CHAPTER 12 EXAMINATION OF A MALE FOR DETERMINATION OF POTENCY Dr. K. Sreekumari.

The common situations where in such an examination is conducted are: 1. 2. 3. 4. Accused in a case of rape, adultery and unnatural sexual offences. Nullity of marriage. Disputed paternity. Claims/Damages arising from injuries resulting in impotence.

The guidelines mentioned below should be followed during such examination: (For proforma, see appendix 1). The examination may be undertaken on the authorization of a competent authority. Before proper examination, a written informed consent is to be obtained. Record the date, time and place of examination. Marks of identification Two permanent marks preferably from the exposed parts of the body to be recorded. History of the case to be recorded as provided in the requisition. Medical history to be elicited relevant to the problem of potency are (a) Habits (i) Smoking (2) Alcohol (3) Drugs (Hallucinogenic drugs like cannabis can cause impotence, (b) Diabetes (when complicated by peripheral neuropathy), (c) Trauma head injury, Traumatic amputation of penis, Spinal injury (the first lumbar vertebra corresponds to the spinal nerve concerned with erection and ejaculation), (d) Exposure to venereal disease (syphilis in its tertiary stage can affect the posterior column of spinal cord which can cause impotence), (e) Hypertension (Ganglion blocking drugs taken as a part of therapy can cause impotence), and (f) Occupation (Painters, compositors and other workers handling lead are likely to develop lead neuropathy). History regarding (i) Sexual development, (ii) marital status (number of children), (ii) Sexual deviations and (iv) night emissions should be enquired into. History related to local diseases like (a) Congenital absence of penis, infantile penis or cryptorchidism and (b) acquired causes like Amputation of penis at the root either by trauma or surgical removal, large hydrocele with penis buried in the scrotum and priapism (due to pain). History suggestive of (a) endocrine diseases like Addisons disease (due to hypoadrenal corticalism which causes decreased testosterone secretion 2) Hypo pituitarism (due to sexual infantilism (b) Central nervous system disorders like (i) Syringomyelia (ii) Locomotor ataxia (iii) Tumors of spinal cord (destroying the lumbar and sacral segments) (iii) Spina bifida (with associated involvement of

spinal cord in the lumbar and sacral segments) (c) Pelvic fractures with involvement of sacral segments) (c) Pelvic fractures with involvement of sacral plexus or fibrosis leading to vascular derangement (d) Lerische Syndrome (e) Cirrhosis of liver (due to testicular atrophy as a result of hyperoestrogenism) (f) Oestrogen therapy, intake of tranquilizers and (g) Surgery for cancer of pelvic organs or deep X-ray therapy leading to fibrosis and consequent vascular derangement. 1. Local Examination (a) Penis: Examination: 1) Physical examination to ascertain whether he has attained puberty. 2) Local examination for (a) Penis (i) present/ absent (ii) Length and circumference in the flaccid/erect state (iii) Anomalies (developmental/acquired if any) (iv) Evidence of disease (filariasis/tumour/any other (v) Foreskin (retractable or non retractable) (vi) Glans penis (presence of/absence of sensation) (vii) Injuries (b) Scrotum (pendulous or non pendulous) (c) Testis (i), present/absent on either side (ii) Development (small, medium or adult size). (iii) Sensations (iv) Disease deformity, injury if any (v) epididymis and cord. (d) Evidence of sexually transmitted diseases (i) Urethral discharge (present or absent) (ii) Ulcers/any other lesion (present or absent). Systemic examination All systems to be examined (with special emphasis to those diseases that can cause impotence. Investigations: 1. Blood for sugar and V.D.R.L. if necessary. 2. X-rays of head, spine or pelvis if trauma is suspected. 3. Arteriography to establish or diagnose Lerische syndrome. 4. Liver function tests to diagnose liver failure. Opinion: (1) There is nothing to suggest that the above person is incapable of performing the sexual act. Opinion is given in the double negative form as the possibility of psychogenic impotence cannot be ruled out by physical examination. (2) The above subject is incapable of performing the sexual act because of the following impediments (the reasons may be noted).

APPENDIX I EXAMINATION OF POTENCY Requisition received from the ........................................... vide his letter No. ......... dated ............................ through P.C./H.C. No. ............. for examination of potency of .... aged................. years involved in Cr. No........................... of ................. police Station. 1. Name and address of the subject 2. Age : : ............. years (as stated by the subject)

3. Occupation : 4. Accompanied by : 5. Date, time and place of examination : 6. Consent 7. Marks of Identification i. ii. 8. Clinical history : Diabetes/Drug addiction/Trauma/Exposure to venereal disease/others if any. 9. History of sexual development : Masturbation/ Night emissions/Homosexual practice/Sexual intercourse. 10. Physical Examination A. General i. Height............. cm. ii. Weight............... Kg. iii. Build: Good/Moderate/Poor iv. Adams apple: v. Hair Public/axillary: Facial: Chest B. i) Local Penis: Present/Absent Length...... cm (flaccid state) Circumference....... cm (flaccid state) Disease (if any) Deformity (if any) Injury (if any) Sensations over glans penis Fore skin retractable/ nonetractable Scrotum: Pendulous/non-pendulous Right testis: Present/Absent Left testis: Present/Absent Development of testes: Small/Medium/Adult size Sensations Disease, Deformity, Injury if any Epididymis & cord C. Systematic examination

ii)

C.V.S. G.I.S. C.N.S. R.S. 11. 12. Special examinations (if relevant) Opinion: 1. There is nothing to suggest that the above person is incapable of performing the sexual act. 2. The above subject is incapable of performing sexual act because of the following impediments:-

Signature: Name: Designation: * Delete whichever is not applicable.