THE TREATMENT OF MALE STERILITY.
Treatmen t, however, I am afraid, is not so successful. But until we decide upon the exact share of the male in the sterility, we cannot say much upon that point. IVe must in the first place distinguish between true sterility and impotence.
Temporary aspermatism is of good prognosis, especially when the other bodily disturbances which may be present are of an easily reme diable character. The etiology and the therapy of the condition is that of temporary psychic impotence, and will be considered under that head ing.
Of much more unfavorable prognosis is permanent aspermatism; the more so the deeper seated is the malady which causes the absence of semen. Phimosis and urethral strictures give the best chances, and are to be treated surgically. If loe,a1 treatment is nnadvisable, or without result, and yet post coitum a fiuid containing zoosperms exudes from the urethra when the organ is relaxed (see ante, etiology), the advice may be given to permit the organ to remain in the vagina post cohabitationem as long as possible, and so to effect a transfer, though an incomplete one, of the semen.
Much more unfavorable is the prognosis in the various diseases of the prostate, the seminal ducts, and the seminal vesicles. Not only are these organs inaccessible; the chief consideration is that we have to deal with old processes, with irreparable changes, scar tissue, etc. The prognosis depends, therefore, upon that of the original malady, and temporary im provement, such as might render conception possible in female sterility, is here useless. We refer the reader to the surgical text-books for the details of treatment.
Even more unfavorable, if possible, is the prognosis of azoospermatism. Almost all these cases occur, together with more or less impotence, and depend upon severe diseases of the testicles, or affections of the central nervous or the general system, which are incurable. And even where chronic affections of the spermatic passages, of the epididymis, vas, and cord, cause the azoospermatism, a cure is rarely to be hoped for. Thus Li(geois reports that the spermatozoa returned in only eight out of eighty-three cases of this kind; and P. Fiirbringer's statistics are even
much more unfavorable. Nevertheless, we should not despair of treat ment. When no local affection can be demonstrated, in the so-called idiopathic sterility, the various means to excite the activity of the testicles, massage and electricity, may be tried. Various observations show us that azoospermatism may exist for a long time; and we should only de cide that the condition isa permanent one after several observations made at long intervals. The causes should be combated, bodily and mental over-exertion be avoided, the general strength supported by appropriate measures, lengthy continence enforced if there has been sexual abuse, and local maladies treated secundum artem.
When oligozoospermatism is present, or when we suspect that dead zoosperms, etc., cause the condition, we must search for the local causes .which originate it. Failing in this we must endeavor to strengthen the constitution and seek to obtain good results in this way.
If the infecundity of the marriage depends upon male impotence, the prospects of offspring depend upon the nature of the malady that causes it. If the genital affections above mentioned can be cured or improved, the prognosis is better. Unfortunately most of the local disorders are sach as render the treatment hopeless from the start.
In the same way the prognosis of impotence due to general maladies depends upon that of those disorders; and the therapy, if there is indica tion for any, depends upon that of the causal disease.
But the weakness dependent upon sexual excesses demands a more direct and specific treatment of impotence.
Of course there can be no question of treatment when paralysis has set in, and the sexual powers have entirely disappeared. As a rule, mar riage is out of the question in such cases, but these men are married rather than marry themselves; and the physician soon finds that the wife's genitals are entirely normal, and that there is no prospect either of marital joys or children.