present during the process of insemination.
11. Maintenance of strict confidentiality of all the records is a must.
12. In suitable cases the sterile husband’s semen and the fertile donor’s semen should be mixed before insemination (e.g. when the semen of the husband contains insufficient amount of motile sperm).
13. Rh. compatibility between the recipient and the donor should be tested.

SURROGATE MOTHER –

A surrogate mother is a woman who accepts pregnancy and beats child either by way of artificial insemination or by way of implantation of in-vitro fertilized ova at the blastocyte stage, till normal delivery (test tube baby) for another woman who is incapable to carry child. The surrogate mother carries the child when the husband and wife for whom she carries child, both desires and give consent for the same. According to the contact, a surrogate mother cannot place future claim on the guardianship of the child. But the legal position is that, her relationship with the child cannot be totally denied.