Female Sexual & Reproductive Dysfunction
Medico-Legal Definitions & Clinical Etiology
1. Female “Impotence” (Sexual Dysfunction)
In women, the term is less rigid than in males. It primarily relates to the inability to experience or participate in intercourse due to physical or psychogenic factors.
- Anatomical/Physical: Vaginismus (spasm), Hymenal abnormalities (rigid/imperforate), Vaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome), Pelvic Inflammatory Disease (PID) causing dyspareunia.
- Psychological/Psychogenic: Sexual trauma, severe anxiety, history of abuse, relationship conflict.
2. Female Sterility (Infertility)
Inability to conceive. Etiology is classified by the reproductive anatomy:
| Level | Common Causes |
|---|---|
| Ovulatory | PCOS, Hypothalamic/Pituitary failure, Premature Ovarian Insufficiency (POI), Age-related decline. |
| Tubal/Uterine | Tubal occlusion (post-infection/chlamydia), Endometriosis, Uterine fibroids, Asherman’s syndrome (intrauterine adhesions). |
| Cervical/Other | Cervical stenosis, hostile cervical mucus (anti-sperm antibodies). |
3. NEET PG High-Yield Pearls
- PCOS: The most common cause of anovulatory infertility. Look for LH:FSH ratio > 2:1 and ultrasound features.
- Tubal Factor: Chlamydia trachomatis is the most common infectious cause of tubal infertility; always screen for pelvic adhesions.
- Endometriosis: A major cause of chronic pelvic pain and infertility; often diagnosed via diagnostic laparoscopy (gold standard).
- Forensic Distinction: Sterility is only relevant to “nullity of marriage” if it is considered incurable and was fraudulently concealed from the spouse. Vaginismus is the most common cause of non-consummation in forensic sexual assessment.