Aspermia

ASPERMIA (from Greek a- negative particle and sperma-semen), a condition in which during sexual intercourse semen is not ejected outward, while its production in the body is not impaired, and in certain cases normal sensation of orgasm is preserved. Aspermia occurs far from frequently and is one of the causes of infertility. Aspermia can be a constant or temporary phenomenon. In the first case, the cause of the disease are local anatomical changes, as a result of which the proper ejaculation of semen is mechanically impaired. In temporary aspermia, changes are usually observed in the central or peripheral nervous system. Therefore, it would be more correct to distinguish between mechanical aspermia and nervous-psychological aspermia. Changes in the configuration of the seminal ducts, each individually or taken together, are the immediate cause of mechanical aspermia. It is most often observed as a result of a pronounced narrowing of the urethra. In these cases, semen is thrown into the prostatic urethra, but cannot overcome the obstacle (narrowing) in the latter and flows out only after the erection ceases. It is not without interest that the impermeability of the urethra for semen is not accompanied by its impermeability for urine. In the presence of such a narrowing, especially if it is located in the area of the external sphincter of the bladder, ejaculation is accompanied by painful sensations of a spasmodic nature in the perineum, in the area of the bladder and rectum. Treatment consists in eliminating the narrowing of the urethra by its dilation. The prognosis is favorable. The second etiological factor of mechanical aspermia is, as especially pointed out by Finger and Ultzmann, an acquired or congenital deviation or obliteration of the ejaculatory ducts. Various processes in the area of the prostatic urethra and prostate (chronic and acute inflammations, tumors, stones) can cause the formation of scar connective tissue here, which blocks the excretory ducts or changes their direction. In the latter case, the ejected semen is directed not forward to the external opening of the urethra, but into the cavity of the bladder and is excreted from there after the end of the sexual act along with urine. Patients in this case usually do not note any painful sensations. The prognosis in these cases is unfavorable, since it is impossible to eliminate the deviation; orgasm in mechanical aspermia is preserved. Nervous aspermia differs from mechanical in that with it neither orgasm nor ejaculation occurs. The sexual act can continue for a very long period of time, up to complete physical fatigue, but does not end with the release of semen. This is explained by insufficient excitability (anesthesia) of the ejaculation center, which can be caused by a disease of the spinal cord [according to Rohleder's opinion, aspermia is one of the early symptoms of tabes]. Cases of temporary, acquired anesthesia of the ejaculation center on the basis of abuses of the sexual act, masturbation, alcohol are observed much more frequently. In some individuals, aspermia may occur only with respect to certain women, while sexual intercourse with other women ends normally, sometimes even too quickly. Apparently, in such cases, external irritations coming from a specific person are insufficient for the sexual centers to come into sufficient excitement, and we are dealing with 'psychological' aspermia. Treatment and prognosis in cases of nervous aspermia are directly related to the factor causing this phenomenon; if we are dealing with an organic disease of the spinal cord, then the prognosis is hopeless, and treatment should be directed at the underlying suffering. In cases of nervous-psychological aspermia, good results are achieved by the use of general strengthening treatment, hydrotherapy, especially in the form of carbonic acid baths, as well as electrotherapy in the form of faradization of the spinal cord. Finally, aspermia can be caused artificially: if repeated normal or masturbatory sexual acts are performed one after another within a very short period of time, then the amount of ejaculate decreases sharply with each time and can reach complete disappearance, in order to restore after sexual 'rest' to its former volume. This factor, well known from everyday life, should be taken into account especially by forensic physicians, since abuses can arise on this basis in questions about determining the ability to fertilize.