The majority of the male reproductive system is lifespan of the male.

external, located in the perineum region between

the upper part of the thighs. Male external genitalia It is approximately 4 to 5 cm in length. During fetal
include the scrotum, its contents and the penis. development, the testes develop as abdominal
th
organs. In the 7 month of the developmental period,
A. Male External Genitalia
each testis moves to descend into the scrotal cavity.
 The male reproductive system consists of a At birth, testes reach their final destination in the
number of sex organs that play a role in the scrotal sacs. This process is called the descent of
process of human reproduction. These the testis.
organs are located on the outside of the body,
and within the pelvis. During their migration to the scrotum, the testes are
enclosed in part by the peritoneum membrane. As
1. Scrotum they descend into the scrotum, the anterior and
lateral surfaces of each testis remain covered by the
 The scrotum is a fibromuscular cutaneous
peritoneal membrane, the tunica vaginalis layer, a
sac, located between the penis and anus. It is
serous membrane that has both a parietal and a thin
dual-chambered, forming an expansion of
visceral layer of the peritoneum.
the perineum.
 Embryologically, the scrotum is derived from
Hormones Made by the Testis:
the paired genital swellings. During
development, the genital swellings fuse in
Testes make hormones like testosterone in the
the midline – in the adult this fusion is
Leydig cells. Testosterone is a hormone thatcauses
marked by the scrotal raphe. The scrotum is
the people to have deeper voices, stronger muscles
biologically homologous to the labia majora.
and body hair. The testes also make these other
 Is a skin-covered, highly- pigmented
hormones.
muscular sac containing the testes.
 Extends from the body behind the penis, a
1. Inhibin B – serum levels of this protein are related
sac of skin that hangs behind the penis. This
to testicular volume and sperm counts in adults.
location is important in sperm production
which occurs within the testes and proceeds
2. Anti-Mullerian hormone – this hormone is
more efficiently when the testes are kept 2 to
O important to the development of internal male
4 C below core body temperature.
reproductive organs.
 The subcutaneous smooth muscle that
makes up the wall of the scrotum is the
3. Insulin-like factor 3 – this hormone helps testicles
dartos muscle. It continues internally to make
descend into the scrotum from the abdomen and to
up the scrotal septum that divides the
continue to develop in the scrotum.
scrotum into compartments, each housing
one testis.
4. Estradiol – this hormone is important in making
 The scrotum is divided into two parts by a
sperm.
crease called perineal raphe. This crease
looks like a line down the center of the
ii. Epididymis – are located at the top of each testicle.
scrotum. The perineal raphe joins the internal
Each is a large tightly coiled tube that stores the
septum with scrotum. The scrotum septum
sperm until they’re mature. It also absorbs excess
divides the scrotal sac into parts. Each side
fluid released by the testicles to help move the
of the scrotum contains the following:
sperm through the reproductive duct.

i. Testicles or testis – are two egg-shaped or oval Each epididymis is divided into the head, body and
shaped structures in the scrotum that produce tail.
sperm and the male sex hormone testosterone. The
spermatic cord holds it in place and supplies them in  Head or caput epididymis – It is the broad
blood. Structures in testicles called seminiferous portion of the epididymis present above the
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tubules a coiled masses of tubes that produce sperm testes posteriorly. It stores the sperms until
cells. Testes are active throughout the reproductive they are ready for maturation. It is connected

1
 to testes by efferent ductules. testes at cooler environment.

4. The Automatic nerves: fibers that supply the

 Body or corpus epididymis – It is the long-
genitalia,
coiled tube, where sperms mature.
5. Vas deference (Ductus deference): a duct that
 Tail or cauda epididymis – It stores the connects to the testis and carries sperm up to the
mature sperm and is connected to the vas ejaculatory duct in the pelvis.
deferens.
The contents of the spermatic cord are mainly
The wall of the epididymis is lined by thick
bound together by three fascial layers. They are all
pseudostratified columnar epithelium. The
derived from anterior abdominal wall:
stereocilia reabsorb the fluid and make the sperms
more concentrated. The principal cells secrete
 External spermatic fascia – derived from the
glycoproteins, which help in the maturation of
aponeurosis of the external oblique muscle.
spermatozoa. The epithelium is thinnest in the tail
region. The tail region is rich in smooth muscles and
 Cremaster muscle and fascia – derived from
has shorter stereocilia. The head region is rich in
the internal oblique muscle.
apical cells, which are rich in mitochondria.

 Internal spermatic fascia – derived from the

When sperms reach the head of the epididymis, they
transversalis fascia.
are not mature and are not motile. Sperms take 2-6
days to mature in humans during their transit in the
The three fascial layers themselves are covered by a
epididymis and become motile. Their motility is
layer of superficial fascia, which lies directly below
reduced in the epididymis until ejaculation. They are
the scrotal skin.
stored in the tail region and at the time of
ejaculation, they are transported to the ejaculatory
iiii. Cremaster muscle – the muscles that surround
duct via vas deferens and finally come out of the
the testicles and spermatic cords. This muscle helps
urethra. The final maturation or capacitation of
move the testicles away from and toward the body to
sperms only takes place in the female reproductive
maintain the ideal temperature for producing sperm.
tract.
The cremaster muscle forms the middle layer of the
iii. Spermatic cords - contain lymph vessels, nerves
spermatic cord fascia. It is a discontinuous layer of
and blood vessels. They also contain a tube called
striated muscle that is orientated longitudinally.
the vas deferens that moves sperm out of the
epididymis into ejaculator ducts. The vas deferens is
surrounded by spermatic cord and transports mature
Cremasteric Reflex
sperm to the urethra before ejaculation. The
spermatic cord is the structure that allows the testes The cremasteric reflex can be stimulated by stroking
to hang within the scrotum. the superior and medial part of the thigh. This
produces an immediate contraction of the cremaster
It is a cordlike structure in the male reproductive
muscle, elevating the testis on the side that has been
system that communicates between the abdominal
stimulated.
cavity and scrotum and transmits to the testes and
genital ducts. It contains of several parts:
This spinal reflex consists of two parts:
1. The extension of abdominal muscles forms the
cremaster muscle and fascia that covers the  Afferent (sensory) limb – ilioinguinal nerve
spermatic cord. (innervates the skin of the superomedial
thigh). Fibers from this nerve enter the spinal
2, The testicular artery: a branch of the abdominal
cord at L1.
aorta to supply the testes.
 Efferent (motor) limb – genital branch of the
3. Pampiniform plexus: a network of veins genitofemoral nerve (innervates the
cremaster muscle).
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surrounding the testicular artery and helps to

counter current arterial heat and make sure the  The scrotal wall surrounds all these

2
 structures. generating cells during spermatogenesis (the
production of sperm).
 A smooth muscle called dartos fascia lines
 They are connected by tight, form occluding
the scrotal wall. This muscle helps tighten
junctions, creating a diffusion barrier called
and expand the skin of the scrotum as it
the blood-testis barrier. The barrier
moves up and down.
maintains a luminal environment favorable
 During times of lower temperatures, for sperm maturation. It keeps blood borne
the cremaster muscle contracts and pulls the substances from reaching the germ cells and
scrotum closer to the body, while the dartos at the same time keeps surface antigens on
fascia gives it a wrinkled appearance; when developing germ cells from escaping into the
the temperature increases, the cremaster bloodstream and prompting an autoimmune
and dartos fascia relax to bring down the response.
scrotum away from the body and remove the  Under the influence of FSH, Sertoli cells also
wrinkles respectively. functions to secrete androgen-binding
protein (ABP) that increases the
 The scrotum remains connected with the concentration of testosterone within the
abdomen or pelvic cavity through seminiferous tubules and facilitates the
the inguinal canal. (The spermatic cord, process of spermatogenesis. They also
formed from spermatic artery, vein and nerve secrete inhibin, a hormone that controls
bound together with connective tissue testosterone and sperm production at the
passes into the testis through inguinal canal. higher brain centers.

 The average thickness of the scrotum is

Cells of Leydig
about 8 mm (millimeters).
 Also known as interstitial cells of the testes
or interstitial cells of Leydig.
Seminiferous Tubules  Are found adjacent to the seminiferous
 Are tightly coiled tubules that form the bulk tubules in the testicle and produce
of each testis. testosterone in the presence of luteinizing
 Composed of two types of cells: hormone.
o 1. the sperm developing  They are polyhedral in shape and have a
spermatogenic cells large prominent nucleus, an eosinophilic
o 2. supporting cells known as cytoplasm and numerous lipid-filled
sustentacular cells vesicles.
 Adult-type Leydig cells differentiate in the
Spermatogenic Cells post-natal testis and are dormant
1.The spermatogenic cells are the cells that form until puberty. They are preceded in the testis
mature sperms by the process of spermiogenesis. by a population of fetal-type Leydig cells
2. Spermatogenic cells are present inside the from the 8th to the 20th week of gestation,
seminiferous tubules of the testis. which produce enough testosterone for
3. The spermatogenic cells divide by mitosis, masculinization of a male fetus.
then meiosis to form gametes, which mature into
sperm by the process of spermiogenesis. Neurovascular Supply
4. The developing spermatogenic cells remain The scrotum receives neurovascular supply from the
connected by cytoplasmic bridges until they have nearby vessels and nerves.
formed a mature spermatozoan.
A. Vessels
Sustentacular (Sertoli cells)
 Elongated, pyramid-shaped, non-dividing The scrotum receives arterial supply from
supportive cells that surround all stages of the anterior and posterior scrotal arteries. The
the developing sperm cell. anterior scrotal artery arises from the external
 They provide support and nourishment to pudendal artery, while the posterior is derived from
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spermatogenic cells and phagocytose the the internal pudendal artery.

3
The scrotal veins follow the major arteries, draining collection of veins in the scrotum.
into the external pudendal veins.
c. Varicocele – is an enlarged vein or a swollen
collection of veins in the scrotum.
B. Nerves
d. Spermatocele – occurs when a fluid-filled sac or
Cutaneous innervation to the scrotum is supplied via growth forms on the epididymis.
several nerves, according to the topography:
e. Testicular torsion – happens when the testicle
rotates in the scrotum. This cuts off the blood supply,
 Anterior and anterolateral aspect – Anterior
nerve function and sperm transport to testicle.
scrotal nerves derived from the genital
branch of genitofemoral nerve and f. Epididymitis – is an inflammation of the epididymis,
ilioinguinal nerve the tube at the back of the testicle that carries sperm.
 Posterior aspect – Posterior scrotal nerves
derived from the perineal branches of the g. Orchitis – is the swelling or inflammation of the
pudendal nerve and posterior femoral testicles. It’s typically related to a mumps infection.
cutaneous nerve.
h. Testicular cancer – forms when cancerous cells
develop in the tissues of one or both testicles.
C. Lymphatics
i. Cellulitis – a type of bacterial skin infection that can
The lymphatic fluid from the scrotum drains to the occur in the skin of the scrotum, causing pain and
nearby superficial inguinal nodes. swelling.

j. Cryptorchidism – occur when one or both testicles

don’t descend into the scrotum. It can repair on its
Asymmetry of the Scrotum: own in some cases however if it doesn’t orchiopexy
One testis is typically lower than the other, which is surgery may be needed to allow the testicle to
believed to function to avoid compression in the descend. An undescended testicle can lead male
event of impact; in humans, the left testis is typically infertility and inability to produce sperms.
lower than the right. An alternative view is that testis
k. Hematoma of the Scrotum - A hematoma may
descent asymmetry evolved to enable more effective
develop in the scrotum as a result of scrotal surgery
cooling of the testicles.
or trauma in the genital region. This results in
swelling (edema) and discoloration of the scrotal skin.
Function of the Scrotum:
Occasionally the origin of bleeding may not arise

The scrotum regulates the temperature of the from the scrotal contents (i.e. spermatic cord and

testicles and maintains it at 35 degrees Celsius (95 testis) but from the basal part of the penile urethra

degrees Fahrenheit), i.e. two or three degrees below (the bulbar urethra) as in “straddle injuries” –

the body temperature of 37 degrees Celsius (99 direct perineal trauma like when falling onto a

degrees Fahrenheit). Higher temperatures bicycle crossbar.

[12]
affect spermatogenesis. Temperature control is
accomplished by the smooth muscles of the scrotum Anatomical Variations

moving the testicles either closer to or further away

from the abdomen dependent upon the ambient There are several possible anatomic variations of the

temperature. This is accomplished by the cremaster scrotum. In general, these variations are quite rare.

muscle in the abdomen and the dartos However, they include:

fascia (muscular tissue under the skin that makes the

scrotum appear wrinkly).  Accessory scrotum: An extra scrotum that
develops, usually further down the perineum,

Conditions and Disorders that can affect scrotum. towards the anus. The accessory scrotum

a. Inguinal hernia – can happen when abdominal does not contain testes. It does not generally

tissues push through an opening in the abdominal cause problems with the primary scrotum.
 Bifid scrotum: This is when there is a cleft in
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wall in the scrotum.

the middle of the scrotum. It occurs when
b. Hydrocele – is an enlarged vein or a swollen
4
 there is not enough testosterone early in a. Root or radix of the penis
development for the scrotum to fuse. Bifid
scrotum often occurs alongside hypospadias.  Is the internal and the most proximal portion
 Ectopic scrotum: Where the normal scrotum of the human penis that lies in the perineum.
is located in a different location.
 Penoscrotal transposition: Where the penis  Attached to the pubic arch of the pelvis and
and the scrotum are located incorrectly with is not externally visible.
respect to each other. The penis can be
below the scrotum (complete transposition)  The root of the penis begins directly below
or in the middle of the scrotum (partial the bulbourethral glands, or Cowper glands,
transposition). and consists of three long masses of erectile
tissue; the bulb and the two crura.
Function of Scrotum:
 This is the part of the penis attached to the
To protect the testes and maintain them at an body and is not visible externally. It contains
appropriate temperature. The scrotum performs this three erectile tissues, which include two
function by holding the testes outside the body and crura and the bulb of the penis, and two
regulating how close they are to the body. A muscles called the ischiocavernosus and
temperature cooler than the core body temperature bulbospongiosus. The urethra connects to
is needed for the testicles to produce sperm the bladder and passes through all parts of
effectively. The cremaster muscles can pull the the penis.
testicles into the pelvis as needed.
 The penis is rich in sensory nerves that aid
with sexual stimulation, arousal,
During sexual arousal, the scrotum will also tighten
and erections.
and thicken in the course of penile erection.
 Penises come in different shapes and sizes,
Having the scrotum and testicles situated outside with an average length of just over 5 inches.
the abdominal cavity may provide additional Some penises are circumcised, while others
advantages. The external scrotum is not affected by are uncircumcised.
abdominal pressure. This may prevent the emptying  The penis is vulnerable to injury as well as
of the testes before the sperm were matured infections and diseases. With age, the nerves
sufficiently for fertilization. Another advantage is it and tissues servicing the penis can start to
protects the testes from jolts and compressions change.
associated with an active lifestyle. The scrotum may
provide some friction during intercourse, helping to b. Shaft of the penis or corpus
enhance the activity. The scrotum is also considered
to be an erogenous zone.  The body or shaft of the penis is the free
portion of the human penis that is located
2. Penis outside of the pelvic cavity.

 It is the primary organ used for copulation

 It is the continuation of the internal root,
(sexual intercourse) and urination in male.
which is embedded in the pelvis and extends
to the glans.
 It is flaccid for non-sexual actions such as
urination and turgid and rod-like with sexual
 Surrounds the urethra and comprises three
arousal.
column-like chambers of erectile tissue that
span the length of the shaft. The two larger
 When erect, the stiffness of the organ allows
chambers, each called a corpus carvernosum,
to penetrate the vagina and deposit semen
located at the dorsolateral surface of the
into the female reproductive tract.
shaft and terminate at the distal shaft of the

 Anatomy of Penis: penis. Together, these make the bulk of the

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penis.

5
  The corpus spongiosum, which can be felt as Circumcision is a religious or cultural tradition for
a raised ridge on the erect penis, is a smaller many Jewish and Islamic families, as well as certain
chamber located at the inferior and middle of Indigenous peoples. Circumcision also can be a part
the penis. This surrounds the spongy urethra of family tradition, personal cleanliness or preventive
and continues till the end of the penis within healthcare.
the glans.
Sometimes there's a medical need for circumcision.
For example, the foreskin might be too tight to be
c. Glans penis
pulled back over the tip of the penis. Circumcision
also is recommended as a way to lower the risk of
 Found at the end of the penis shaft.
HIV in countries where the virus is prevalent. This
includes parts of Africa.
 Typically cone- shaped or mushroom
shaped. Circumcision might have various health benefits,
including:
 Has a high concentration of nerve
endings, resulting in very sensitive skin  Easier hygiene. Circumcision makes it
that influences that like hood of simpler to wash the penis. Still, boys
ejaculation. The skin from the shaft who haven't been circumcised can be
extends down over the glans and form a taught to wash regularly beneath the
collar the prepuce or foreskin. foreskin.

 Parts:  Lower risk of urinary tract infections

(UTIs). The risk of UTIs in males is low.
a. Neck: The neck of the glans penis But these infections are more common
separates it from the shaft of the penis. in males who haven't been circumcised.
Serious infections early in life can lead
b. Corona: This is the rounded border that to kidney problems later.
projects from the base of the glans penis.
 Lower risk of sexually transmitted
c. Meatus: The meatus is the opening of infections. Men who have been
the male urethra that’s located at the very tip circumcised might have a lower risk of
of the glans penis. certain sexually transmitted infections,
including HIV. But it's still key to have
d. Prepuce (foreskin): The foreskin is a loose safe sex, which includes use of
layer of skin that covers the glans penis. In condoms.
some men, this is removed by a procedure
called circumcision.  Prevention of penile
problems. Sometimes, the foreskin on a
penis that hasn't been circumcised can
Circumcision be hard or impossible to pull back. This
is called phimosis. It can lead to
Circumcision is a surgery to remove the skin that swelling, called inflammation, of the
covers the tip of the penis, also called the foreskin. foreskin or head of the penis.
The procedure is fairly common for newborn boys in
parts of the world, including the United States.  Lower risk of penile cancer. Although
Circumcision later in life can be done, but it has more cancer of the penis is rare, it's less
risks and recovery may take longer. common in men who have been
circumcised. What's more, cervical
For some families, circumcision is a religious ritual.
cancer is less common in the female
The procedure also can be a matter of cultural or
sexual partners of men who have been
ethnic traditions, personal hygiene, or preventive
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circumcised.
healthcare. But for others, circumcision doesn't seem
to be needed, or it seems risky.
6
Still, the risks of not being circumcised are rare. The than 7.9 inches) is referred to as a "long
risks also can be lowered with proper care of the penis."
penis.

Your healthcare professional may recommend that

you delay circumcision for your baby or not have it
Penis Color
done if your baby:

As with the skin on any part of your body, the color of

 Has a condition that affects how blood
the penis can vary with race or ethnicity. Based on
clots. genetics, skin cells called melanocytes will produce
or less of skin a pigment called melanin that
 Was born early and still needs medical determines whether the penis) are light-skinned,
care in the hospital nursery. dark-skinned, or in between.

 Was born with conditions that affect At the same time, the rush of blood into a penis
the penis. during an erection can change its color, making it
look darker, bluish, reddish, or purplish. This is due to
Circumcision doesn't affect a child's ability to have a
a higher concentration of capillaries near the surface
baby in the future. And in general, it's not thought to
of the skin.
lessen or improve sexual pleasure for men or their
partners.
Some people simply have more capillaries than
Functions of the Penis: others, accounting for why some people experience
this and others don't.
1. The glans penis is important for both urination and
reproduction. When the penis is flaccid, urine may be Penis Curvature
expelled from the body via the urethra.
Penile curvature typically ranges from 5 to 30
2. During sex, semen exits the urethra when a degrees. A 5-degree curve in the penis looks like
man orgasms. Additionally, while the penis is rigid when the hands of an analog clock read 9:13. A30 30
when erect, the glans penis itself is softer. This helps -degree curve looks like when the hands of read 9:30.
to act as a shock absorber during sex.
Congenital Conditions Affecting the Penis
3. The glans penis also contains a high concentration
of nerve endings. This makes it the most sensitive There are several congenital conditions that can
part of the penis. This sensitivity is important for cause a penis to be abnormally formed. Congenital
sexual stimulation and ejaculation. In fact, some disorders are those that are present at birth and
studies indicate that increased sensitivity of the caused by something that interferes with the normal
glans penis, along with the penis shaft, could development of the fetus.
contribute to premature ejaculation in some men.
Congenital penis abnormalities are usually caused by
Average Size of Penis : an imbalance of male or female sex hormones that
influence penis development.
 The average flaccid penis length is 3.4 inches.
 The average erect penis length is 5.5 inches. 1. Hypospadias and Epispadias
 The average erect penis girth (circumference)  Hypospadias is a condition in which the
is 4.6 inches. opening of the urethra is on the underside of
 When an erect penis is two standard the penis rather than at the tip. It is one of
deviations below the average for a male's age the most common congenital abnormalities
(less than 3.7 inches for an adult), it is in males. Epispadias is a similar condition in
referred to as a "micropenis." which the urethra opens on the top side of
 A penis that is two standard deviations the penis.
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above the average for a male's age (larger  Surgery is generally recommended to
correct hypospadias either during infancy or
7
 early childhood. However, there are risks of stretched penis of less than 2.75 inches.
long-term complications, including difficulty
urinating and an increased risk of urinary  It is thought to be caused by abnormally low
tract infections. production of male hormones, called
androgens, during pregnancy.
2. Chordee
5. Aphalia
 Chordee is an abnormal curve of the penis at
the time of birth. It is more common in males  The congenital absence of a penis, called
with hypospadias but can also occur on its aphalia, is an extremely rare condition,
own. In adolescent and adult males, chordee affecting one of every 30 million births. It
is most noticeable during an erection. usually occurs with other congenital
abnormalities affecting the heart or digestive
3. Peyronie's Disease tract. The cause of aphalia is unknown. So far,
fewer than 100 cases have been reported.
 Peyronie's is a condition that develops in
adult males that causes an abnormal curve of Medical Conditions Affecting the Penis
the penis. Peyronie’s disease is a condition
in which scar tissue (plaque) in the penis  There are a number of medical conditions
causes it to bend, curve or lose length or that can affect the function or appearance of
girth (circumference). You may be able to feel the penis in later life. These may affect the
the scar tissue through your skin, or you may glans, foreskin, urethra, or erectile tissues.
have pain in a specific part of your penis as
the scar tissue forms. When have an erection, 1. Erectile Dysfunction
the penis may bend up, down or to the side,  Erectile dysfunction occurs when a person
depending on the location of your scar. Some with a penis cannot get or maintain an
people who have Peyronie’s disease don’t erection sufficient for sexual intercourse.
have a curve, but might have an indentation Erectile dysfunction may be caused by
that gives their penis an “hourglass” medical reasons, including medications or
appearance. heart disease. It may also be the result of
stress, anxiety, or relationship problems.
 Peyronie's disease (PD) is an abnormal curve
of the penis that occurs in later life. Studies 2. Penile Fracture
suggest that around 0.5% to 13% of adult  A penile fracture occurs when the thick
males will experience PD at some time in membrane surrounding the corpora
their lives. The risk increases as a person gets cavernosa, known as the tunica albugenia,
older. ruptures during vigorous sex.

 Peyronie's disease is mainly the result of a  The tunica albuginea is supplied with a rich
prior injury to the penis during sex. With that network of blood vessels that can cause
said, PD is poorly understood and may occur bleeding and severe pain when ruptured. The
for no known reason. If the symptoms of PD scar tissue that results from a penile fracture
are severe, they can cause erectile may lead to Peyronie's disease.
dysfunction.
3. Phimosis and Paraphimosis
4. Micropenis  Phimosis is a condition in which the foreskin
is too tight to be pulled back over the head of
 Micropenis is an abnormally small penis. It is the penis. Phimosis is normal in male babies
defined as a stretched penis that is at least and toddlers, but, in older children, it may be
2.5 times smaller than what would be the result of a skin condition that causes
expected at that stage of a male's scarring. It is not usually a problem unless it
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development. In adults, this would be causes symptoms.

8
  Paraphimosis occurs in an uncircumcised Penile Erection
penis when the foreskin gets stuck in the
retracted position. It is a medical emergency  Penile erection or tumescence refers to the
that can lead to tissue death if not treated physiologic process during which the penis
immediately. becomes engorged with blood, causing it to
expand and become firm usually in response
4. Priapism to sexual arousal but sometimes
spontaneously.
 Priapism is an erection that lasts more than
 An erection starts in the brain. Sexual
four hours. It is not always the result of sexual
excitement causes parasympathetic division
arousal and can be quite painful.
activation causing erection.

 Priapism occurs when blood becomes  Penile erections are the result of congestion
trapped in the penis and is unable to drain. If or engorgement of the tissues because of
the condition is not treated immediately, it more arterial blood flowing into the penis
can lead to scarring and permanent erectile than is leaving in the veins.
dysfunction.
 During sexual arousal, nitric oxide (NO) is
released from the nerve endings near the
 Priapism can occur at any age and is more
blood vessels within the corpora cavernosa
common in males with certain blood diseases
and spongiosum.
like sickle cell disease and leukemia. Certain
medications can also increase the risk of  An erection occurs when blood engorges
priapism. tissues in the penis, causing it to become
swollen, enlarged, and rigid.
5. Infection and Inflammation
 The penis is vulnerable to infection. This  Erections involve several key structures in the
includes sexually transmitted infections penis:
like genital herpes or human papillomavirus
(HPV), which affect the skin, o Corpus cavernosa: These are two
and gonorrhea or chlamydia, which can affect spongy columns that run through the
the urethra. These and other infections can shaft of the penis from the base to
lead to penis inflammation. the tip. During sexual arousal or
manual stimulation of the penis,
Inflammatory conditions affecting the penis include: blood vessels inside the corpus
cavernosa will dilate (widen), flooding
 Balanitis: Inflammation of the head of the the tissues with blood.
penis o Corpus spongiosum: This is a third
 Posthitis: Inflammation of the foreskin spongy column that runs alongside
 Balanoposthitis: Inflammation of the head the corpus cavernosa on the
and foreskin underside of the penis. The
 Urethritis: Inflammation or infection of the engorgement of the corpus
urethra spongiosum keeps the urethra open.

 Urethral stricture: The abnormal narrowing The urethra is the tube-like structure

of the urethra through which urine and semen exit

the penis.

6. Penile Cancer o Ischiocavernosus and bulbospongiosu

s muscles: As the penis engorges
 Penile cancer (cancer of the penis) is very
with blood, these ring-like muscles at
rare. However, it can be one of the more
the base of the penis constrict
aggressive forms of cancer. Around 95% of
(narrow), trapping blood inside the
cases are caused by a type of skin cancer
penis.
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called squamous cell carcinoma.

o Tunica albuginea: This is a sheath of

9
 fibrous tissues that surround  Intercourse and repetitive penile stimulation
the corpora cavernosa and corpus force additional blood into the corpus
spongiosum. The tunica cavernosa and corpus spongiosum,
albuginea works with the increasing tumescence.
ischiocavernosus and
bulbospongiosus muscles to constrict Rigid Erection
blood vessels and maintain the
erection.  As the corpus cavernosa and corpus
spongiosum become engorged, the
Stages of an Erection ischiocavernosus and bulbospongiosum
muscles will contract to prevent the flow of
 An erection involves a complex interplay of blood out of penile veins.
physiological and psychological mechanisms

that work in tandem to engorge the penis The engorgement, in turn, causes the corpus
with blood. Hormones, blood vessels, nerves, cavernosa and corpus spongiosum to
and muscles all play a part. become compressed against the walls of the
tunica albuginea. This not only further
An erection ultimately involves two processes: restricts blood flow but also makes the penis
harder as the swollen interior tissues press
 Arterial dilation: Penile arteries are those against the walls of the fibrous outer sheath.
that deliver blood to the penis. Dilation refers
to the widening of the arteries as smooth  This is the stage when the penis is at its
muscles inside the arterial walls start to relax. maximum rigidity and sensitivity.
 Venous occlusion: Penile veins are those that
take blood away from the penis. Occlusion Return to Softness (Detumescence)
refers to the entrapment of blood as the
veins are either compressed or constricted  After ejaculation or the cessation of manual
(narrowed). stimulation, the tunica albuginea will relax
along with the ischiocavernosus and
The stages of an erection can be described as follows: bulbospongiosus muscles. This allows blood
to flow out of the penis, returning it to its
Softness (Flaccidity) normal, flaccid state.

 This is the natural state of the penis when it  After ejaculation, there will be a refractory
is limp and soft (flaccid). period during which you can’t get another
erection even with stimulation. This can be as
 During sexual arousal or the manual short as 15 minutes, or as long as a day or
stimulation of the penis, the brain will more.
activate nerves that cause the corpus
cavernosa and corpus spongiosum to relax. How Hard Is a Normal Erection?
It will also trigger the release of a chemical
called nitric oxide that causes penile arteries  An erection that is hard enough to allow for
to dilate. penetrative sex is considered a normal,
healthy erection. This typically occurs during
Swelling (Tumescence) the rigid erection stage.

 The relaxation of penile tissues and the  For most people with penises, the stage
dilation of penile arteries increase blood flow where the penis is hardest is at the rigid
into the penis by 20- to 40-fold. Penile erection stage. At this stage, the pressure
tumescence describes the swelling and within the corpus cavernosa—as measured in
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hardening of the penis. millimeters of mercury (mmHg)—will be

around 100 mmHg.

10
How Long Does an Erection Usually Last? How to Have a Better Erection

 The duration of an erection can lasts  If you are dissatisfied with your erections,
anywhere from a few minutes to a few hours, speak with your healthcare provider or a
depending on the individual. Age can specialist in the male reproductive tract
influence how long you are able to maintain called a urologist. Although erectile
an erection (due to aging-related changes in dysfunction is very common, only around
blood vessels, nerves, or muscles). 10% of those who experience it seek medical
treatment.
 Erections in a normally functioning penis
generally last until ejaculation occurs. On  Practicing good health is the first step to
average, the time from erection to ensuring and maintaining strong erections.
ejaculation is between five and seven This may involve:
minutes.
o Exercising regularly and eating a
Erectile Problems heart-healthy diet to improve
cardiovascular fitness
 The more common problem related to o Quitting cigarettes which cause the
erections is erectile dysfunction (ED). This is narrowing of blood vessels
broadly described as the inability to achieve o Avoiding drugs and alcohol which can
or sustain an erection suitable for penetrative independently cause ED
3
sex. o Maintaining a healthy relationship
with your sexual partner
 There are different types of ED caused by o Talking openly about any sexual
different physiological and psychological anxieties you may have.
factors, many of which co-exist. These are

referred to as: If needed, your healthcare provider can
prescribe oral ED medications like Viagra
o Organic ED: This involves problems (sildenafil) or Cialis (tadalafil) to improve
with the arteries, veins, muscles, erections. These pills work by augmenting
nerves, or hormones that regulate the work of nitric oxide in the body including
erections. It is especially common as the penis and it’s important to note that
you get older due to aging- these medications does not boost sexual
associated conditions desire instead it assists in the natural
like atherosclerosis (hardening of the physiological process of attaining and
arteries), diabetes (which affects sustaining an erection when stimulated
nerves), hypogonadism (low sexually. Severe cases may benefit
testosterone), and Peyronie's from alprostadil, a type of ED drug injected
disease (the spontaneous, abnormal into the shaft of the penis.
curve of the penis).
o Psychogenic ED: This type of ED is  Non-pharmaceutical options include penile
more common when you are younger vacuum pumps with constriction rings ("cock
but can affect people of any age. It is rings"). A less common but potentially
caused by psychological factors like beneficial option is penile implant surgery.
stress, anxiety, depression, guilt, low
self-esteem, or relationship problems. EJACULATION
About 40% of ED cases are
considered psychogenic, either in  The release of sperm cells
part or in full. and seminal plasma from the
male reproductive system.
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 Ejaculation takes place in two phases: in the

first, or emission stage, sperm are moved

11
 from the testes and the epididymis (where products of metabolism, and cellular debris.
the sperm are stored) to the beginning of The secretions of the testes and accessory
the urethra, a hollow tube running through glands are produced under the influence of
the penis that transports either sperm or the male hormone testosterone; without
urine; in the second stage, ejaculation proper, sufficient testosterone the glands degenerate
the semen is moved through the urethra and and cannot secrete fluids.
expelled from the body.  After ejaculation (the expulsion of semen
 Sperm cells that are stored in the male body from the penis) or the cessation of
are not capable of self-movement because of stimulation, an erection will subside. The
the acidity of the accompanying fluids. When time this takes depends on the length and
the sperm receive fluids, called seminal thickness of the penis.
plasma, from the various internal accessory
organs (prostate gland, ejaculatory Refractory Period
ducts, seminal vesicles, and bulbourethral
glands), the acidity decreases.  Experienced by most men immediately
 As they leave the body, the sperm following orgasm and ejaculation.
receive oxygen, which is vital to motility.  During this time, they are unable to achieve
Unable to leave the male body by their own another erection with a longer period before
motivation, the sperm cells are transported they are capable of ejaculating again.
by muscular contractions.  It is common for a male to feel a deep sense
 During the emission phase, the muscles of relaxation particularly in the groin and
around the epididymis and ductus thighs and its duration varies considerably
deferens (the tube extending from the among individuals. Typically, younger males
epididymis) contract to push the sperm into recover faster than older men.
the prostate and urethra.
 During ejaculation, the semen is expelled by Types of Ejaculation
strong spasmodic contractions of
the bulbocavernosus muscle, which encircles 1. Nocturnal Emission or Wet Emission or Wet Dream
the corpus spongiosum (the structure in the or Sex Dream or Sleep Orgasm
penis that encloses the urethra). The whole
process of ejaculation is accomplished by  Is a spontaneous occurrence of sexual
nerve impulses received from the penis; once arousal during sleep that
ejaculation is started it becomes includes ejaculation (nocturnal emission)
a reflex reaction that cannot be voluntarily and orgasm for a male, and vaginal
interrupted. lubrication .
 The seminal fluid is not passed from the
various accessory glands simultaneously. A 2. Anejaculation
small amount of mucus like secretion is first
passed from the bulbourethral and urethral  is the term for the condition of being unable
glands to flush out the urethra and prepare it to ejaculate.
for the sperm. Next follows the fluid from
the prostate gland, and then that from 3. Dysejaculation
the seminal vesicles. Finally, the fluid actually
containing the sperm is ejaculated.  painful or dis- pleasurable ejaculation
 After the bulk of the sperm cells have passed,
more fluids follow and again flush out the 4. Retrograde ejaculation
urethra. The total volume of the ejaculate
averages between 2 and 5 millilitres (0.12 to  is the condition where semen travels
0.31 cubic inch) in the human; of this, only backwards into the bladder rather that out
about 1 to 5 percent are actually sperm cells. the urethra. This is sometimes referred to as
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The other constituents of semen a “dry orgasm” as little or no semen is

include nutrients, water, salts, waste ejaculated when this occurs. Though sexual

12
 climax still happens this type of ejaculation carries pee or sperm to outside of the body,
and the act is not harmful when it occurs, it in preparation for ejaculation. It is also called
can lead to infertility in men. ductus deferens or sperm duct.

5. Premature ejaculation o The vas deferens, or ductus deferens,

can be 30 centimeters (almost 12
 is when ejaculation occurs before it is inches) to 45 centimeters (almost 18
intended. inches) long. Some parts of it are
coiled, but other parts are straight.
6. Anorgasmia The tube is described as being
fibromuscular, meaning that it’s made
 delayed ejaculation. Anorgasmia is when an of fibrous tissue and muscle tissue.
orgasm is absent, delayed, infrequent or
lacks intensity despite being aroused. This  Ejaculatory ducts. The ejaculatory
disorder causes distress and affects your ducts (ductus ejaculatorii) are paired
sexual relationships. structures in the male reproductive
system.[1] Each ejaculatory duct is
Internal male reproductive organs formed by the union of the vas
deferens with the duct of the seminal
The internal organs of the male reproductive system, vesicle.[2] They pass through the prostate,
also called accessory organs, include the following: and open into the urethra above
the seminal colliculus.
 Rete testis. It is the first duct to receive During ejaculation, semen passes
sperm from the seminiferous tubules within through the prostate gland, enters the
the testis. They are small ducts located in the urethra and exits the body via the urinary
posterior of the testis. The rete testis is an meatus.
interconnected network of small tubes
located in the mediastinum of the testis. It  Urethra. The urethra is the tube that
contains sperm cells that travel from the carries pee from the bladder to outside of
testicle to the epididymis. the body. It has the additional function of
 The testes are the place where sperm cells ejaculating semen at orgasm. When your
are created. From there, the sperm moves penis is erect during sex, the flow of pee
into the epididymis, which is a structure is blocked from the urethra, allowing only
located on top of the testicle. The epididymis semen to be ejaculated at orgasm.
stores sperm cells and has a job of bringing
them to maturity so they’re able to fertilize  Seminal vesicles. The seminal vesicles are
eggs. When sexually aroused, muscle sac-like pouches that attach to the vas
contractions move the sperm from the deferens near the base of the bladder.
epididymis to the vas deferens from there The seminal vesicles produce a sugar-
into the urethra so that able to ejaculate rich fluid (fructose) that provides sperm
semen outside the body. During the process, with a source of energy to help them
the body adds secretions to the sperm cells move. The fluid of the seminal vesicles
to make semen. makes up most of the volume of a man's
ejaculatory fluid, or ejaculate.
 Vas deferens (vasa differentia – plural). The
vas deferens is a long, muscular tube that o They are the glans that contribute
travels from the epididymis into the pelvic approximately 75% of semen by
cavity, to just behind bladder and connects volume. It secretes whitish yellow,
the urethra through a structure called thick and viscous fluid. The fluid
ejaculatory duct. The vas deferens is contains large amount of fructose
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surrounded by spermatic cord and transports for the sperm’s nourishment and
mature sperm to the urethra, the tube that prostaglandins which are used by

13
 the sperm’s mitochondria to are those that typically undergo
generate ATP to allow movement benign hyperplasia (BPH)
through the female reproductive
tract. The secretion of seminal  Peripheral zone – makes up the main body of
vesicles is under the influence of the gland (approximately 65%) and is located
testosterone. posteriorly.

 Prostate gland . The prostate gland is a o The ducts of the glands from the
walnut-size structure that is located peripheral zone are vertically
below your bladder and in front of the emptying in the prostatic urethra;
rectum. The prostate gland contributes that may explain the tendency of
additional fluid to the ejaculate. Prostate these glands to permit urine reflux.
fluids also help to nourish the sperm. The o That also explains the high incidence
urethra, which carries the ejaculate to be of acute and chronic inflammation
expelled during orgasm, runs through the found in these compartments, a fact
center of the prostate gland. The that may be linked to the high
prostate also converts some of the incidence of prostate carcinoma at
testosterone into another hormone, the peripheral zone.
called dihydrotestosterone (DHT), which o The peripheral zone is mainly the area
plays a part in sexual development felt against the rectum on DRE, which
throughout life. When you're an adult, for is of irreplaceable value.
example, it's involved in both prostate
growth and male pattern baldness. The fibromuscular stroma (or fourth zone for some)
is situated anteriorly in the gland. It merges with the
o The prostate is the largest tissue of the urogenital diaphragm. This part of the
accessory gland in the male gland is actually the result of interaction of the
reproductive system. It prostate gland budding around the urethra during
secretes proteolytic enzymes into prostate embryogenesis and the common horseshoe
the semen, which act to break -like muscle precursor of the smooth and striated
down clotting factors in the muscle that will eventually form the internal and
ejaculate. This allows the semen external urethra sphincter.
to remain in a fluid state, moving
throughout the female Vasculature
reproductive tract for potential
fertilization.  The arterial supply to the prostate comes
from the prostatic arteries, which are mainly
The prostate into three zones (according to McNeal): derived from the internal iliac arteries. Some
branches may also arise from the internal
 Central zone – surrounds the ejaculatory pudendal and middle rectal arteries.
ducts, comprising approximately 25% of
normal prostate volume.  Venous drainage of the prostate is via
the prostatic venous plexus, draining into the
o The ducts of the glands from the internal iliac veins. However, the prostatic
central zone are obliquely emptying venous plexus also connects posteriorly by
in the prostatic urethra, thus being networks of veins, including the Batson
rather immune to urine reflux. venous plexus, to the internal vertebral
venous plexus.
 Transitional zone – located centrally and
surrounds the urethra, comprising Innervation
approximately 5-10% of normal prostate
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volume.  The prostate receives sympathetic,

parasympathetic and sensory innervation
o The glands of the transitional zone from the inferior hypogastric plexus. The
14
 smooth muscle of the prostate gland is urethra.
innervated by sympathetic fibres, which o The fluid from the glands is released
activate during ejaculation. after the male becomes sexually
aroused and shortly before the
Neurovascular Bundles release of the semen. It is sometimes
called pre-ejaculate for this reason. It
 The prostate is flanked by the is important to note that, in addition
two neurovascular bundles that travel to the lubricating proteins,
through the pelvic floor towards the penis, bulbourethral fluid can pick up sperm
supplying it with nerve fibers and blood already present in the urethra and
vessels for the corpora cavernosa. The therefore it may be able to cause
integrity of these bundles is critical for pregnancy.
normal erection.
Ejaculate
 During surgery for prostate cancer (radical  It is the fluid from the 3 accessory glands
prostatectomy), damage is often inevitable combines with sperm from the testes to
to one or both of these bundles, resulting in make sperm.
impairment of erectile function. Special nerve  When it is released during intercourse, the
-sparing techniques may prevent extensive semen is called ejaculate.
damage to these bundles, thus allowing for  It is about 3-5 in volume and contains 200-
post-operative potency. 500 million sperm.
 Any disturbance of semen quantity or quality
Clinical Correlation will interfere with the capability of fertilization
and conception.
1. Benign Prostatic Hypertrophy (BPH)
Sperm Cell or Spermatozoon
Abnormal growth of the prostate is usually caused by  Is the male reproductive cell, or gamete.
the enlargement of the mucosal and submucosal  Sperm cells form during the process known
parts of the glands that lead to constrictions of the as spermatogenesis, takes place in
urethra as it passes through the middle of the the seminiferous tubules of the testicles. This
prostate gland. By the age 60, approximately 40% of process involves the production of several
men have some degree of BPH and by age 80, successive sperm cell precursors, starting
affected individuals as many as 80 %. with spermatogonia,
which differentiate into spermatocytes. The
2. Prostatic Adenocarcinoma or Prostate Cancer spermatocytes then undergo meiosis,
reducing their chromosome number by half,
 Usually arises from the largest and outer part which produces spermatids. The spermatids
of the glands, the prostatic bulk that open via then mature and construct a tail, or flagellum,
long ducts to the urethra. Some forms grow which gives rise to the mature, motile sperm
very slowly and aggressive forms can cause cell. This whole process occurs constantly
metastasis to vulnerable organs like lungs and takes around 3 months from start to
and brain. finish.
 Are smaller than most cells in the body, the
o Bulbourethral glands. Also called volumes of a sperm cell is 85,000 times less
Cowper's glands, these are pea-size than of the female gamete.
structures located on the sides of the  Approximately 100 to 300 million sperm are
urethra just below the prostate gland. produced daily whereas women typically
These glands produce a clear, salty, ovulate only one oocyte per month.
slippery fluid that empties directly
into the urethra. This fluid serves to Parts of the human sperm cell:
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lubricate the urethra and to neutralize

any acidity that may be present due 1. Head: The head region is usually a flat pear-
to remaining drops of pee in the
15
shaped structure with a pointed tip and a broad base
that contains the genetic material of the sperm cell 3. Tail: The tail or flagellum of the sperm makes up
within the cell nucleus. It is covered by a cap-like about 80% of its entire length. The tail gives the
structure called acrosome which contains hydrolytic sperm cell movement. It contains the axoneme
enzymes essential for penetrating the layers of the which is a bundle of microtubules surrounded by
egg during fertilization. This process is called the mitochondria. In the axoneme, there are two central
acrosome reaction. The human sperm cell nucleus is singlet microtubules surrounded by nine microtubule
haploid meaning it contains only 23 chromosomes. doublets. The movement of the flagellum is powered
When this haploid cell fertilizes with the ovum, it by dynein motor proteins which use the energy from
produces a diploid zygote containing 46 ATP hydrolysis produced by mitochondria in the
chromosomes. midpiece.

The head is an oval-shaped structure, which size What is Spermatogenesis?

ranges from 5 to 8 µm. It consists of:  Spermatogenesis is the process of formation
of sperm cells in the testes. The testes are
 Acrosome the male reproductive organs producing
Accounts for 40% to 70% of total sperm sperm and testosterone. They contain tightly
head area, and is located at one end of coiled structures called seminiferous tubules
the sperm cell. It contains proteolytic within which the sperm cells are produced.
enzymes that help to destroy the outer There are specialized cells scattered among
layer of the egg cell, thereby allowing the these tubules called Sertoli cells, which
sperm to enter into it easily. provide nutrients to the developing sperm
 Nucleus cells.
Contains all the 23 chromosomes of the
 The process of spermatogenesis
sperm cell, that is, half the genetic
starts with spermatogonia which are
information of the future embrion. This is
immature cells derived from stem
the only part of the sperm cell that enters
cells called primordial germ cells in
into the egg cell. As such it is the most
the outer wall of the seminiferous
important part of the spermatozoon. Its
tubules. These stem cells migrate into
purpose is to fuse with the nucleus of the
the testis during early embryogenesis
egg cell and complete the genetic
and proliferate continuously by
complement of the new being.
mitosis. Half of the resulting cells
 Plasma membrane
remain as stem cells, while the others
Surrounds the acromosome and nucleus
stop proliferating and proceed to
to separate them from the rest of the
become future sperm cells.
sperm body. Inside is a small amount of
cytoplasm with high levels of
 The cells that mature into sperm cells
polyunsaturated fatty acids.
differentiate into primary spermatocytes.
These primary sperm cells migrate towards
2. Body: The body, also called the midpiece, is the the Sertoli cells where they further develop.
middle portion of the sperm cell that contains Then, the primary spermatocytes undergo
mitochondria. This region is essential for providing meiotic division I to form secondary
the energy required for the movement of the cell. spermatocytes. While the nucleus of
The neck and the middle piece, as the name primary sperm cells contains 46
suggests, are the parts that can be found between chromosomes, secondary sperm cells
the head and the tail. They measure between 6 - 12 contain only 23 chromosomes, similar to
microns, a little longer than the head. The width is the egg. The secondary spermatocytes
hardly visible under the microscope. further proceed through meiotic division II
Inside this part are millions of mitochondria. The to produce haploid spermatids.
mitchondria provide the sperm will the energy  The haploid spermatids mature and
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needed required by the tail to allow it to swim in the differentiate into mature sperm cells called
female reproductive tract. spermatozoa through the process of

16
 spermiogenesis. This maturation process cells in the testes. These cancerous cells tend
involves specific changes in the structure of to grow rapidly, spreading to other body
the sperm cell. The nucleus assumes an parts. Most of the testicular cancer begins in
oval shape forming the head of the sperm. the germ cells in the testes. The causes of
At the opposite end of the head is the tail testicular cancer are not clearly understood.
which originates from the cytoplasm of the It usually begins when certain factors change
secondary sperm cell. After fully matured, the DNA of cells in the testes, causing them
the sperm is stored within the epididymis to grow and multiply abnormally.
of the testes.

Functions of the Sperm Cells  Varicocele is a condition that occurs due to

 The main function of sperm cells is to fertilize swelling of the veins within the scrotum that
the female egg cell to form a new drain blood from the testicle. Varicocele
individual. The fusion of a sperm cell with causes low sperm count, reduced sperm
an egg forms a zygote which undergoes motility, and abnormal sperm morphology.
cell division to form an embryo. These issues can significantly affect fertility.
 The sperm cell contributes a haploid set of They can also affect testicular growth and
chromosomes to its offspring. This genetic function. Surgery of varicocele improves
material determines the genetic traits and sperm motility and morphology.
characteristics of the offspring.  Infections of the reproductive system such as
 Sperm cells are highly specialized for motility epididymitis and some sexually transmitted
and contain a flagellum that allows them to infections can also affect sperm production.
swim through the female reproductive These infections can block the passage of
tract. This movement is needed to reach sperm.
the egg within the fallopian tube for
fertilization.

Diseases and Disorders of Sperm Cell

 Azoospermia is one of the main causes of

male infertility. It is a disorder that occurs due
to the absence of sperm in the ejaculate. The
causes of azoospermia may include
blockages in the reproductive tract, hormonal
imbalances, or certain genetic conditions.
 Oligozoospermia is a condition that occurs
due to a low sperm count, where the number
of sperm is below the normal range.
 Asthenozoospermia is a condition that
occurs due to reduced sperm motility. Sperm
motility is important for reaching and
penetrating the egg during fertilization.
Sperm with reduced motility have difficulty
reaching and fertilizing the egg. This can
reduce the chances of successful fertilization.
 Teratozoospermia is characterized by
abnormal sperm morphology. Abnormal
sperm morphology may cause difficulty in
penetrating the barriers of the egg for
fertilization. This condition also reduces the
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chances of successful fertilization.

 Testicular cancer is the abnormal growth of

17