_Impotence of copulation_, except in the anomaly known as vaginism, is very rarely found in women. Conjugation is, of course, impossible in the rare cases of total absence of the vagina. In hypospadia, where the vaginal orifice is situated within the rectum, vaginal conjugation is well-nigh impossible. Adhesions of the labia majora or minora, a rigid imperforated hymen, an extreme vaginal atresia near the orifice and elephantiasis of the vulva will cause impotence of conjugation. All acute inflammations of the vulva, vagina, rectum, uterus tubes, or ovaries may render approach painful and impossible. Urethral caruncles, urethritis, fissures at the neck of the bladder, rectal fissures or hemorrhoids may also render conjugation difficult. The tetanic contraction of the sphincter cunni and the tetanic spasm of the perineal muscles, constrictor cunni, transversus perinei, sphincter and levator ani which close tightly the orifices of the vagina and the entire vaginal canal will also be the cause of impotentia coeundi. The solitary tetanic contraction of the sphincter cunni, known under the name of vaginism, will make conjugation impossible until the hymen is removed. The following case operated by the author illustrates this anomaly: Mrs. X., twenty-two years of age, for three months married to a physician, was unable to be approached by her husband. As soon as the penis touched the labia, the sphincter cunni contracted so tightly that there was an utter impossibility to transverse the virginal portals. During the examination, at the least touch of the nymphae, the sphincter could be observed contracting, just as seen in animals after defecation when the sphincter ani contracts. The ablation of the hymen cured the anomaly. This fact shows that it was only a reflex-irritation, started at the highly sensitive hymen. The sphincter itself was perfectly normal. _Impotence of reproduction._—More frequent than impotence of copulation is female impotence of reproduction. This anomaly is naturally found in all those cases where there is impotence of copulation. It is sometimes met with in excessive acid reaction of the vaginal contents, where the spermatozoa are killed before they reach the uterus. When one lip of the cervix is considerably elongated, covering apron-like the external os, the spermatozoa will not be able to enter the cervix, and sterility will result. Sterility is also found in the obliteration of the cervical canal, produced by caustics or scars after tears during confinements and after curettings. Ectropion, stenosis of the external or internal os of the cervical canal, endocervicitis, causing an increased cervical secretion, and the swelling of the plicae palmatae may prevent the entrance of semen into the uterus and thus cause impotence of propagation.