STERILITY OF THE MALE.
This division into two group- s, it is true, does not rest upon a patho logical basis, which at the present time is rightly niade the chief criterion in classifying diseases and functional disturbances, and which we have also followed in speaking of the causes of sterility in the female, but yet it offers so many practical advantages, especially in regard to diagnosis, tluit it seems justifiable in this case to depart from the rule.
In the first place, there may be no ejaculation of semen whatever, or the seminal fluid, though properly introduced into the female genitals, anflt for propagation; or secondly, cohabitation is impossible, or takes place in such an imperfect manner that the seminal fluid cannot be de posited in the vagina. The former condition is called " Impotentia gen erandi," or male sterility proper, whereas imperfect coition is called " Impoteutia coeundi," or simply " Impotence." The first form must here be particularly emphasized and more thoroughly discussed, because the more exact knowledge of it belongs to recent times, and because it occurs, as the latest researches have shown, with a frequency of which, until now, we had no idea. Its interest is the greater because, as has been said, it occurs during a cohabitation that is regular in other respects, a circumstance which so far has not allowed the acceptation to gain ground that the cause of the sterility resides in the husband. Very often in such cases suspicion is entirely directed to the wife, and gives rise to a very faulty therapy; it is, therefore, of very great importance to gyne cologists. The existence of this form, moreover, shows that the sterility of the two sexes is not separable, as regards diagnosis, by so hard and fast a line as has been customary.
This form of sterility of the male, where cohabitation is performed in the regular manner but without success, may be due to different causes. It may happen during coitus that, though the orgasm has taken place, and the feeling of voluptuousness has been fully satisfied, yet no ejacu lation of semen into the female genitals occurs. This condition is called aspermatism (aspermia, aspermatia, aspermasia, absence of semen). It may sometimes be a temporary condition, confined to certain periods dur ing which the male is deprived of generative power (temporary or relative aspermatism), or it may cause permanent sterility in marriage, beginning either in youth or at a later period (permanent or absolute aspermatism). These two kinds differ both etiologically and anatomically. Temporary aspermatism depends mainly upon a nervous disorder; the sperms is there, though perhaps not in large quantity, but the impulses from the central nervous system are wanting or the nerves presiding over ejaculation fail to perform their office—there is no discharge of semen. Even though material disorders in the genitals themselves be present, they do not pre vent ejaculation directly, but only through the action of the nervous tracts.
The causes of these nervous disturbances are manifold in their nature. They have this in common, that they may disappear again after a longer or shorter time, or under certain external conditions; when they are re moved, their influence upon. the genital organs also disappears, and their functions may then resume a normal character. These causes that work temporarily are about the same as those which may lead to the so-called psychical impotence, and they will be mentioned with dust affection.
A much more serious trouble is the permanent, absolute aspermatism. It depends, contrary to the preceding, upon material, and, as a rule, last ing changes in the genitals; here, too, seminal fluid is produced and there is an erection, but an obstruction in the course of the male ducts does not allow the semen to enter the vagina. It will be seen that it is only the absence of semen in the female genitals after completed coition that is comprised, according to the present doctrine of sterility, in the term aspermatism; the cases where, in consequence of mal-development and of acquired changes in the testicles, there is no production of semen at all, are not here considered, especially since with the anomalies there is as a rule no erection, so that the consequence is usually not really sterility but impotence. (See the remarks on azoospermia further on.) The obstruction to the ejaculation of semen again may vary in its seat and its nature. A strongly pronounced phimosis may lead to retention of semen. Very narrow strictures of the urethra likewise are capable, throughout their entire course, of preventing the ejaculation of semen. In these cases the semen is poured into the urethra, but it remains there in consequence of the obstruction. The fact that urine can still be voided through the stenosed parts that obstruct the semen, can be explained by the great force that is employed in passing urine by the contraction of the bladder and by abdominal pressure, exceeding by far the force with which semen is ejaculated. It is also possible that the erection of the penis increases the stenosis, so that the spermatic fluid, with less vis a tergo, would have to overcome a much greater obstacle than the urine hsa to overcome when the penis is relaxed. Thus it may happen that the setninal fluid does not flow from the urethra during cohabitation, but only after removal and relaxation of the penis. If the stricture is situ ated rather far back in the pars pendula penis, the sperms, after collect ing in the urethra, may even be discharged into the bladder, so that the spermatic fluid becomes mingled with the urine, and is not voided until the next micturition, when it can be microscopically demonstrated in the urine.