STERILITY.
This condition must not he confounded with impotence, though both conditions may exist together. Where impotence is absent and the sexual act is performed in the normal manner, but where there is absence of spermatozoa from the seminal fluid, little need be expected from any methods of treatment unless in those rare cases where the azoospermia is caused by some temporary obstruction of the efferent ducts of the testicles, as from recent epididymitis, when appropriate remedies may be of use. Should this condition depend upon exhaustion from recent venereal excesses, without impotence, abstinence will generally correct it in a short time but, where prolonged abuse of the sexual instinct has led to marked atrophy of the testicles, no medication will be of the least use in cases where spermatozoa are absent from the seminal discharge or in cases where both testicles are retained in the canal or abdomen. Exposure for a long time to the X rays necessitated by prolonged lupus or other treatment may cause azoospermia, which, however, may pass off.
In Aspermia there is absence of the seminal emission at the time of sexual intercourse, if this depends upon any mechanical impediment as hypospadias, disease or concretions in the prostate, stricture of the urethra, etc., it may be remedied effectually by removal of the urethral obstruction. The sterility following epididymitis through closure of the duct has been successfully dealt with by effecting an anastomosis between the vas dcferens and a healthy portion of the epididymis.
When from psychical causes the discharge of seminal fluid is delayed or absent, though the sexual act may be otherwise successfully performed, treatment generally is of little avail, though in such comparatively rare cases the remedies mentioned under Impotence (p. 455) as Phosphorus, Strychnine, Electricity, may have a trial. Curling and M'Carthy recommend the application of blisters and irritants to the glans and penis in those cases characterised by deficient sensibility of this portion of the genital apparatus.
Sterility caused by the habitual use of alcohol, opium or cocaine may entirely disappear after the cure of the drug habit; such cases are, how ever, usually examples of impotence.
In the female, sterility is more frequent than in males. When due to excessive obesity and syphilis, constitutional treatment should be insti tuted. In most instances the causes are local and often remediable, but it must be borne in mind that not unusually more than one cause may be present at the same time, and the mistake should not be made of stopping short of correcting all abnormal conditions of the various parts of the genital tract. Details of treatment here are unnecessary, as they are supplied under the different headings of the abnormal or diseased con ditions interfering with conception, as Uterine Displacements, Metritis, Leucorrhcea, Ovarian Disease, Gonorrhoea, Vaginismus, Dysmenorrhoea, Tumours, Salpingitis, Endometritis, etc.