Infertility in females refers to the incapacity to conceive and give birth to a living baby. Infertility or failure to reproduce must be distinguished from frigidity which denotes failure to perform the sex act or performing it imperfectly.
Impotence and infertility are not the same thing. Impotence in a male would be understood as the absolute inability to achieve and sustain an erection and/or the absolute inability to penetrate the female and/or the absolute inability to achieve ejaculation of at least some human fluid within her. For the female, impotence would mean that the woman does not possess a vaginal opening capable of receiving the male penis.
An impotent can be sterile. For conception, only the discharge of semen with living sperms is required. It does not matter whether the erection is strong or the retentive power is long or the female is duly satisfied. The sterility on the part of the male is the absence of living sperms in the semen. Either they are not present at all or are dead. In such a case a man cannot produce however virile he may be. Gonorrhœa and Syphilis are the common and unquestionable causes of depriving the semen of spermatozoa.However,if the semen is found quite normal then the cause should be treated out in the female.
The sperms of the male are injected into the vagina during sexual intercourse. At the very same time an alkaline fluid is secreted from the vaginal walls.Two factors are important in ensuring a normal secretion of this fluid.
Firstly, there should be an adequate nerve supply to the vagina ducts. This is the reason why very nervous women fail to conceive.
The second important factor is to ensure that the fluid flowing from the vaginal walls is alkaline. If this is not so, the sperms are destroyed by the acidic fluid, usually present in the vaginal canal and womb.
Age:
As the woman is the passive agent in the sexual act, the age has no effect on potency.Sexual desire is not completely lost in old age.A woman is usually fertile from puberty to the menopause. A girl of 6 years and 6 months delivering fall term baby has been reported. Kennedy records a case in which a woman gave birth to her twenty-second child when she was 63 years old after which she still continued to menstruate.
*Defects of Development and Acquired Abnormalities:
The vagina is sometimes absent in malformed females and Turner type intersexuals which makes a female completely and permanently impotent and sterile. Impotence may result from some organic defects of the genitals, e.g., total occlusion of the vagina, adhesion of the labia, and the tough imperforate hymen, which can be cured by surgery. Vaginal injury or severe infection may lead to stricture, and kraurosis vulva in old women may cause narrowing of the vagina. The conical cervix and absence of uterus, ovaries or Fallopian tubes produce sterility but not impotence. Occlusion of the vagina does not indicate sterility as long as the internal organs are healthy. Cessation of oral contraceptives - hormonal balance may take some time after stopping the pill.
* Acidic secretions:
Sometimes the cause is the presence of acidic secretions specially lactic acid in the vagina and soon as the semen is discharged all the sperms are killed as they cannot live in acid. But the acidity is only detrimental to pregnancy when the male organ is too small to ejaculate the semen direct into the uterus.
* Local Diseases :
Diseases of the genital organs do not cause impotence but may produce sterility, e.g., gonorrhea involving the cervix, uterus, ovaries and Fallopian tubes. Hyper aesthesia of vagina, prolapsed of the uterus or bladder, and vulval or vaginal tumors produce temporary impotence. Sterility may result from disease of the ovaries, obstruction of the Fallopian tubes or neck of the uterus, rectovaginal fistula; rupture perineum, disorder of menstruation, leucorrhoea, acid discharges from the vagina, etc.
On rare occasions, gonorrhea can spread through non-sexual contact. An infected woman may transmit the infection to her newborn during childbirth.Young girls who contract gonorrhea either from sexual abuse or intimate contact with recently contaminated objects (such as a damp towel) develop a severe infection called vulvovaginitis.
Ultimately, gonorrhea may result in scarring of the fallopian tubes and permanent sterility (inability to become pregnant). Scar tissue formation around the uterus and tubes may result in painful intercourse (dyspareunia) and chronic pelvic pain.
* General Diseases:
As the woman is the passive agent in sexual act, general diseases do not cause impotence. Occupational exposure to lead or
exposure to X-rays lead to sterility. Drug dependence may also lead to sterility.
* Psychic Causes:
Psychological factors like emotional stress, tension, mental depression, anxiety, and fear may also result in psychosomatic sterility. Psychic factors may lead to impotence as in males.In males, the impotence is passive leading to non-erection, but in females it is of an active nature, leading to vaginismus.
Vaginismus is a classical example of a psychosomatic illness. Anatomically, it may affect the perineal muscles exclusively, or may be felt as a varying constriction of the levator ani, right up to the vaginal fornices.There is usually a definite
cramps-like spasm of the adductor muscles.Physiologically, these muscle groups contract
spastically instead of their rhythmic contractual response to orgasmic experience.
Hysterical hyper aesthesia co-exists with this condition, which in some cases may be more prominent than the spasm itself. The hyper aesthesia starts at the vaginal introitus, but in extreme cases it may be present all over the vulva and even over adjacent part of the abdomen and thighs.
The spastic contraction of the vaginal outlet is completely involuntary reflex, stimulated by imagined, anticipated, or real attempts at vaginal penetration. In a fully developed state, constriction of the vaginal outlet is so severe that penetration by the penis is impossible. If an attempt is made to examine the hymen by passing a glass rod through hymenal orifice, sphincter muscles of the vagina contract due to which the rod is tightly grasped, and such severe pain is caused that she may scream. In a severe case, the legs cannot be separated sufficiently for the examination of the vulva and occasionally she may rise in a bow-shape, so that she rests only on her head and heels.
It can occur with equal severity in the woman who has borne children as in the virgin. The etiological factors are :
(1) Male sexual dysfunction.
(2) Psychosexually inhibiting influence of excessively severe control of social conduct due to religious orthodoxy.
(3) Specific incidents of prior sexual trauma.
(4) Stimulus derived from attempted heterosexual function by a woman with prior homosexual practice.
(5) Secondary to dyspareunia. Severe laceration of the broad ligament, pelvic endometriosis, ulceration or fissures in the vagina, if untreated may lead to increasingly painful coitus and vaginismus.
(6) Rarely, personal dislike or a general feeling of disgust at the ;idea of coitus. Psychotherapy is beneficial. Psychological causes affect fertility adversely. A woman may be sterile or impotent with a particular man but not with another. Both environment and nutrition have some influence upon conception.
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