Manhood: The Rise and Fall of the Penis (45 page)

Canada also has a shortage because it has been made unlawful to pay people for donating it, requiring recipients who wish to purchase it to import it from the United States. The United States, on the other hand, has had an increase in sperm donors during the late 2000s recession, with donors finding the monetary compensation more favorable.

Naturally, waiting times have gone up, and as a result more and more patients look for a donor by themselves: brothers, brothers-in-law, cousins, close friends, etc. In addition donors advertise, though this raises questions about the quality and safety of the sperm. Waiting times of almost two years also drive patients abroad to countries like Belgium, where there is still complete anonymity.

Do parents tell their children that they have been conceived with the help of a donor? With single people and lesbian couples the question doesn’t arise. The greatest dilemma is whether children and sperm donor actually want to get to know each other. Suppose someone in late adolescence is told that his father is not his biological father, what will their reaction be? It’s hard to imagine. Very probably few sixteen-236

vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y year-olds are dying to trace their ‘roots’. It would seem more obvious for them to do that when genealogical factors like birth, death, marriage or divorce come into the picture.

In my hospital donors are recruited through adverts in the regional daily newspaper. Men of 55 and over are excluded, since their generally poor sperm quality entails a higher risk of a child being born with a chromosomal abnormality. More than 80 per cent of volunteers are rejected, usually for the same reason, though occasionally a hereditary problem is grounds for rejection. Traceability and potential pressure have led to the number of families a donor may help to create being limited to five. This means that the number of times he may be approached in future is limited. The recipient of the sperm is promised that she may also have a second or subsequent child from the same donor, so that her children are true brothers and sisters. The restriction on the number of women per donor also has the advantage that the period of donorship need only be short. The men come for a period of between one and two years, every two or three weeks, in order to build up a large quantity of sperm. Of course some basic information is recorded, including height, weight, skin, eye and hair colour and certain personality features.

The sperm is released only after it has been in quarantine for six months. Meanwhile the donor has been screened again for hepatitis b and c, syphilis, chlamydia, cytomegalia and hiv. Experience has shown that the chance of a full-term pregnancy for each artificial donor insemination is approximately one in eight.

Sick sperm and original sin

‘Babies Made with Sperm from Sick Donor’ read the front-page headlines in the Dutch daily
Trouw
at the end of February 2002. The report that followed these striking headlines was shocking enough! Eighteen children were found to have been artificially conceived with sperm from a donor suffering from a congenital muscular disease, which had only manifested itself in the donor later in life. The chance of this being passed on was 50 per cent for each child. A nasty fright, and not just for the (foster-)parents. The report confronted the newspaper reader, just out of bed, with the alienating effects of reproductive medicine.

The headline chosen only reinforced this and at any rate stayed with me, and kept buzzing through my head all that week. And certainly, the headline was ‘provocative, polemical and piquant’, as the editor said in justification, after extensive reader comment. ‘It is a radical shock to be confronted with the downside of the “messing about” with modern reproductive techniques’, wrote the editor.

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‘Yet that wasn’t what concerned me most’, wrote a very interesting magazine with a Christian perspective on faith and culture. The writer expressed his view as follows:

I have long disliked the downside of the ‘messing about’.

There’s no need for the paper to define me with this headline.

It’s a little late, it seems to me. It disturbs me too. There’s something hypocritical about wanting suddenly to focus in the light of this unpleasant incident on the messing-about with nature’s reproductive techniques. As if when they are supposedly successful, they raise no questions. Apart from that, it is all so relative. The messing about and manipulation surrounding conception is only a special variant of the universally accepted messing and manipulation surrounding contraception. It may provoke its own moral questions, questions which are real, but to act as if natural conception in a period when contraceptives are deliberately not used is not messing about, goes too far for me. Children are not only made in laboratories, nowadays.

The headline ‘Babies Made with Sperm from Sick Donor’

approved by a conscientious editor concerned me because I found it an almost poetic line, reflecting as it does both modern life (‘made’) and the classical Calvinist teaching of man’s mortal condition, or original sin (‘sperm from sick donor’).

And a little further:

The article casts an unusual light on something as everyday as the desire for children. It seems as if the scope and depth of the desire for children is realized precisely where this desire is not immediately fulfilled in a natural way. The fact that the desire proves to have undreamed-of highs and lows, becomes clear in the lengths people go to in order to realize their wish after all.

Nether the medical route nor the adoption route are pleasant, but they are demanding, both mentally and physically. The desire is such that some people are prepared to make do with a child that is not fruit of both members of a couple.

This is in no way new. On the eve of writing I read precisely the stories of Sarah and Hannah in Genesis and Samuel.

The story of Sarah in particular displays many parallels with the newspaper article. In the absence of a well-trained gynaecologist Sarah took the route of the surrogate mother. The

‘fuss’ casts an unusual light on such people’s desire for chil-238

vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y dren: honour must be saved. Without wishing to argue that the desire for children is inspired only by the desire for honour –

general values (virtues) like care and love are also at issue – I would not wish to play down its importance for our age. In our children we finally transcend the finiteness and futility of our existence, perpetuate ourselves, retain our grip on the world after our death.

If in the practice of reproductive medicine you listen to what involuntarily childless couples have to say, you realize the extent to which the

‘death is final’ feeling can affect the ability to retain the unfulfilled desire for children. It makes everyone it affects doubly aware of human mortality. The line dies out, the name is lost. Looked at in this light, the often laborious journey through the medical circuit or the adoption mill, sometimes accompanied by moments of loss of decorum, takes on the character of a battle against the finiteness of existence. The childless couple want a share in what others regard as axiomatic.

But where awe at the mystery of procreation and sense of vulnerability are lost, or are even absent, the human soul is damaged. Parents who with the aid of assisted reproduction techniques want to ‘make’ a child as part of their life project, sooner or later run up against the boundaries of narcissism, certainly when a child demands a different kind of care and love than its parents had planned. Instead of blessing their child, they may come to curse it and such curses can extend a long way. If they cling to the ‘project’, sad self-pity is the lot they have chosen for themselves.

Vibro-ejaculation and electro-ejaculation

A spinal cord lesion is a traumatic injury to the spine. The consequences depend on the location and severity of the trauma. Fortunately it is a rare injury. It is estimated that the annual incidence of spinal cord injury (sci), not including those who die at the scene of the accident, is approximately 40 cases per million population in the usa or approximately 11,000 new cases each year. Since there have not been any overall incidence studies of sci in the usa since the 1970s it is not known if incidence has changed in recent years. Before the Second World War the prognosis for such people was poor, but thanks to the advance of medical science life expectancy has risen markedly and at present is only slightly a few years below the norm. The number of people in the United States who were alive in December 2003 who have sci has been estimated to be approximately 243,000 persons, with a range of 219,000 to 279,000 persons.

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Many people with a spinal cord lesion experience problems in their sex lives. Irrespective of the height of the lesion, experiencing a ‘normal’

orgasm is no longer possible. However a portion of spinal cord lesion patients are able to experience a form of orgasm. Often these are pleasant sensations in the transitional area between presence and absence of sensation. Possibly erratic nerve activity in the brain plays a part in this, since such activity bypasses the spinal cord.

The feeling of an orgasm is sometimes actually unpleasant, although patients turn out to experience a certain relaxation afterwards. The nerves that exit on a level with the spinal segments from the eleventh thoracic vertebra to the second lumbar vertebra (t11-l2) deal with the first part of ejaculation in men. If there is trauma above the tenth thoracic vertebra there is no more transportation of sperm, so that ejaculation is no longer possible. If there is a complete spinal lesion between t11 and l2 the results are unpredictable, depending on whether there are still impulses via this level to the epididymides, seminal ducts and seminal glands. In the case of a complete spinal cord lesion between the third lumbar vertebra and the first sacral vertebra (l3 and s1), sperm transportation and ejaculation generally remain intact.

In involuntary childlessness the poor quality of the sperm plays a role in addition to erection and ejaculation problems. The causes of this are ‘accumulation’ due to the lack of spontaneous ejaculation, epididymal inflammations and too high a temperature. In wheelchair patients the testicles hang more or less constantly in a warm environment.

There are various methods of treating fertility problems in cases of spinal cord lesion. If manual stimulation does not produce an ejaculation, an ordinary vibrator can be used, and if that doesn’t help, a more powerful vibrator. In 80 per cent of men with a spinal cord lesion an ejaculation can be produced in this way. In individuals with a spinal cord lesion above the sixth thoracic vertebra, though, it may cause raised blood pressure and even cerebral haemorrhaging. For that reason there must be a doctor on hand, at least the first time. A similar expensive vibrator can also be used in the case of
anejaculation
with different causes, including psychological ones. Both the vibration frequency and the amplitude can be adjusted. The optimum amplitude with spinal cord lesion is 2.8 mm and a frequency of 100 Hertz. If no ejaculation can be produced with this method, the next step is electrostimulation. This involves the giving of electrical impulses via a thick probe in the rectum, causing the release of sperm cells which can subsequently be removed from the bladder. If the quality is good, the sperm cells are frozen and are used at a later date for icsi.

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vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y This equipment was developed by vets involved in breeding programmes in zoos. In the 1970s zoos stopped capturing animals straight from the wild. An out-and-out sex and sperm tourist business developed. The sperm was obtained, with the animals under anaesthetic, by electro-ejaculation. If necessary the males went travelling.

Coordinated breeding programmes monitor the reproduction of several hundred animal species of virtually all the zoos on earth. The experts look at the sex distribution, age structure and the degree of relatedness of all animals of the same type in the various parks and zoos. In this way a breeding plan is drawn up, laying down what animals may have descendants with what others.

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chapter nine

Spilling One’s Seed

Not so long ago, as I was walking round the Hermitage in St Petersburg, I spotted among the many paintings a wonderful etching by Rembrandt van Rijn (1606–1669) depicting a nude male model in front of a curtain. The young man is undoubtedly masturbating. Commentators speak of an ‘academic posture in a classical attitude expressing balance and harmony’. I don’t believe a word of it.

Male self-gratification means that the man does not inject his seed into the appropriate aperture in a female body, but wastes it. At least, for centuries this was the view of many religions. Other terms for self-gratification include masturbation, onanism and solo sex. ‘Masturbation’ derives from the Latin words
mas
, meaning ‘manly/manliness’ and
turbare
, meaning ‘to move (violently)’. In reality it refers to the pheno -

menon that occurs in both sexes of humans and animals, namely bringing oneself through certain actions to a state of sexual arousal, whether or not followed by an orgasm, and in men the ejaculating of sperm. In Thailand they call it ‘flying your kite’.

In many primates both sexes masturbate with some regularity, for example the red-capped mangabey, a soot-coloured West African monkey with a long tail and extravagant hair growth on its cheeks.

And orang-utans stimulate themselves with sex toys that they make from twigs and leaves. Male red deer do it by rubbing the tips of their antlers on the grass. It takes no longer than fifteen seconds from beginning to end. Elephants of course use their trunks in masturbation.

The Romans associated masturbation with the left hand, traditionally seen as the wrong or evil hand. In general the spilling of seed has been regarded as sinful or a necessary evil. The Talmud makes no bones about it: it is forbidden to hold one’s member even while urinat -