Overview of Impotency, Sterility and Virginity with Medicolegal aspects

1. IMPOTENCE, STERILITY AND
VIRGINITY
DR. HIMANSHI

2. IMPOTENCE
• Inability of a person to perform sexual intercourse.
Impotence
Males
Impotency
Man who is not able to
initiate or maintain penile
erection or sexual intercourse
Females
Frigidity
The inability of a woman to
attain orgasm during sexual
intercourse.

3. CAUSES OF IMPOTENCE
Males
Psychological (most
common cause)
Generalized Age Related Decline
Situational
QUOAD HOC: Selective impotence
towards a particular female.
Performance related
Fear of impotence or fear or
inability to complete the act. (First
Night Impotence or Honeymoon
Impotence)
Psychogenic Distress
related
Organic

4. COMMON TESTS FOR MALE IMPOTENCY
1. NOCTURNAL PENILE TUMESCENCE TEST
• A test to distinguish between organic and psychological impotence.
• Usually men have 3-5 erections during sleep.
• Men suffering from psychological causes can still have erections during sleep.
• Absence of such nocturnal erections suggests impotence due to organic
causes.
2. Penile Doppler Ultrasound
3. Intra-cavernosal injection test
4. Pudendal arteriography.
5. Bulbocavernous reflex

5. CAUSES OF IMPOTENCE
Females
Development Defects
Vaginal Atresia, Adhesion in
Labia, Imperforate hymen
etc.
Cancers
Uterine, Vulvul, Bladder,
Cervix
Local Diseases
Gonorrhea
Prolapse of uterus, Vagina
Psychosocial Difficulties
(m.c.c.)
Vaginismus

6. VAGINISMUS
• It is spasmodic contraction of vagina due to hyperesthesia.
• Anatomically it affects the perineal groups of muscles but may be felt
as varying constriction of levator ani muscles.

7. VAGINISMUS
• Physiologically, these groups of muscles contract spastically instead of
their rhythmic contractual response to orgasmic experience.
• Hysterical hyperesthesia co-exists with this condition.
• An attempt to sexual intercourse may cause a painful reflex spasm of
levator ani, perineal muscles, adductor muscles of thigh and erector
spinal muscles.
• It is completely involuntary reflex.
• In fully developed state constriction is so severe that penetration by
the penis is impossible.

8. CAUSES OF VAGINISMUS
Causes
Male Sexual Dysfunction
Religious orthodoxy
Prior sexual trauma
Prior homosexual experience
Secondary to dyspareunia
Personal dislike of disgust
Psychological Causes

9. FECUNDATION AB EXTRA
• Conception is possible without penetration of vagina by the penis due
to deposition of semen on the vulva or thigh.
• The insemination occurring due to passage of spermatozoa from the
external genetalia to the uterus.

10. FRIGIDITY
• It is inability to initiate or maintain the sexual arousal pattern in the
females.
• Causes:
1. Hypothyroidism
2. Dislike the partner
3. Use of sedatives or depressants
4. Menopause

11. GROUND FOR DIVORCE
• Frigidity>>> Sterlity

12. SATYRIASIS AND NYMPHOMANIA
• SATYRIASIS
Excessive sexual desire in males
• NYMPHOMANIA
Excessive sexual desire in females.

13. TWIN PREGNANCY
Twin Pregnancy
Superfoetation
Fertilization of two
different ova from two
different acts of coitus in
two different menstrual
cycle.
Superfecundation
Fertilization of two
different ova released in
one menstrual cycle.

14. STERILITY
Sterility
Males
Unable to
impregnate a female
Females
Unable to conceive
pregnancy
Inability to procreate
or reproduce

15. MEDICOLEGAL SCENARIOS OF IMPOTENCE
AND STERILITY
MLI
CIVIL CASES
Adoption
Controversial paternity
Nullity
Divorce
Property inheritance
CRIMINAL CASES
Adultery
Rape
Unnatural sexual offences
Criminal Claims Individual becoming impotent due to injury.

16. MARRIAGE
• Contract between a male and a female, male being >21years and
female being > 18 years.
• Benefit of contract: Implied consent for sexual intercourse.
• SEXUAL GROUNDS FOR SEPARATION:
• Impotency
• Nullity of marriage
Sterility is not the ground for divorce.

17. DISSOLUTION OF MARRIAGE
Dissolution of marriage
Null and Void
Living spouse
Prohibited
relationship
Women pregnant at
time of marriage
with other man.
Voidable
Impotency
Insane
Fraud
Divorce
Adultery Cruelty Disease
HIV, Leprosy
> 3years
Disappearance >7
years

18. STERLISATION
Sterilization
Direct
Intentional
Indirect
Unintentional
Making a male or female sterile without
any interference with the potency.

19. STERLISATION
Types
Compulsory Voluntary
Therapeutic
To prevent danger to
health and life of women
Eugenic
To prevent conception of
children likely to have
genetic abnormalities.
Contraceptive
To limit the size of the
family.

20. STERLISATION
Methods
Permanent
Vasectomy in males
Tubectomy in females.
Exposure to deep X-Rays in both sexes.
Temporary
Coitus interruptus
Loop
OCP
Diaphragm

21. STERLISATION
• Written consent of both the husband and wife required.
• It is not unlawful if performed on therapeutic or eugenic grounds
after obtaining valid and true consent.
• Preferable to check after vasectomy. The person is to be advised to
abstain from sexual intercourse for at least 3 months and seminal
examination shows no spermatozoa on 2 successive occasions.

22. ARTIFICIAL INSEMINATION
• The artificial introduction of semen into the vagina, cervix or uterus to produce pregnancy.
• Amount of semen Required for AI = 1ml
Types
Artificial Insemination
Homologous (AIH)
Artificial Insemination
Donor (AID)
Artificial Insemination
Homologous Donor/
Pooled (AIHD, AIP)

23. A.I.
Semen
Sperm
10%
Seminal
Fluid 90%
Secretion of
semen
Bulbourethral
Gland 10%
Prostate 30%
Seminal
vesicles 60%

24. GROUNDS FOR AI
Types
Artificial Insemination Homologous (AIH)
Husband Impotent
Husband sterile
Cervical stenosis
Structural abnormality e.g. hypospadiasis, epispadiasis
Thick cervical mucous
Artificial Insemination Donor (AID)
Hereditary disease in husband
Husband Suffering from HIV, or any STD
Rh incompatibility
Artificial Insemination Homologous Donor/ Pooled
(AIHD, AIP)
Oligospermia

25. ARTIFICIAL INSEMINATION
PRECAUTIONS
Identity of donor always kept secret.
Donor should be physically and mentally fit.
There should not be any Rh Incompatibility between donor and
recipient.
Consent must of husband and wife both.
Donor should have atleast one child before.
A single donor semen is not used to produce more than 10
children.
Donor should be less than 40years of age.
Blood group of donor should be same that of husband.

26. DELHI ARTIFICIAL INSEMINATION ACT, 1995
• Valid Ground for AFI.
• Consent of Husband must.
• No XX or XY segregation permitted.
• Recipient do not get to choose race, ethnicity, community of the
donor.
• Donor does not get to know where semen is being used.
• If the donor is married then consent of his wife is must.

27. AFI BIRTH AND LEGALITY
MLI Legitimacy
If birth happens the child
taken as illegitimate.
Adultery
Cannot be taken as
adultery
Divorce
The nullity of marriage
does not dissolve, it can
still be granted to wife.

28. SURROGATE MOTHER (WOMB LEASING)
• A surrogate mother is a women who by contract agrees to bear child for
someone else with intention to give away the child to the parents after it is
born.
• Intended to help couple, of whom women is infertile, but the male has no
reproductive deficiency.
Surrogacy
AI with semen of barren women
husband is carried out in hired
women (womb leasing)
With donated sperm, donated
ovum, donated embryo
Remove mature healthy ovum from
the wife and fertilize it in vitro with
husband semen and implant the
embryo in womb of hired women.

29. SURROGACY BILL, 2016
• Passed on December, 2018
• Bill prohibits commercial surrogacy, but allows altruistic surrogacy.
• Surrogacy clinics cannot function unless registered under the act.
Types of surrogacy
Altruistic
No monetary compensation to the
surrogate mother other than medical
expenses during the pregnancy.
Commercial
Surrogacy undertaken for monetary
benefit or reward exceeding the basic
medical expenses.

30. PURPOSE FOR WHICH SURROGACY IS PERMITTED
Purpose for which
surrogacy is permitted
For intending couples who suffer from infertility
Couple who has been married for at least 5years and must be
Indian citizens
No charges or monetary incentives given except medical costs.
Only altruistic surrogacy permitted.
Not for producing children for sale, prostitution or other forms
of exploitation.

31. SURROGACY BILL, 2016
Salient Features
Who are barred
Complete ban on commercial
surrogacy
Homosexuals, unmarried
couples, single parents,
foreigners, live-in partners.
Surrogate
mother
A close relative, married with at
least one child of her own.
Only once in lifetime, cannot be
paid except medical expenses.
Punishment
10 years jail + 10 lakh fine

32. HYMEN
• It is fold of mucous membrane
about 1mm thick present at
vaginal outlet.
• Anomalies of hymen:
1. Septate
2. Cribriform
3. Imperforate
4. Microperforate
5. Semilunar (m.c.)
6. Infantile
7. Fimbriated
8. Annular

34. CAUSES OF RUPTURE OF HYMEN
Causes
of
Rupture
of
Hymen
Sexual Intercourse
Trauma
Surgery or Gynecological examination
Scratching due to irritation of parts from lack of cleanliness
Sanitary Tampons
Masturbation
Foreign Bodies Artificial manoeuvres – Sola pith

35. POSITION OF RUPTURE OF HYMEN
CAUSE POSITION
Most common site 6 ‘o’ clock
Congenital rupture Anterior
Rupture due to sexual intercourse, trauma,
foreign body
Postero-laterally 5 ‘o’ clock to 7 ‘o’ clock
Rupture due to masturbation 11 ‘o’ clock to 1 ‘o’ clock

36. VIRGINITY
• A female who have not undergone sexual intercourse.
Primary Signs of
Virginity
An intact hymen
Normal condition of
fourchette and
posterior commissure
Narrow vagina with
rugose walls

37. DEFLORATION
• A female who have undergone sexual intercourse.
Absolute Signs
of Defloration
Hymen +Torn
Torn fourchette
and posterior
commissure
Dilated vagina
with absence of
rugosity
Disappearance
of fossa
navicularis.

38. VIRGINITY vs. DEFLORATION
Signs of Virginity Signs of Defloration
1. Breasts: Hemispherical, firm and
rounded
2. Nipples: Small, areola pink
3. Labia majora: firm, rounded and pink
4. Labia Minora: soft, sensitive, pink
5. Fourchette and posterior commissure:
Intact
6. Vaginal Wall: closely approximated
7. Vaginal mucosa: rugose, reddish,
sensitive to touch
8. Hymen: Intact, Deeply situated in
children and superficial after puberty,
Usually semilunar in shape
9. Hymen rupture not seen in children due
to its deep location and
1. Hymen: Torn
2. Labia majora and Labia
minora: Lost of rugosity
and tone.
3. Labia Minora: Leathery
4. Carunculae myrtiforms:
several small, granular tags
of tissue (hymen tags)
5. Loss of vaginal rugosity
occurs in repeated
intercourse

39. FIMBRIATED HYMEN VS. HYMENAL TEAR
Fimbriated Hymen Hymenal Tear
Notches commonly mistaken for hymenal tear
Notches are symmetrical
Notches occur anteriorly
Do not extend to vaginal wall
Mucus membrane intact.
Extend up to vaginal wall
Present anywhere
Asymmetrical
Mucous membrane torn.

40. PSEUDO VIRGIN
• Hymen not ruptured since it is thick, fleshy, cartilaginous, even after sexual intercourse other
signs will confirm non virginity
• Free margin of hymen sometimes fimbriated and shows numerous notches round the clock.

41. TRUE VIRGIN vs. FALSE VIRGIN
TRUE VIRGIN FALSE VIRGIN
Breast Elastic, hemispherical, unenlarged
nipple with brown areola
Loose, Lax, flabby
Labia Majora Firm, well apposed and does not gap on
abduction of thigh
Flabby, may gap on abduction of thigh
Clitoris and Labia
Minora
Unenlarged clitoris, narrow vestibule,
Labia minora is elastic and pink, do not
protrude out of vulva
Clitoris enlarged, vestibule gaping, L.minora
loose, blackish-brown, cutaneous,
Hymen Intact hymen, free regular margin,
opening allowing tip of little finger
Intact but thick, elastic distensible allowing 2
to 3 fingers easily, Evidence of C. Mytiformis
Vagina Narrow, conical, vaginal mucosa
rugosed
Deep, roomy, dilated and capacious with less
rugosed Wall
Fourchette Normal, intact Normal and intact

42. Parous uterus Nulliparous uterus
Size 9 cm. long; 6.5cm. Wide. Larger and thicker 7cm. Long; 4.5cm.wide. Smaller and thinner.
Weight 80 to120 g. 40 to60 g.
Length The body is twice the length of cervix The body and the cervix have the same length.
Fundus The top of the fundus is convex and on a
higher level than the line of broad
ligament.
Upper surface of fundus less convex and on
same level as broad ligament
Cavity The walls are concave from inside The wall are convex from inside forming
smaller traingular cavity.
Cervix Irregular and edge show scar, external os is
transverse, irregular and fissured. Internal
os is not well defined.
Regular, no scar. External os is rounded and
appear as small hollow in the centre of cervix.
Internal os circular and well defined.
UTERUS OF PAROUS AND NULLIPAROUS WOMAN

43. Thank you..