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IMPOTENCE, FRIGIDITY

STERILITY, MARRIAGE

&

DIVORCE

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An unhappy wife is complaining to the Qazi about her husband's impotence. Ottoman miniature.

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‘The possession of virility and procreative power neither requires to be , nor can be proved to exist by any physician, but is rather, LIKE EVERY OTHER NORMAL FUNCTION to be supposed to exist within the usual limits of age’

Casper in his text book of Forensic Medicine states

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Impotence

Inability to perform sexual intercourse and achieve gratification
A person who is unable to copulate
Halsbury’s Law of England defines impotence to be such a state of mental or physical condition, which makes consummation of the marriage a practical impossibility
Failure to obtain or maintain erection of the phallus in a male

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Physiology of Erection

Filling blood in spongy erectile tissue
Penile erection is managed by two mechanisms:

The reflex erection, which is achieved by directly touching the penile shaft uses the peripheral nerves and the lower parts of the spinal cord,
The psychogenic erection, which is achieved by erotic or emotional stimuli through the limbic system of the brain.

In both conditions, an intact neural system is required for a successful and complete erection

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STERILITY

Inability to procreate children
For women it means inability to conceive during child bearing age
For men it means inability to make a woman of child bearing age to conceive
A sterile person may not be impotent or frigid and similarly an impotent or frigid person need not be sterile. Both may coexist or be independently present
Infertility is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual intercourse -using no birth control methods. �

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Types of Impotence (Males)

Absence of sex desire
Despite sex desire failure of erection
Weak and fleeting erection which subsides before penetration is complete
Partial Impotence-Normal erection and penetration but failure to reach orgasm & ejaculation (Retrograde Ejaculation)

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Causes of Impotence & sterility in Males

Physiological- Very young and very old are impotent but no definite age. Precocious development of sexual organs may take place in very young. Fertility begins with puberty or when the adolescent starts ejaculating semen. Boys of 9 years and old people of 94 are recorded of having fathered a child

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Defect of Development

Absence of penis
Infantile & non –erectable penis
Malformations- Intersexuality, Hypospadias, epispadias, double penis, or adherent to scrotum
Loss of both testes, cryptorchids

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Local Acquired Abnormalities

Amputation of Penis
Castration in childhood
Large hernias, elephantiasis, large hydrocele, phimosis or paraphimosis, adherent prepuce
Temporary impotence with wounds of penis
Operations on penis, bladder, testis, vas etc
Accidental injury to genitals, brain, or spine
X-ray irradiation may cause azospermia

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Diseases leading to Impotence

Diabetes and other hormonal disorder
Neurological diseases like GPI, tabes dorsalis, hemiplegia, paraplegia, syringomyelia, injury to spinal cord, spinabifida
Chronic infective disorder like tuberculosis nephritis, and other debilitating disorders
Malignancies
Tumour or injury damaging reflex arc at sacral level
Excessive sexual indulgence or masturbation may cause temporary impotence

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Psychological

By far the commonest cause of impotence
With all women or with a particular woman (Impotence quoad hance)
Large number of males are impotent at their honey moon night because of anxiety and inexperience
Homosexuality
Inculcation in childhood that sex is wicked

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DRUGS AND ADDICTION

Antihypertensive, diuretics,& psychotropic drugs.
Chronic alcoholism
Cannabis, Marijuana, Hashish, Charas, Opium, Heroin,
Hormonal preparations like administration of Oestrogen to a male

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Treatment of Impotence

Greatest source of earning of Charlatans
Cause for killing of many wild animals
In 1983 papaverine induced erection was demonstrated
First major breakthrough is ‘Viagra’
Venom from a Brazilian spider causes erection and considered a potential drug

Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley, Ph.D. dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine induced erection.^[33] The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, orally effective drug therapies.

A study done at the Medical College of Georgia has found that venom from the Brazilian wandering spider contains a toxin, called Tx2-6, that causes erections. Scientists believe that combining this toxin with existing medication such as Viagra may lead to an effective treatment for erectile dysfunction.^[39]

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Impotence in Female�(Apareunia & Dyspareunia)

Impotence in female is incapacity for sexual act which is also called apareunia.
Dyspareunia means that the act is difficult and painful or penetration is incomplete
Disparity in size between male phallus and the vagina-Theoretical possibility
Inaccessibility of the vulva due to extreme obesity or adduction deformities associated with diseases of hip and legs usually overcome by modification of coital posture

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Causes in Females

Extremes of age, less marked because of passive nature of function, sterility present
Obstruction at introitus or vagina
Local developmental anomalies-

Absence of vagina, malformation of vagina, imperforate hymen or tough hymen
Inherent narrowness and inelasticity of vaginal orifice.
Anomalies of uterus fallopian tubes causes sterility

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Causes in Females

Acquired defects-

Fibrosis and adhesions following injury or chemical burn in vagina or stricture of introitus
Hysterectomy, tubectomy, removal of ovaries causes sterility.

Diseases- Any painful condition of the pelvis
Psychological causes-Vaginismus,

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VAGINISMUS

Commonest & Important Cause of impotence in females
It is a condition manifested by spasm affecting sphincter vagina and levatores ani muscles especially the latter resulting in to closure of lower vagina and in severe form is accompanied by spasm of the adductor muscles of the thighs making vulva inaccessible
May or may not be associated with frigidity

If the partners are virginal, the first night is a great disappointment because excitement and tension of the wedding day causes physical and emotional exhaustion, add to this embarrassment, nervousness, and inexperience and the result is impotence or premature ejaculation. If this does not occur,then vulva appears to be inaccessible, or the entrance to the vagina proves narrower than expected, or the hymen is tough or nervousness causes vaginismus. So penetration rarely takes place on first attempt. This experience provides more pain than pleasure.The male finds his self confidence shattered.

Within a few days partial penetration is possible but it might take 3 to 4 weeks before intercourse is complete and satisfactory. It may take 1 to 2 years before the wife regularly experiences full orgasm

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Causes of vaginismus

Tender organic lesion in pelvis
Functional-

Hysterical hyperaesthesia of vulva & thigh
Fear of pregnancy or child birth
Previous criminal assault or rape
Highly strung and overanxious women usually spoilt

Faulty sex education & ignorance

Husband may be over considerate and lacking in virility
Initial painful & clumsy attempts at coitus

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FRIGIDITY

Woman who are sexually cold
Absence of sexual urge (libido)
Incapacity of an woman to achieve vaginal orgasm during coitus
Psychosexual defect in women which may include lack of sexual interest, inability to experience pleasure during coitus, & inability to reach orgasm.
Abnormal aversion to sexual intercourse

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True Frigidity

It is absence of libido
The subconscious mind is the centre for libido
Ovarian hormones play some part but are not essential for libido, also hypothyroidism
Sex desire is not spontaneous in women as in men and has to be roused
Organic lesion of pelvis is never a cause
It is due to, physiological, constitutional, psychological, or environmental factors

Physiological-Age-Frigidity is normal in youth before arousal and in later life when it is part of aging but majority of married woman still enjoy coitus regularly though less frequently at the age of 60 years

During pregnancy,& lactation

Constitutional-Women widely differ in their appetite for sex as they have for food music and games. Given the favourable environment majority of women display sexual urge though in some it may be very weak or rarely absent

Early Impression- Frigidity can reflect a puritanical upbringing that sex is sinful and coitus is merely a wifely duty

Lack of affection for the husband

Children of unhappy family where parents are always fighting

Interference with the genitalia and lower bowel, of masturbation, and homosexual practices subsequently inhibiting sexual urge

Fear of pregnancy & childbirth, Dread of venereal diseases, guilty conscience of premarital sexual behaviour, fear of being hurt during coitus,

Pituitary hypo function, adrenal failure, thyroid dysfunction, diabetes mellitus

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Failure to achieve orgasm

Sexual drive normal or heightened
Commonly it is a psychological inhibition
With regular sexual experience about 90% women reach orgasm
Causes in remaining 10%

Inherent orgasmal incapacity
Clitoridal and vaginal anaesthesia
Female circumcision (FGM)
Loose introitus and dilated vagina

The woman is looking back over her shoulder and is subconsciously afraid to let herself go

Failure on the part of the husband to control ejaculation till the wife is ready for orgasm

In some races circumcision is done to reduce sensitivity of glans thereby prolong sexual act and make better lover

Similarly female circumcision [Female Genital Mutilation(FGM)] been illegal in the United Kingdom since

1985 under the Prohibition of Female Circumcision Act. It is estimated that two million women and girls worldwide are at risk of female genital mutilation each year "Cultures are only sacred if they are consistent with human rights," said Ms Christine McCafferty, MP and chairwoman of All Party Parliamentary Group on Population, Development and Reproductive Health.She demanded among other things to Categorise female genital mutilation as a form of physical abuse

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Examination & Report

Consent for examination should be taken in writing with clear warning that the report might go against him/ her
If there is a finding which makes the person impotent that should be reported
In majority of cases genital organs are normal
Report should be in negative like

“There is nothing to suggest that the person is not potent”

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MEDICO-LEGAL ASPECTS

CIVIL CASES

Nullity of marriage, & divorce
Legitimacy, disputed paternity
Compensation cases due to loss of sexual function

Criminal cases

Rape and other sexual offences
Blackmailing, & breach of promise of marriage
Criminal slander & defamation cases

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MARRIAGE

A formal union of a man and a woman, typically recognized by law, by which they become husband and wife
Voluntary union for life of one man and one woman to the exclusion of all others
Both the man and the woman are supposed to have given their consent for sexual intercourse at the time of marriage which they can not withdraw during the continuation of marriage
Common Law Marriages
Gay / Lesbian Marriages

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The Consummation of Marriage

After ceremony of marriage the first act of sexual intercourse with full penetration of vagina and emission of semen.
Consummation requires ordinary and complete sexual intercourse
Variously interpreted by court

Always use of Condom, Coitus interruptus, and AIH were not recognized as Consummation

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Adultery

Voluntary sexual intercourse between one spouse and a person of the opposite sex, not his or her spouse, during the subsistence of marriage
Voluntary coitus between one spouse and a person of opposite sex during continuation of a valid marriage

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Section 497 IPC

Who ever has sexual intercourse with a person who is and whom he knows or has reason to believe to be wife of another man, without the consent or connivance of that man, such sexual intercourse not amounting to the offence of rape is guilty of the offence of adultery and shall be punished with imprisonment of either description for a term which may extend to 5 years or with fine or with both. In such case wife shall not be punishable as an abettor.

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The ANNULMENT OF MARRIAGE

Null and Void marriage-To be declared

Either party has a spouse living
Either party is an idiot or a lunatic
The male has not completed the age of 21 years or the female the age of 18 years
The parties are within the degrees of prohibited relationship
Husband continues to be impotent since marriage

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Voidable-Annulled by a degree of nullity

Not consummated due to wilful refusal of one party
Woman pregnant at the time of marriage by some other person
Consent for marriage obtained by coercion or fraud

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Judicial Separation

Desertion for a period not less than 2 yr
Cruelty-Living together Harmful or injurious
Virulent Leprosy for not less than 1 yr
Communicable Venereal disease for not less than 3 yr
Continuously unsound of mind for not less than 2 yr
After marriage sexual relationship with some one else also (Adultery)

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Divorce

Is living in adultery
Converted to another religion
Incurably of unsound mind for not less than 3 yrs
For not less than 3 yrs suffering from virulent and incurable form of leprosy
For not less than 3 yrs suffering from venereal disease in communicable form
Renounced the world by entering religious order
Has not been heard of as being alive for at least 7 yrs by those who would naturally have heard of it
No sexual relationship for two yrs after judicial separation or degree of restitution of conjugal rights

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