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The Impediment of Impotency and the Condition of Male Impotence

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The Impediment of Impotency and the Condition of Male Impotence The Linacre Quarterly Volume 26 | Number 1 Article 4 February 1959 The mpI ediment of Impotency and the Condition of Male Impotence: A Canonical-Medical Study: Medical Considerations Paul V. Harrington Charles J.E. Kickham Follow this and additional works at: http://epublications.marquette.edu/lnq Recommended Citation Harrington, Paul V. and Kickham, Charles J.E. (1959) "The mpeI diment of Impotency and the Condition of Male Impotence: A Canonical-Medical Study: Medical Considerations," The Linacre Quarterly: Vol. 26 : No. 1 , Article 4. Available at: http://epublications.marquette.edu/lnq/vol26/iss1/4 in serious hemorrhage before one in contrast to the questio1 ,ble resorts to curettage. Had curettage morality of direct extraction. ·not' been performed during the ad­ m.1ss10.n prior , the present hos­ CONCLUSION The Impedimer of Impotency and . pitalization, t,,-. pregnancy might TI terine curettage for th_e at- have contintwct on to full term. ,_t of serious hemorrhage )n­ The Conditio' · Male Impotence This possibility is postulated on 'nt upon pregnancy prio to the fact that the patient went t• ttainment of fetal viabili , is A Can011. Medical Study through . an uneventful full-term lly licit only after the I tus pregnancy the yea_r before in spite h.:i ':ed or becomes detachec REV. PAUL V. HARRINGTON, JC. CHARLES J. E. K1cKHAM, M.D .. P.A.C.S. of her long history of chronic l pel­ '. 're is a high probability hat To_ present the proble s ,m,. ' , :, the matter of ma e impotence as related to vic inflammatory b disease. at 5t one of these conditio1 ; is the validity of marriage, t he c . onsiderations, as prepared y Rev. Paul V. J.C.L., were pub I ,s"j" 1 , August· and November 1958 issues :>f The There is possibly room Harrington, l for some fuF cd when hemorrhage i. so Linacre Quarterly. Th� me_dical ,_ EIS t forth by Dr Char es 1- E. K,ckham, debate as to whether or not r gra ua t f Holy c;oss College and Harvard ex­ se, ,. , that it constitutes an ir ne­ appears in this issue. Dr. K,cklwm er o traction of Medical School. He is sso e r f U o log at Tufts M edical Scho l and the fetus was actually dia l and serious threat to the life A ciat P: , Uo i° l o Departme 7,t- lfrlizabeth's Hospita , Bright n; justified when it is Surgeon,in_-Chief, f/ o was unexpectedly of L',e mother. In such cin: 1m­ Carney Hospital, Boston, an d ond'., ' -11e rci:/c�r H�spital at Norf lk, Mass. He is a discovered at the time of"examina­ sta nces it is unlikely that the f tus dip/ornate of the American Board of Urology. tion under ;mesthesia. Although is obtaining sufficient metal Jlic one might argue that the preg­ st,pport from the mother via the MEDICAL CONSIDERATIONS nancy appeared to be doomed placental circulation to sustain ife. emphasis on those features, per­ (there is no doubt AYING set forth the histori-­ that it was cer­ This justifies the assumption : is H taining to the sex apparatus, must tainly prejudiced cal evolution and present un­ by the "preceding dead or detached. be elicited. An evaluation of the curettage) it must derstanding of the impediment o� be admitted that Application of this criterion re­ person's attitude towards the oth r death of the impotency and the condition of � fetus was by no - supposes that the physician re, :,g­ sex is necessary. A careful physi­ means certain male impotency, it remains no v to at the time and .the nizes the distinction between d.i ect : _ cal examination should be carried placenta was· consider .this can·onical defimt1on s·ubsequently found abortion and licit removal c a out and an impression obtained as to have in the light of present-clay medical been firmly attached. In dead fetus. The theoretical i eal to the gonadal type involved. 1 ­ the absence of knowledge and determine what � severe enough of absolute certainty is not al"' ays spection of the genital organs will bleeding liable to be an immediate diseases, anomalies or abnormal­ attainable by all physicians. Th 're­ ities would or might constitute an reveal the existence of any anoma­ threat to the life of the mother it fore, a reasonable margin of ho est impotent condition. The possibil­ lies or gross defects. Palpation of would have been ethically more error in making judgments in , ev­ ities of cure or remedy of such a the scrotal contents is of impor­ prudent to use conservative hemo­ ere hemorrhagic emergencie� is condition will also be discussed· in tance as any abnormal findings static measures such as oxytocics tolerable as a realistic calcul.· ted an attempt to discover _ which may be of real significance. The and packing in this case. Then risk until greater precision beco•nes might be judged to be permanent. vas should be followed to the in­ even if indirect abortion occurred I possible in the diagnosis of fetal As mentioned previously, the an­ guinal canal and the size, consis­ it would have been a natural ·event death or detachment. tecedents of each condition can be tency and location of the testes determined by the fact of its con­ should be noted. The status of the genital nature or by the date of epididymis must likewise be re­ the surgery or accident which ac­ corded. The normalcy of the penis counts for it. must be confirmed. These relative­ ly simple procedures may provide _ The etiological background of a clue to the solution of the entire impotence may, in many instances, problem in an individual case. tax the diagnostic acumen of �he A complete neuropsychiatric most meticulous and painstakmg . investigator. A detailed present evaluation may, at times, be m­ and past history with - particular dicated. Neurogenic factors may 12 LINACRE QUARTERLY FEJIRUARY, I 959 . 13 be present whereby the reflex act early period of married life nay all the glands of internal secretion. is prevented by disturbances in 1,tanding of the physiologinl not have particular signific nee The anterior pituitary secretes the the higher centers, or. damage to mechanisms of erection and Ci-" ,_ especially in the sexually ine pe- gonadotrophic hormone \\ h i c h the neµromus, -ar mechanisms. as Jation and the associated n r•enced. The sex act general], at­ to stimulates the in , r�t,tial cells to a result of n, ' ..: lesions, may be anatomy is essential the p• · ! ,ns normalcy after a ce ain the production of androgen and evident. appreciation of the problem ,111 �unt of mutual adjustment has volved in male impotence. controls spermatogl'ncsis and regu­ t ·n place. These couples sh uld Organic factors, acquired or The so-called seminal tr, lates endocrine efficiency. be 1 cassured and advised � • a congenital. are commonly noted formed ·by the testis, epidic The scrotum exercises a thermo­ and. as previously stated, lack of co11 p�tent medical authority. An vas deferens, ampulla of ua., regulatory role. It has demonstrat­ continuity of the conducting chan­ im; nrrant aspect of prem, ure ejattdation is that in a def nite inal vesicle and ejaculatorv ed that sperm do not reach matur­ nels of. the seminal tract may re­ ity nu, •l,er of cases especially in the These organs are bilateral ,. in the higher temperatures of sult in an impotent condition ac­ normal individual. The flr<•· · 11c the inguinal canal and particularly intrc, nective type, its repet ion cording to the opinion of Cardinal gland has an accessory SC\ ,,,le. within the abdomen. may result in lack of confldl' ice, Gasparri and his. followers. The testis has a two-fold fumt1c,11. disc, .1ragement and frustr, ion Following the production of On the purely functional basis, The fundamental purpose is sper­ whith may terminate in an inti ,ct­ sperm in the testes, they and any loss of potency may be. _due to aiatogenesis-the production of ablr true psychic impotence. w .ich ancillary secretions are transported neurotic or psychoneurotic sources sperm which have their origin ll1 mav require intensive psychot ,er­ along the convoluted tubules of· with no gross pathologic changes the germinal cells of rhc semenifer­ apr the epididymis through the vas demonstrable in the structure of ous tubules. The s.:,.ond purpose deferens which dilates before the sex apparatus and no neuro­ ft should be recognized that the is the elaboration of an androgenic entering the prostate gland to form genic dysfunction or mechanical male is born with certain inhe, ent hormone by · the interstitial cells. the ampulla. At the base of the to impediment erection or ejacula­ sex endowments. In the weakly en­ The hormones exercise a control­ prostate it is joined by the duct of tion present, even · though there dowed, the sex factor may b, an ling power over the reproductive the seminal vesicle to form the may be minor and insignificant inconspicuous and unobtrusive ·le­ organs and promote male growth ejaculatory duct which traverses pathologic ch;rnges. Unconscious ment in his life and may n. :an and are required · for the normal the prostate and empties into the emotional disturbances, lack of little or nothing to him. He 1 1ay development and physiological ef­ urethra. Obviously, occlusion of confidence, sense of inferiority. not be aware of such deficiency ficiency of. the sex and accessory this seminal avenue at any point introspection, frustration, worry, until conjugal requirements rr 1ke sex apparatus. The development will prevent the testicular secre­ indifference and occasionally sex him realize his inadequacy.
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