Presented by :--

Nebula Devkota :14031

Shreya Gautam:14039
CONTENTS
 Definitions
 Case of impotency
 Examination
 Preliminary data
 General examination
 Local examination
 Systemic examination
 Laboratory examination
 Report of the case
 Opinion
 DEFINITION

 Impotence is the inability of a person to perform

sexual intercourse.
 Sterility is the inability of male to beget children
and in female to conceive children.
 Frigidity is the inability to initiate or maintain the
sexual arousal pattern in the female.
CASE OF IMPOTENCY

 Geeta kunwar, a 23 year old women filed a case of

divorce for nullity of marriage on 23rd march 2018 for
which her husband Ram kunwar age 28 years, an
inhabitant of Narayangadh who was sent with memo
no. 130 dated 24march,2018 from police of
Narayangadh and accompanied by police constable
Hari Tamang for report as to the result of examination
for impotency.
EXAMINATION FOR CASE OF IMPOTENCY
 Preliminary data :
 Date, time and place of examination should be noted
 Name, age, sex, address, religion, occupation should
be recorded
 Name of the police constable who brought and
identified should be noted
 Consent should be taken from individual for
examinaion
 Two identification marks are noted
 General examination:
 Physical development i.e. average bulit, height, weightis
recorded
 Secodary sexual characteristics is noted
 Mental status is also noted
 Pulse, blood pressure, pallor, cyaosis,
lymphadenopathy, oedema are examined
 Local examination
 Penis:
1) any malformation,length(erected and flaccid), local
disease, sensation of glans is examined
2) bulbocavernous reflex test: in this the glans penis is
squeezed and the contraction of internal and external
anal spinchter is noted if the nerve sensation of penis
is intact.
3)nocturnal penile tumescence test (NPT) : This test is
done to differentiate the organic cause of impotency
from pshycogenic cause. Man have 3 to 5 erection per
8 hours of sleep.
 4) PGE1 OR Papavarine test: In this the intracorporeal
injection of PGE1 causes erection of penis
 Scrotum: any malformations, condition of right and left
testis, local disease is noted
1) cremasteric reflex test: in this test poking on the
middle thigh causes contraction of cremaster muscle
which leads to pulling of the testis ipsilaterally
 Testes: whether it is present in the scrotum or not, size
and volume is noted.
 Systemic examination
 Examination of respiratory, cardiovascular,
gastrointestinal, and central nerous system is done.

 Laboratory examination
 Blood examination
 Urine examination
REPORTING OF THE CASE
 Date: 24th march 2018
 Time and place of examination : at 11:00 am . and at
CMS-TH
 Name: Ram Kunwar
 Age : 28 years
 Sex : male
 Address : Narayangadh
 Religiion : Hindu
 Occupation : buisnessman
o Brought by : P.C. Hari Tamang
o Consent of the individual for exam: signature or
left thumb impression.
o Marks of identification :
(1)pre-auricular tag on left ear
(2) A non elevated, black, non hairy mole
of 2 mm diameter on right cheek 3cm medial to
tragus.
GENERAL EXAMINATION
 Physical development - Average built, normal physical
development with 65 kg wt. & 5 ft 7 inches Ht.
 Secondary Sexual Characters - Present including growth of
moustache, beard, pubic and axillary hair
 Mental Status - Normal, well oriented to person, time and
place
 Pulse – 80 BPM
 B.P - 110/70 mmHg
 Pallor - Absent
 Cyanosis - Absent
 Clubbing - Absent
 oedema- Absent
 Lymphadenopathy - Absent
PENIS :
Malformation/abnormalities - Absent
Length(erected) – 13.0 cm
Length(flaccid) –9.0 cm
Girth(flaccid) – 9.0cm
Girth(erect)-11.0cm
Local diseases - Absent
Sensation of glans – present
Bulbocavernous reflex – present
NPT(nocturnal penile tumescence test) monitoring-
positivesssssssssss
PGE1 or Papavarine Test- normal
CONT……..
SCROTUM :
 Malformations - Absent
 Condition of left and right testis – Normal (left
is lower than that of right testis)
 Local diseases - Absent

 Cremasteric reflex - normal

CONT…..

TESTES
Present in the scortum
size-adult size:3cm*3cm*4cm
Volume:15 cc square
Respiratory system- Resp. rate is 18 breaths/min,
Auscultation – clear vesicular sounds were
heard.
Cardiovascular system-Auscultation-S1,S2,Mo

Gastrointestinal system- No any organomegaly found.

LIVER and SPLEEN- not palpable.
Left and Right KIDNEY- not palpable
 Central nervous system
(1)Mental status: Awake & alert: oriented to person
,place & time.
(2)All the functions of cranial nerves were normal.
(3)Motor system: normal tone of extremities.
(4)Sensory system: light touch - normal
position sense - normal
vibration – normal
(5)Coordination: gait & balance – normal
BLOOD:
Hb, TC, DC, ESR - No abnormalities found, normal
blood count
LFT, RFT - No abnormalities found
VDRL Test – negative
T3 level – 100-200ng/dl
T4 level – 4.5-11.2 microgram/dl

URINE :
Microscopy - No abnormalities found
Any other relevant investigations - No abnormalities
noted
From all of the above examination, it can be
concluded that there is nothing to suggest that
the male examined is not capable of performing
sexual act.

Date:24 march 2018

Name of MO: Dr. Nebula Devkota, Dr. shreya Gautam
NMC. Regd no:31289
Designation:Medical Officer
Signature:
(OFFICE SEAL)