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Frigidity and sterility in the female
112
THE
AMERICAN
.JOCRNAL
OF
OBSTETRICS
AXD
GYNECOLOGY
are found, further careful examination of both husband and wife is required to determine the cause of their absence. Examination of specimens taken from the fundus uteri demonstrate the absence of any mechanical interference with the ascent of the snermatozoa into the iundus a.nd tubes, as well as any inimical action in the endometrium. The aut,hor gives his technic in detail. MARGARET SCHULZE.
Rubin: The Nonoperative Determination of Patency of the Fallopian Tubes. Jowl& American Medical Association, 1921, lxxv, 661. A not infrequent cause of sterility is occlusion of the fallopiau tubes which may occur in the absence of palpable lesions of the adnexa. An operation was formerlp necessary to determine the patency of tubes. To obviate t,his difficulty, Rubin injects oxygen int,o the abdomen by means of a canula inserted into the ut,erus and connected to a gas tank. A manometer is connected to the line and indicates the pressure under which the gas flows. In normal eases, t.lie gas passes through the tubes at a pressure as low as 40 mm. of mercury and usually at between 60 and 80 mm. If the pressure indicated by the manometer rises to 150 mm. or more, it is reasonably eertain that both tubes are occluded. A minimum of 100 to 150 C.C. of gas are used unless it is desired to take advant.age of the pneumoperitoneum produced for radiographic purposes. In this case somewhat more is required. Under proper precautions, this method has been found to be harmless. It is indicated in all cases where i-t is desirable to know whether the tubes, or a remaining tube, are patent. Its only contraindications are active pelvic inflammation or infectious processes of t,he lower genital tract. R. E. Woscs.
Talmey:
Frigidity and Sterility in the Fern&. Medical Record, 1921; c, 631. Copulat.ion is conditioned upon three potencies and procreation requires an additional potency. There is necessarg (1) the potency of voluptas or the transcendental desire of the individuals of the two (2) This union must give the two parties a certain sexes to unite. satisfaction or libido. Libido lacking, union becomes disgusting and coeundi. For is avoided altogether. (3) Tl lere must be facultas procreation must be added the facultas genera&i. There must be living spermatozoa and ova and the genital tract,s of both sexes must Fe pervious. Lacking one of the four faculties, the individuals are suffering from impotence. Impotence of voluptas or true frigiditv is exceedingly rare in men or in women. The transcendental attraction between t.he sexes is never absent in man from infancy to old age. Inherited frigidity is occasionally found in low idiots. Impotentia eoeundi, the idiopathic impotence of copulation is also a rare occurrence in either sex. But the pathologic or rather acquired impotentia coeundi is the impotence common in the male, while in the female it is ra.re. Painful copulation clue to acute genital inflammations is not real impotence in the strict sense of the word. If the woman is willing to bear pain, copulation is possible. Idiopathic impotence of libido is very rare. It is sometimes found in men in cases of grave neurasthenia. It is a, frequent anomaly in the female and is falsely named frigidity; it ought to be calidity for they are suffering either from relative or absolute orgasmus retardatus. Impotentia generandi,
REVIEWS
BND
ABSTRACTS
113
the idiopathic impotence of fertilization or sterility is rare in either sex, but the acquired impotence of procreation is very frequent. Half of the sterile marriages are due to azoospermia of the male as a result of gonorrhea and at least 90 per cent of the eases of sterility of the female are caused by the infection of the wife from her husband. Talmey regards electriseity the best remedial agent in the treatment of endometritis, metritis, salpingitis, ovaritis, and pelvic peritonitis. Its use is strictly cont,raindicated where there is pus. The author believes that dyspareunia and lack of orgasm are not r,arely the cause of sterility, and that electricity is of great therapeutic value in these cases. C. 0. MALAND. Nassauer schrift,
:
Treatment of Sterility. 1920, lxvii, 1463.
Muenchener
medizinische
Wochen-
The author briefly reviews the known causes of sterility in the female emphasizing the probable importance of the r81e played by the internal secretions and deriding simple anteflexion of the cervix, simple retroversion of the corpus uteri and especially the “stenosis of the cervix” as causes of sterility. He holds that the nervous element as a faetor in producing sterility has been overlooked and proposes it as the underlying cause for the so-called “stenosis of t.he cervix” which is only a temporary uterine cramp. Dilatation therefore is not indicated nor successful (because the internal OS remains unaffected by this procedure). It is fair to assume that uterine cramps like those excited by the irritation of a sound, occur during coitus (a parallel is found in vaginismus). Sterile women, by whose temperament it may be assumed that this phenomenon occurs, are treated first for their nervous conditionrest, tonic, change of surroundings, etc. Then the author employs an instrument which he calls “ das Fruchtulet,” an aluminum tube (sides perforated) that conforms to the size and shape of the cervical passage, extending from just above the internal OS to the external OS where it is joined to al doubly concave, centrally perforated button that fits the portio and also serves to gather the semen and guide It leads to an it into the uterine cavity via the cannula in the cervix. improved circulation of the uterus, the uterine contr,aetions do not recur, and hence the instrument serves the double purpose of maintaining the passage open for semen to pass, and of preventing its expulsion after having reached the uterine cavity. The “Fruchtulet” is inserted (repeatedly if necessary) shortly after menstruation and allowed to remain until just. preceding the following menses. The woman is advised to remain quiet, with buttocks raised, for some time following insemination. The author reports four cases where the employment of this device ‘was followed by impregnation of patients long sterile. E.B. SOLHAUG. IBandler: The “Higher Up” Theory of Sterility and Its Rela,tion to the Endocrines. Kew York Medical Journal, 1919, cix, 309. After excluding gross inflammatory conditions and tumors, Bandler -thinks that sterility is largely a matter of endocrine dysfunction and remediable by the administration of the proper gland extracts. He
THE
AMERICAN
.JOCRNAL
OF
OBSTETRICS
AXD
GYNECOLOGY
are found, further careful examination of both husband and wife is required to determine the cause of their absence. Examination of specimens taken from the fundus uteri demonstrate the absence of any mechanical interference with the ascent of the snermatozoa into the iundus a.nd tubes, as well as any inimical action in the endometrium. The aut,hor gives his technic in detail. MARGARET SCHULZE.
Rubin: The Nonoperative Determination of Patency of the Fallopian Tubes. Jowl& American Medical Association, 1921, lxxv, 661. A not infrequent cause of sterility is occlusion of the fallopiau tubes which may occur in the absence of palpable lesions of the adnexa. An operation was formerlp necessary to determine the patency of tubes. To obviate t,his difficulty, Rubin injects oxygen int,o the abdomen by means of a canula inserted into the ut,erus and connected to a gas tank. A manometer is connected to the line and indicates the pressure under which the gas flows. In normal eases, t.lie gas passes through the tubes at a pressure as low as 40 mm. of mercury and usually at between 60 and 80 mm. If the pressure indicated by the manometer rises to 150 mm. or more, it is reasonably eertain that both tubes are occluded. A minimum of 100 to 150 C.C. of gas are used unless it is desired to take advant.age of the pneumoperitoneum produced for radiographic purposes. In this case somewhat more is required. Under proper precautions, this method has been found to be harmless. It is indicated in all cases where i-t is desirable to know whether the tubes, or a remaining tube, are patent. Its only contraindications are active pelvic inflammation or infectious processes of t,he lower genital tract. R. E. Woscs.
Talmey:
Frigidity and Sterility in the Fern&. Medical Record, 1921; c, 631. Copulat.ion is conditioned upon three potencies and procreation requires an additional potency. There is necessarg (1) the potency of voluptas or the transcendental desire of the individuals of the two (2) This union must give the two parties a certain sexes to unite. satisfaction or libido. Libido lacking, union becomes disgusting and coeundi. For is avoided altogether. (3) Tl lere must be facultas procreation must be added the facultas genera&i. There must be living spermatozoa and ova and the genital tract,s of both sexes must Fe pervious. Lacking one of the four faculties, the individuals are suffering from impotence. Impotence of voluptas or true frigiditv is exceedingly rare in men or in women. The transcendental attraction between t.he sexes is never absent in man from infancy to old age. Inherited frigidity is occasionally found in low idiots. Impotentia eoeundi, the idiopathic impotence of copulation is also a rare occurrence in either sex. But the pathologic or rather acquired impotentia coeundi is the impotence common in the male, while in the female it is ra.re. Painful copulation clue to acute genital inflammations is not real impotence in the strict sense of the word. If the woman is willing to bear pain, copulation is possible. Idiopathic impotence of libido is very rare. It is sometimes found in men in cases of grave neurasthenia. It is a, frequent anomaly in the female and is falsely named frigidity; it ought to be calidity for they are suffering either from relative or absolute orgasmus retardatus. Impotentia generandi,
REVIEWS
BND
ABSTRACTS
113
the idiopathic impotence of fertilization or sterility is rare in either sex, but the acquired impotence of procreation is very frequent. Half of the sterile marriages are due to azoospermia of the male as a result of gonorrhea and at least 90 per cent of the eases of sterility of the female are caused by the infection of the wife from her husband. Talmey regards electriseity the best remedial agent in the treatment of endometritis, metritis, salpingitis, ovaritis, and pelvic peritonitis. Its use is strictly cont,raindicated where there is pus. The author believes that dyspareunia and lack of orgasm are not r,arely the cause of sterility, and that electricity is of great therapeutic value in these cases. C. 0. MALAND. Nassauer schrift,
:
Treatment of Sterility. 1920, lxvii, 1463.
Muenchener
medizinische
Wochen-
The author briefly reviews the known causes of sterility in the female emphasizing the probable importance of the r81e played by the internal secretions and deriding simple anteflexion of the cervix, simple retroversion of the corpus uteri and especially the “stenosis of the cervix” as causes of sterility. He holds that the nervous element as a faetor in producing sterility has been overlooked and proposes it as the underlying cause for the so-called “stenosis of t.he cervix” which is only a temporary uterine cramp. Dilatation therefore is not indicated nor successful (because the internal OS remains unaffected by this procedure). It is fair to assume that uterine cramps like those excited by the irritation of a sound, occur during coitus (a parallel is found in vaginismus). Sterile women, by whose temperament it may be assumed that this phenomenon occurs, are treated first for their nervous conditionrest, tonic, change of surroundings, etc. Then the author employs an instrument which he calls “ das Fruchtulet,” an aluminum tube (sides perforated) that conforms to the size and shape of the cervical passage, extending from just above the internal OS to the external OS where it is joined to al doubly concave, centrally perforated button that fits the portio and also serves to gather the semen and guide It leads to an it into the uterine cavity via the cannula in the cervix. improved circulation of the uterus, the uterine contr,aetions do not recur, and hence the instrument serves the double purpose of maintaining the passage open for semen to pass, and of preventing its expulsion after having reached the uterine cavity. The “Fruchtulet” is inserted (repeatedly if necessary) shortly after menstruation and allowed to remain until just. preceding the following menses. The woman is advised to remain quiet, with buttocks raised, for some time following insemination. The author reports four cases where the employment of this device ‘was followed by impregnation of patients long sterile. E.B. SOLHAUG. IBandler: The “Higher Up” Theory of Sterility and Its Rela,tion to the Endocrines. Kew York Medical Journal, 1919, cix, 309. After excluding gross inflammatory conditions and tumors, Bandler -thinks that sterility is largely a matter of endocrine dysfunction and remediable by the administration of the proper gland extracts. He