STERILITY IN THE FEMALE WITH SPECIAL REFERENCE TO PSYCHIC FACTORS

Abstract

In the foregoing pages we have adopted criteria of the presence of sterility and briefly described the anatomy and physiology of reproduction. We have seen that a male may occasionally be relatively, or absolutely, infertile even though he have a “normal sperm count,” and that this factor must be kept in mind constantly in dealing with clinical material. We have seen the importance of degrees of relative fertility. The complex structural and functional pathologies involved in the problem have been pointed out. We have noted the many local and generalized somatic and psychic diseases which may be etiological, and we have paid particular attention to endocrine and psychosexual factors. An attempt was made to show how the function of the generative tract may be linked anatomically and physiologically to the cerebral cortex and the endocrines. Certain aspects of sexual hygiene have been related to fertility, and evidence has been collected from the literature tending to support the hypothesis that psychic factors may be involved in the etiology of sterility. In discussing the significance of this extremely complex mass of information, we feel that it is essential first to recognize one outstanding implication. The implication is that the organism must be regarded as a psychosomatic unit, and that the functioning of the generative tract is determined, as one function of that unit, by an anatomical and physiological syncytium, or meshwork, of all the parts--psyche, nerves, endocrines, smooth muscles, and viscera. This means that an endogenous or exogenous influence or force, of whatever nature, affecting any one of the parts of this syncytium in such a way as to modify its normal functioning, will be likely to be felt in all the other parts, and appreciated clinically as repercussions widely scattered throughout the whole organism. As we have seen, psychic conflicts may result in vegetative tensions and imbalance of such a nature as to produce malfunctioning of any, or all, parts of the reproductive system. We think the evidence offers some support to the thesis that a woman's life experiences, and the conflicts arising therefrom, may, and do, make themselves evident in the form of impaired fertility. It is evident, however, from the foregoing section on psychosexuality in its relation to fertility, that while there are many opinions as to what the nature of this relationship might be, carefully controlled study of psychosexual problems in infertile women has been decidedly meager. The second phase of the present work will attempt to investigate this relationship more fully. A third phase will then be undertaken with a few selected patients by means of the psychoanalytic technique. It is believed that such studies might lead to a better understanding of the psychodynamics involved in the relationship between an individual's life experiences and her fertility.