IMPOTENCE & STERILITY

BY
Dr. Riaz ul Haque
Chief Executive
Hamdard University Hospital
Faculty of Engineering Sciences & Technology (FEST)
Prof Dr. Valiuddin Dean
Prof. Dr. Pervez Director

IMPOTENCE

▪ Definition
Impotence, often called erectile dysfunction
(ED), is the inability to achieve or maintain an
erection of penis long enough to engage in
sexual intercourse. This problem may not
cause much concern when occuring
intermittently. However it may affect a
relationship negatively and break a person’s
self confidence when the condition tends to
be ongoing.
STERILITY

▪ Definition
Sterility is defined as the inability to procreate.
This could imply on the male as well as
female.
 Impotence & Sterility

Both the conditions may be present together or

exist separately
CAUSES / PREDISPOSING
FACTORS
▪ Physical Causes:
There are four main types of health conditions
that can cause physical problems resulting in
ED.
These are vasculogenic, neurogenic, hormonal
and anatomical.
Medicolegal Importance

▪ According to the Law Sterility – Impotence may form a

basis of investigation by the medical Jurist.
The circumstances are:
1. Contested paternity
2. Nullity of marriage
3. Divorce
4. Alleged adultery
5. Rape
6. Unnatural sexual offences
7. Injuries followed by deleterious effects on sexual
functions.
Medicolegal Importance

▪ It is very difficulty to label an individual sterile

or impotent without the presence of a gross
and definite positive finding.

▪ Usually it is supposed that virility and

procreative power is possessed by individuals
within the age limits as one of the normal
functions of the body.
▪ Vasculogenic
Conditions that affect the flow of blood to the
penis.
Examples of vasculogenic conditions that can
cause ED include:
▪ Cardiovascular disease – Such as atherosclerosis
(hardening of the arteries), high blood pressure
(hypertension).
▪ Diabetes – This can affect both the blood supply
and the nerve endings in the penis.
▪ Neurogenic
Conditions that affect nervous system, which
is made up of brain, nerves and spinal cord.

Examples of neurogenic conditions that can

cause ED include:
▪ Multiple sclerosis (MS) a disease which causes
demyelination of the brain and spinal cord
nerve cells.
E.g. Contd….

▪ Parkinson’s disease – a condition that affects

the way that the brain coordinates body
movements, including walking, talking and
writing
▪ A spinal injury or disorder
▪ A stroke – a serious medical condition that
occurs when the blood supply to the brain is
interrupted.
▪ Hormonal
conditions that affect hormone levels

Examples of hormornal conditions that can cause

ED include:
▪ Hypogonadism – a condition that affects the
production of the male sex hormone,
testosterone, causing abnormally low levels
▪ An overactive thyroid gland (hyperthyroidism) –
where too much thyroid hormone is produced.
▪ An underactive thyroid gland
(hypothyroidism) – where not enough thyroid
hormone is produced
▪ Cushing’s syndrome – a condition that affects
the production of a hormone called cortisol.
▪ Anatomical
conditions that affect the physical structure of
the penis.

Example:
Peyronie’s disease, which affects the tissure of
the penis, is an example of an anatomical
condition that can cause ED.
▪ Medicinal Causes
in some men, certain medicines can cause ED., including:
▪ Diuretics – medicines that increaes the production of urine
and are often used to treat high blood pressure
(hypertension), heart failure and kidney disease
▪ Antihypertensive – medicines, such as beta-blockers, that
are used to treat high blood pressure
▪ Fibrates – medicines that are used to lower cholesterol
levels
▪ Antipsychotics – medicines that are used to treat some
mental health conditions, such as schizophrenia
▪ Antidepressants – medicines that are usesd to treat
depression and some types of pain
Causes of Impotence and
Sterility in Males
▪ Possible causes of impotence and sterility in males
are:

▪ 1. Age
Before puberty boys can not perform the act of
intercourse. There is no definite age limit, but
generally it is thirteen or fourteen years. In individual
cases more impotance should be laid on the physical
development that age as regards the capacity to
perform the act of sexual intercouse =. Rarely cases
have been reported where a male over 90 years had a
child from a very young wife.
Causes of Impotence and
Sterility in Males
▪ 2. Malformations
a.) Absence or maldevelopment of penis
b.) Acute form of hypospadins and epsipadius

However, all such cases can not be declared

sterile
c.) Congenital or subsequent loss of testicles
d.) Partial amputation of penis; double penis
e.) Cryptorchids are invariably impotent and
sterile.
Causes of Impotence and
Sterility in Males
▪ 3. Local Disease
a) Large hydrocele
b) Scrotal hernias
c) Elephantiasis
d) Inflammatory disease of genital system
i. Acute
ii. Chronic
e) Cancers of genital system
f) Accidental injuries to the external genital organs.

Some of the above conditions render the patient temporarily sterile

and impotent. If treated at the proper time they can be treated
and the patient can recover.
Causes of Impotence and
Sterility in Males
▪ 4. General diseases
a) Diabetes mellitus
b) Pulmonary tuberculosis
c) Chronic nephritis
d) Hemiplegia and paraplegia render the patient sterile
and impotent only in some cases
e) Injuries and disease of the spine.
f) Insanity
g) Endocrine disturbances.
Causes of Impotence and
Sterility in Males
▪ 5. Chronic habituates of alcohol, oplum,
cocaine, bromides and certain other narcotics.
▪ 6. Psychological causes
a) Fear and guilt
b) Aversion
c) Over excitement

These result in temporary impotence and sterility.

Causes of Impotence and
Sterility in Females
▪ Following are the causes of impotence and
sterility in females:
▪ 1. Age:
▫ Generally it is believed that girls start their firt
menstrual cycle at the age of 13 or 14 years. This is
the onset of their fertility till menopause.
However, certain cases have been reported where
female children had their menstrual cycles at a
meagre age of 3 years and subsequent born
children as well.
Causes of Impotence and
Sterility in Females
▪ 2. Malformation
a) Congenital absence of vagina or agensis of vagina.
b) Strong adhesions of the labla
c) Tough imperforate hymen.
d) Absence (congenital) of uterus, ovaries, tubes and
ovaries.
e) Conical cervix

Some of the above causes could be surgically corrected

and lead to the capacity to perform sexual acts and
procreate in some cases.
Causes of Impotence and
Sterility in Females
▪ 3. Local diseases
These usually lead to sterility. The act of sexual
intercourse can be achieved despite some
dysparreunia in some cases.
a) Inflammatory diseases of the genital tract –
commonest being genococol infection
b) Tumours of the uterus
c) Leucorrhoea
 Causes of Impotence and
Sterility in Females
▪ 4. General disease:
These usually do not effect the fertility of the woman
provided ovulation is taking place. Impotence can never
occur as the female plays a passive role.
▪ 5. Psychological causes:
some as in males.
Vaginismus i.e. in young virgins with fear of sex if a touch is
made to vagina – there is spasm of perineal and thigh
muscles.
Proof of potency in males:
1. Normal genitalia
2. Erection of penis on seeing nude pictures etc. but its
absence does not mean impotence.
3. Semen shows motile sperms in adequate numbers.