IMPOTENCE OF THE MALE.
By this term is meant that defect in the male which renders him incapable of introducing the penis into the female genitals for the purpose of ejaculating semen. This genentlly implies that it is impossible to bring the penis into an erect condition or to keep it so until coition is completed, and, therefore, this condition, especially in the more vulgar acceptation, is termed im potence in the niore restricted sense. In impotence the spermatic fluid may behave regularly, it may even, though in very rare exceptions, come in contact with the female genitals, and bring about an impregnation, but in the vast majority of cases this does not happen, but impotence has sterility as a consequence. On the other hand there may even be erec tions with ejaculation of semen, but certain local causes residing in the male individual himself may prevent the introduction of the penis, and thereby render conception impossible. These cases must also be classed with impotence. But as a rule, a want of erection coexists with impo tence.
However sharply these two categories, sterility proper and impotence, are distinguishable from one another in the majority of cases, yet they have many things in common. Especially in regard to etiology is there a certain connection between them, inasmuch as the same cause is liable to bring about sometimes the one disturbance, sometimes the other; again in the same individual the two conditions may alternate with one another, as also the same therapeutic measures may not infrequently be used with success in both abnormalities.
This impotence of connection, which, as has already been observed, with very rare exceptions, has sterility as its consequence, can be most naturally traced back to two classes of causes. Either it is founded upon alterations of the genital orga,ns, more or less easily seen, or other severe troubles, especially disturbances of nutrition, or else the gt nitals are nor mal and the general constitution is not broken dovrn, but yet erections do not occur because of insufficient innervation. The first form has been termed organic, the latter inorganic or psychical impotence.
As regards organic impotence, the congenital defects of the testicle must be mentioned first. Very rarely both testicles are absent (anorch ism); there is then of course neither sexual desire nor erection. More frequently a testicle is present only on oue side; the degree of impotence then depends upon its greater or less development. Still more frequently
an insufficient development (hypoplasia) of the testicle is observed; it is too small, and a microscopical examination either shows no trace or but slight indications of seminal canals; and even if the latter are less imper fectly developed, yet there is no production of spermatozoa. If the tes ticles are not contained in the scrotum, this fact of course does not prove an absence of these organs, for they may have been retained in tbe ab dominal cavity (cryptorchism). They may indeed be well developed, but not infrequently they are of small size, especially if they have remained in the inguinal canal. With this anomaly, therefore, impotence is not of rare occurrence, even when one testicle has descended into the scro tum; for it seems that a testicle like the one that remained in the abdomi nal cavity is either of defective construction or degenerates later.
The loss of both testicles in adults also produces sterility and impo tence. They may perish either by absolute removal (accidents, etc.) or by acute and chronic inflammations, whether these are the result of a trauma, a gonorrhceal infection, or some other local trouble confined to the genital and urinary organs, or some general disease. Complete dis appearance, howsver, as a consequence of disease, takes place very rarely; much more frequently there is a shrivelling of the connective tissue brought about directly or by suppuration, an atrophy with loss of secret ing tissue; but this is of the same significance in regard to the sexual functions as complete destruction. It deserves attention that, when the testicles of adults are destroyed, the sexual desire and the faculty of coi tion are not by any means immediately abolished—a similar observation as with women after removal of their ovaries, where sexual tendencies also remain for some time. But sterility certainly follows upo'n loss or atrophy of these parts in either sex. It must also be observed that not every inflammation, not even the most intense, necessarily leads to an atrophy of the testicles; thus in syphilis, in gonorrlicea, the form and size, and probably also the structure of the testicles not infrequently remain as before, but as a consequence aspermatism and azoospermia occur. The various new growths also, that affect the testicles, may abolish the power of reproduction by a destruction of the glandular tissue.