Voluntary and Involuntary. Sterility
The controversial history of sterilization in men, vasectomy, begins with Cooper’s publication of 1832 on the severing of the seminal duct in dogs. The first sterilization was carried out in the United States at the end of the nineteenth century in order to prevent the spread of crime. There was a fear that the usa would be inundated by mentally and socially inferior people. The procedure was also carried out in the United Kingdom, but in this case on eugenic grounds, to protect the race from self-destruction by its own descendants. At the beginning of the twentieth century Sharp reported on 450 sterilizations he had carried out in the state of Indiana on members of the Reformed Church. In their case vasectomy was intended to suppress masturbation. It was performed without anaesthetic and took no longer than three minutes. The severed end of the duct on the testicle side was left open so that the sperm cells could drain away freely and be absorbed by the body. In 1907 a law was introduced in Indiana that permitted the sterilization of ‘mental defectives’ and the ‘insane and feeble-minded’ for eugenic reasons. In the following decades similar laws were passed by 32 states, while twelve also legalized the forced sterilization of criminals. Up to i960 over 60,000 sterilizations were carried out for the above – mentioned reasons.
In Germany in 1933 vasectomy was made to serve eugenics, based on ‘modern racial hygiene’. In the first year after its introduction 28,000 sterilizations were carried out. In 1936 Adolf Hitler discussed sterilization with the German cardinal Faulhaber, the Archbishop of Munich. Hitler had argued for the sterilization of those with hereditary defects, and is reported as saying the following: ‘The operation is simple and does not make the man unsuitable for an occupation or marriage, and now we are being thwarted by the church.’ Cardinal Faulhaber is supposed to have said: ‘Chancellor, the state is not being
forbidden by the church to remove these harmful individuals from the community within the framework of the laws on public decency and given a genuine emergency. But instead of physical mutilation other methods must be tried, and such a means exists: the internment of people with hereditary defects.’
Internment camps amounted to concentration camps; such an institution fell within the laws on public decency and sterilization did not. Sterilization led to sexual pleasure without reproduction and that in the view of Catholic moral theologians could not possibly be permitted. For the ordinary Catholic sexual intercourse had repercussions, as Uta Ranke describes in her book Eunuchs for the Kingdom of Heaven.
In 1935 a question came from Aachen to the Holy See as to whether a forcibly sterilized man could be admitted to a church marriage. On 16 February the reply was received that the man’s marriage must not be forbidden, since it involved an unjust coercive measure by the state.
In Sweden it has been possible since 1935, with the approval of a committee, to sterilize those whom ‘the law has declared non compos mentis’, or who because of a psychiatric condition are deemed unsuitable for parenthood. In 1948 a law was promulgated to control sterilization on eugenic grounds; in practice many sterilizations were actually performed for socio-economic reasons. Between 1948 and 1962 14,000 sterilizations were carried out in Japan, and the number of illegal sterilizations was estimated at four times that figure.
A large proportion of people with a mental handicap are not able to give informed consent with regard to sterilization. In those cases the carer should fulfil his/her obligations towards the parents or guardian and, with those who are of age, towards those charged with the person’s welfare. If the handicapped person is capable of informed consent and is over the age of twelve but not yet sixteen, the permission of parent or guardian is also required. Everything seems perfectly regulated, but in practice the picture is different. When the parents of a strapping lad of fourteen with Down’s syndrome asked me to have him sterilized, since their son had already made a spontaneous attempt at intercourse, I acceded to their request without hesitation. Some readers might think that a Down’s syndrome male with his 47 chromosomes cannot father children, but in certain circumstances that is perfectly possible.
Even today forced sterilizations take place, and not only of the mentally handicapped. The following story may serve as an illustration: Patient a, a 37-year-old man of Iranian origin, came to the urology clinic after having failed for the third time to father a child. His ejaculate repeatedly contained almost no sperm cells. After some years’
residence in the Netherlands both he and his wife wanted to extend their family. He had fled from Iran for political reasons, having endured extended periods of torture, including electric shocks to his genitalia, which had often rendered him unconscious. Echographic examination led to a diagnosis of an epididymal cyst on the right side and on the left; the head of the epididymis was irregular; the testicles themselves showed no abnormalities. At the patient’s request the diagnostic process was continued in our clinic after two years, and it was decided to perform an exploratory operation under anaesthetic. When sections of tissue from the testes were examined the pathologist found a slight disruption of sperm production on both sides, though adult sperm cells were present. After the removal of scar tissue, non-soluble green knotted stitches were observed on both sides, consistent with a postvasectomy condition. The loose ends were stitched back together on both sides, without any post-operative complications. When the hospital did a follow-up check, the patient indicated that he had absolutely no knowledge of the sterilization.
Sometimes men are ignorant of the fact that they have undergone sterilization. Another illustrative case history: A 47-year-old man was referred to me by a gynaecologist in relation to the patient’s involuntary childlessness with his new partner. He had two children from a previous marriage. Three examinations by the gynaecologist showed a complete absence of sperm cells. In another hospital a section of testicular tissue had been removed under local anaesthetic. The production of sperm cells, spermatogenesis, was shown to be only slightly disrupted, which suggested an obstruction, for instance a double epididymal inflammation. When asked if he had had diseases or operations in the past, the patient’s answer was negative. It was decided to explore further under anaesthetic. No obvious abnormalities were apparent to the touch, but after incision it soon became clear that he had been sterilized: the gap between the two ends of the seminal duct was so small on both sides that it had not been felt and likewise on inspection of his shaved scrotum the tiny scars were virtually invisible. The ducts were rejoined on both sides, and there were no post-operative complications. At a follow-up check the patient mentioned that in the years before and following his divorce his alcohol intake had been very high, and that he could remember little or nothing from that time. When asked about the case the referring gynaecologist said that he had information only from the gp of the present partner. Three months after the restorative operation microscopic examination showed over 20 million spermatozoa per millilitre, and it was soon possible to fulfil the desire for children.
When divorced people enter into a new relationship, there is of course a good chance that they will not have the same gp. If the referral process in relation to an unfulfilled desire for children subsequently begins with the woman, usually only her medical records are forwarded. In this case the urologist had omitted to request possibly relevant information on the man from the gp.