Impotence, sterility, artificial insemination

1. IMPOTENCE,STERILITY,
ARTIFICIAL INSEMINATION

2. IMPOTENCE,STERILITY, FRIGIDITY
Potency: Potency means ability to perform
sexual intercourse and achieve gratification.
Impotence/ Impotency: Inability of a person to
perform sexual intercourse and achieve
Gratification.
Frigidity: Inability to initiate or maintain sexual
arousal pattern in females

3. Sterility: Inability of a male to beget children
In females: inability to conceive children.
Or, Sterility means inability to procreate, which
for women means inability to conceive during
child bearing age and for men means inability to
make a women of child bearing age, to conceive.
Both Impotence and Sterility may co-exist

4. Medicolegal Importance
• CIVIL :
–Nullity of marriage
–Divorce
–Adultery
–Disputed paternity
– Legitimacy
–Suit of adoption
–Claim for damages

5. Medicolegal Importance
•CRIMINAL:
–Adultery
–Rape
–Unnatural sexual offences
–Blackmailing
–Breach of promise of marriage

6. Causes of Impotence & Sterility in males
•Age: Poor physiological development of penis before puberty
•Defects in development: Absence of penis
•Acquired abnormalities: Amputation of penis
•Local diseases: Elephantiasis, hydrocele, syphilitic chancre etc.
•General diseases
Infection(Tubeculosis)
Metabolic disorder(DM)
Sex linked hormonal disorder
Neurological disease(paraplegia)
•Psychic causes
•Chronic exposure of poison : Lead& Arsenic
•Drugs: Alcohol

7. Quoad hanc
Quoad hanc is an individual, who is impotent
with one particular female but not with
others.

8. Causes of Impotence & Sterility in females
•Age: Before Puberty and after menopause.
•Defects in development:Absence of vagina, imperforated
hymen etc.
•Acquired abnormalities: Hysterectomy, ovariectomy,
tubectomy etc.
•Local diseases: Bartholin’s cyst ,gross ulceration etc
•General diseases: Infective, metabolic and hormonal
disease
•Psychic causes: Fear or pain for intercourse.

9. Vaginismus
Definite involuntary cramp like spasm of
perineal muscles or levator ani or adductor
muscles instead of rhythmic contractual
response to orgasmic experience.
It is a spasmodic contraction of the vagina due
to hyperesthesia. It is a classic example of
psychosomatic illness.

10. Frigidity: Inability to initiate or maintain sexual
arousal pattern in females
Cause of Frigidity in female
• Sedative and depressive drugs
• Local Conditions
• Systemic disase
• Neurological factors
• Menopasue
• Psychological causes

11. Sterilisation
Sterilisation is a procedure to make a male or
female person sterile, without any interference
with potency.

12. Types of Sterilisation
Medicoligally sterilisation is two types:
•Compulsory: It is Compulsory by an order of the state. It may
be carried out on mental defectives & others from a strictly
eugenic point of view or as a punishment for sexual criminals.
It is not done in Bangladesh.
•Voluntary:
–Therapeutic: To prevent danger to the health of the woman
due to pregnancy.
–Eugenic: Sterilisation to a physically or mentally defective
person.
–Contraceptive: To limit size of the family.

13. Clinically sterilisation is two type:
1)Permanent:
Vasectomy(Male)
Tubectomy ( Female)
Exposure of deep x-rays in both sexes
2)Temporary:
Condom
Coitus interrupts
Loop
OCP
Foams etc.

14. Precautions
• Written consent of both wife and husband
• Checkup after vasectomy(Abstain for 3
months)
• Complication of contraceptive pills.

15. Difference Between Impotence and
sterility
Steriliy Impotence
1. Sterility is the inability of a male to
beget children and in the female the
inability to conceive child.
2. About 10-15% of all married couples are
involuntarily sterile.
1.Impotence is the state of inability of a
person to persorm sexual intercourse.
2. Almost all married couples are potent

16. Difference Between Impotence and
frigidity
Impotence Frigidity
1. Impotence is the state of inability of a
person to persorm sexual intercourse.
2. The term s applicable for both sexes
3. Important cause os divorse in both
sexes
1. Frigidity is the inability to initiate or
maintain the sexual arousal pattern in
female.
2. Applicable only for famale.
3. In most cases frigidity is reversible

17. Fecundation ab extra:
Conception is possible without penetration of the
vagina by the penis due to deposition if semen on
the vulva which leads to “fecundation ab extra”, the
insemination occuring due to passage of
spermatozoa from the external genitalia to the
uterus.
McCune Albright sundrome:
It is the syndrome where, the sexual organ show
advance development as compared to the body as a
whole. It is found in case fo gonadal or adrenal
tumours, where there is excess secretion of sex
hormone.

18. Artificial Insemination
The artificial introduction of semen into the
vagina, cervix or uterus to produce pregnancy is
called artificial insemination.

19. Types of Artificial Insemination
• Artificial insemination homologous/artificial
insemination husband/AIH:In this type semen of the
woman’s husband is used
• Artificial insemination donor/AID : In this type semen
of another person other than husband is used
• Pooled/Artificial insemination husband and
donor/AIHD: Here the semen is mixture of husband
‘s semen and donor’s semen.

20. Medicolegal importance
• Adultery: The donor and recipient cannot be held
guilty of adultery
• Legitimacy: The husband is not the actual father of
the child, and as such, the child is illegitimate &
cannot be inherit property.
• Nullity of marriage and divorce:
• Natural birth
• Unmarried woman or widow
• Incest.

21. Indication of artificial insemination
• When the husband is sterile
• When the husband is impotent but fertile
• When the husband is unable to deposit the semen in
vagina
• When some disease likely to be transmitted from the
father to the offspring
• When husband is suffering from heriditary disease
• In special cicumstances Rh- incompitibility may be
considered as an indication
• Widow and unmarried women desiring for child

22. Procedure of artificial insemination
Pre-reuisites/ Pre-cautions:
• Consent of donor and his wife
• Written conesnt of the woman to be inseminated
and her husband
• Identity not to be revealed
• Donor should not know recipient
• Donor must be physically and mentally healthy

23. • Donor not relative
•Donor should have had children of his own
• Race and characteristic of donor should resemble
with husband
• Couple should be psychologically fit.
• Witness present at the time of insemination
• Pooled semen should be preferred
• Physician doing insemination should avoid
delivering the child

24. Procedure of artificial insemination:
• Semen is collected preferably after one week
abstinence & used within about 2 hours
• Usually 1 ml of semen is deposited above
internal os by means of a sterile syringe, at or
about the time of ovultaion.

25. Surrogate mother
Surrogate mother is a woman who by a contract
agrees to bear a child for someone else.
Medicolegal importance:
• According to contact surrogate mother cannot
place future claim in the guardianship of the child
• Question of legitimacy may arise
• Question of adultery may arise
• Question of incest may arise

26. Test tube baby
• If fertilization is done in –vitro, i.e. Outside the
uterus and then implanted into the uterus
upto the termination of pregnancy, then the
born child is called test tube baby.

27. Cloning
It is the technique of producing a genetically
identical duplicate of an organism artificially. First
clonal creation is “Dolly the sheep”, in Scottland.
Types of cloning:
• Molecular cloning
• Celluler cloning
• Organism cloning
• Reproductive cloning

28. Thanks to all