impotence and sterility and their ML aspects

Clinical forensic medicine. Impotence and sterility and their medicolegal aspects

1. IMPOTENCE

2. * I nability of a person to perform sexual intercourse. * Sterility:- Male: Inability to beget children. Female: Inability to conceive children. * Frigidity/Hypo active sexual disorder :-Inability to start or maintain the sexual arousal pattern in female.

3. Medico-Legal aspects ***CIVIL. *Nullity of marriage/Divorce *Disputed paternity and legitimacy. *Claim for damages.(assault/accident). ***CRIMINAL. * Adultery, Rape and Unnatural Sexual offences.

4. CAUSE OF IMPOTENCE Most common cause :-Poor physical development of sex organs.

5. DEFECTS OF DEVELOPMENT AND ACQUIRED ABNORMALITIES

6. Sexual act may not be possible Intersexuality

7. Loss may produce complete sterility but not impotence HYPOSPADIASIS EPISPADIASIS

8. LOCAL DISEASES

9. # Pelvis with injury to parasympathetic # Spine at L-1 with injury to sacral segments

10. GENERAL DISEASES Common during the course of any acute illness. Diabetes, pulmonary TB and chronic nephritis:- Temporary impotence

11. * Syringomyelia * Tabes dorsalis *Excessive masturbation *Excessive use of drugs like

12. PSYCHIC CAUSES Emotional disturbance Fear of impotence Fear of inability to complete the act

13. QUOAD HANC

14. BRIDEGROOM IMPOTENCE:- ** Excessive passion may lead to premature ejaculation and causes flaccidity of penis. ** Common in newly wedded person.

15. * Vasculogenic impotence :-Most frequent cause of erectile failure(40%) *Diabetes mellitus(20%) *Psychogenic (12%) * Neurogenic (7%) *malignancy, testosterone deficiency , trauma etc (20%)

16. FRIGIDITY :CAUSES- Age has no effect on potency.

17. DEFECTS OF DEVELOPMENT AND ACQUIRED ABNORMALITIES Intersex

18. Kraurosis vulva in old women

19. VAGINAL TRAUMA STRICTURE OF VAGINA

20. CAUSE STERILITY

21. LOCAL DISEASES * Hyperaesthesia of vagina UTERINE PROLAPSE VAGINAL TUMOURS

22. PSYCHIC CAUSES passive leading to non erection of penis BUT VAGINISMUS Classical example for PSYCHOSOMATIC ILLNESS

23. CAUSE FOR VAGINUSMUS * Male sexual dysfunction. HISTORY OF SEXUAL TRAUMA

24. *Secondary to dyspareunia . *Stimulus derived from attempted heterosexual function by a women with prior homosexual practice. *Rarely ,personal dislike or a general feeling of disgust at the idea of coitus. PSYCHOTHERAPY IS BENEFICIAL

25. IMPLIED CONSCENT IS NECESSARY…DONE ONLY WHEN ASKED BY POLICE OR COURT

26. OPINION If the male external genitals are normal and subject examined is found not to be suffering from ED, Then opined as; There is nothing to suggest that the subject examined is incapable of performing sexual intercourse .

27. OPINION. There is nothing to suggest that the subject examined is incapable of performing a sexual intercourse in general. However the possibility of incapability with respect to {write name of person here} cannot be ruled out.