Part 79

Amputation of the vaginal portion of the cervix, an operation sometimes undertaken for the relief of sterility in cases of hypertrophy of the cervix, may on the other hand lead to sterility in cases in which a cicatricial stenosis of the cervical canal results from the operation.

By the too frequent application of caustics to the cervical canal, or by the employment of these agents in too powerful a form, occlusion of the os externum may be caused, or even adhesion of the opposing walls of the vagina just below the cervix, thus giving rise to sterility. Rough use, also, of the uterine sound, and maladroit and violent gynecological massage, have often enough been responsible for the occurrence of sterility, by giving rise to perimetritic inflammation. Landau enumerates among the causes of intrapelvic abscesses, “whereby the specific functions of womanhood are nullified in consequence of degeneration of the tubes or the ovaries,” “certain therapeutic procedures,” and more especially, intra-uterine therapy, (the use of the sound, curettage, injections, cauterization), and operations on the cervix or the vagina, on which intrapelvic inflammation and even suppuration has ensued. How easily pelvic peritonitis and its consequences lead to sterility in women, has been shown many times in the course of our exposition of this subject.

Finally, we must class with operative sterility the result of surgical procedure undertaken by gynecologists to save women, whose lives have already been seriously threatened by pregnancy or parturition, from a repetition of this experience. In such cases, Blundell recommends division of the Fallopian tubes, having found from experiments upon rabbits that this is a safe and certain means for the prevention of conception. Frorieps and Kocks have both frequently brought about an artificial sterility in women by closure of the tubes, the first-named by cauterization with nitrate of silver—the caustic being attached to the end of a piece of whalebone and introduced through a canula into the uterine orifice of the Fallopian tube—whilst Kocks has constructed for the same purpose a galvano-caustic uterine sound, which is only rendered red-hot by passage of the current after it has been introduced into the uterine ostium of the tube. Both these methods are in the first place too uncertain to be relied upon for the attainment of the desired end, and in the second place their employment appears to be neither easy, nor free from danger.

As the importance of conservative methods of procedure becomes once more fully recognized in modern gynecology, cases of operative sterility will become ever more and more rare.

TABLE SHOWING THE CAUSES OF STERILITY IN WOMEN.

I. STERILITY DUE TO INCAPACITY FOR OVULATION.

ABSOLUTE AND IRREMEDIABLE.

Complete absence of the ovaries.

Congenital atrophy of both ovaries.

Premature atrophy of the ovaries, in consequence of infectious disorders, constitutional diseases, and toxic influences.

New-growths of the ovaries, destroying all the follicles.

Senile changes in the ovaries.

Complete oophorectomy, or any equivalent form of operative sterility.

RELATIVE AND TRANSIENT.

Incomplete development of the ovaries.

Imperfect formation of ova, owing to marriage when still too young (amenorrhœa).

Ovarian tumours and oophorectomy, whereby, however, a remnant of healthy ovarian tissue is spared.

Chronic oophoritis and perioophoritis; syphilitic disease of the ovaries.

Excessive obesity, anæmia, chlorosis, scrofula, morphinism, alcoholism, various conditions affecting unfavourably the innervation or nutrition of the ovary; change of climate or mode of life; emotional disturbance; inbreeding, hereditary predisposition.

II. STERILITY DUE TO INTERFERENCE WITH THE CONTACT OF NORMAL SPERMATOZOON AND OVUM.

A. On the Part of the Wife.

ABSOLUTE AND IRREMEDIABLE.

Congenital or acquired universal thickening of the tunica albuginea of the ovaries, preventing the dehiscence of the follicles.

Absence of both tubes, developmental defects of these organs.

Absence or rudimentary condition of the uterus. Foetal uterus.

Congenital atresia of the uterus with arrest of development.

Complete absence of the vagina.

Extreme contraction of the pelvis, whereby the vagina is rendered inaccessible.