Male Genital Disorders

ANATOMY OR SYSTEM AFFECTED: Genitals, reproductive system

DEFINITION: Disorders and diseases of the male reproductive system

CAUSES: Psychological factors, anatomic dysfunction, genital cancer, sexually transmitted diseases, infection, certain medications

SYMPTOMS: Vary; can include sexual dysfunction, infertility, impotence

DURATION: Acute or chronic

TREATMENTS: Depends on cause; may include psychotherapy, counseling, hormone therapy, discontinuation of medications or addictive drugs, corrective surgery (e.g., penile implants), drug therapy, surgery, radiation, chemotherapy

Process and Effects

Before discussion of male genital disorders and diseases, it is useful to describe the male reproductive system, which is composed of the scrotum, testes, epididymis, vas deferens, prostate and bulbourethral glands, seminal vesicles, penis, and urethra. The scrotum, composed of skin and underlying muscle, encloses the two testes and protects these sperm-making organs.

Each human testis is an ovoid structure about 5 centimeters long and 3.3 centimeters in width. A testis is composed of seminiferous tubules, a structure that surrounds the sperm-producing tubules, and accessory cells (the Leydig cells). The production of sperm, spermatogenesis, is controlled by hormones from the brain’s and pituitary glands. It begins with the secretion of testosterone, the main male sex hormone, by Leydig cells. Brain hormone and actions cause the metamorphosis of cells called spermatogonia into during a two-month passage through the seminiferous tubules.

The highly coiled seminiferous tubules, tiny in diameter and more than 200 meters long, coalesce into the efferent tubules, which release sperm into the epididymis. In a twelve-day trip through the highly coiled, 4.5-meter-long epididymis, sperm attain the ability to move (motility) and to fertilize a human egg cell, or ovum. Next, they enter the vas deferens, paired structures that connect the of each testis to its ejaculatory duct and the urethra. The only known vas function is to transport sperm, as a result of the action of nearby nerves and muscles, into the latter structures. The vas are cut in bilateral surgery, which is often used for male sterilization.

The prostate, seminal vesicles, and bulbourethral glands produce the secretions that constitute most sperm-containing semen, which is ejaculated during intercourse. The is situated immediately below the urinary and surrounds the portion of the closest to the bladder. It is a fibromuscular gland that empties into the male urethra on ejaculation. Prostate secretions contain important enzymes and make up a quarter of the seminal fluid.

The seminal vesicles are 7.5 centimeters long and empty into the ejaculatory ducts. They produce more than half of the liquid portion of semen, contributing rich in fructose, the main source of sperm. The tiny, paired bulbourethral (or Cowper’s) glands are located below the prostate. They secrete lubricants into the male urethra that ease passage.

The male urethra passes from the urinary bladder, through the prostate, and then through the penis. At the end of the penis, it reaches outside the body, to pass semen and urine. The penis, a cylindrical erectile organ, surrounds most of the male urethra and contains three cavernous regions. One, the corpus spongiosum, is found around the urethra. The others, the paired corpora cavernosa, are erectile tissues that fill with blood to produce an upon male sexual arousal. Erection is a complex reflex that involves both the sympathetic and parasympathetic portions of the human nervous system.

At the time of erection, nerve impulses dilate blood vessels that communicate with the and allow them to fill with blood. Sphincters then close off the portion of the urethra closest to the urinary bladder. At the same time, sperm, prostate secretions, secretions, and seminal secretions enter the urethra. Next, upon stimulation sufficient to achieve orgasm, muscle contractions propel the ejaculate out of the urethra. The blood then leaves the corpora cavernosa, and the resumes its flaccid state.

Complications and Disorders

Proper male sexual function involves several closely coordinated hormonal, nervous, and chemical processes. After a discussion of the male reproductive system, it thus becomes clear that many factors can cause male genital problems and diseases. Male infertility, for example, can be attributable to inadequate sperm production; undersecretion by the seminal vesicles, Cowper’s glands, and/or prostate; malfunction of other or of the nervous system; and or lack of the epididymis. Impotence, the inability to have or maintain a satisfactory erection for intercourse, is another frequent male genital problem. It may be or caused by anatomic dysfunction, disease, or medications used to treat health problems.

The male sexual response cycle is mediated by the complex interplay of parasympathetic and sympathetic nerves. For example, penis erection is mostly parasympathetic, while is largely attributable to sympathetic enervation. Dysfunction disorders include low sexual desire, (erectile dysfunction), and lost orgiastic control (premature ejaculation). Impotence is the most frequent of these problems.

Erectile dysfunction is said to occur when the failure to complete successful intercourse occurs at least 25 to 30 percent of the time. Most often, it is short term (secondary impotence) and related to individual partners or to temporary damage to male self-esteem. Secondary impotence may also be caused by diseases such as diabetes mellitus, medications such as tranquilizers and amphetamines, and other psychoactive drug addictions, and minor genital abnormalities. Aging is not necessarily a cause of impotence, even in octogenarians. Effective medications called phosphodiesterase type 5 inhibitors have been developed for treating erectile dysfunction; the main ones include sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis).

Long-lasting (or primary) impotence that occurs despite corrective medical treatment is generally attributable to severe psychopathology and must be treated by and counseling. Psychogenic impotence is implicated when an erection can be achieved by masturbation. The treatment of impotence caused by problems may include testosterone administration, the discontinuation of drug therapy or addictive drugs, or corrective surgery, which may include inflatable penis implants.

Male infertility is a problem found in about a third of all cases in which American couples are unable to have children. The problem is thus estimated to occur in 4 to 5 percent of American men. There are a wide number of causes for male infertility, which is always characterized by the failure to deliver adequate numbers of mature sperm into the female reproductive tract as a result of organic problems. Impaired spermatogenesis, a frequent cause of male infertility, may have numerous causes. Examples include severe childhood mumps, and/or testicular hormone imbalances, drug abuse, or anatomic malformation of the seminal tract (especially the seminiferous tubules and epididymis), and a defective prostate gland.

Diagnosis includes careful by a urologist and evaluation of ejaculated semen to identify the number, activity, and potential for of its sperm. Blood tests will identify hormone imbalances and other possible causative agents. Many treatments are possible for male infertility, ranging from medications to corrective surgery to artificial with sperm collected and frozen until enough are on hand to effect fertilization.

Cancer of the male genital organs may occur in the prostate, urethra, penis, or testis. The most important of these is prostate cancer. Urethral cancer is rare. More common is of the penis, which occurs most often in uncircumcised men who practice poor genital hygiene. It is very often located beneath the foreskin and does not spread quickly. Total or partial removal of the penis is often required in advanced cases that have been ignored for long periods. Testicular cancers account for most solid genital malignancies in young men. These cancers appear as painful scrotal masses which increase rapidly in size. Any large, firm mass arising from a testis is suspicious and should be examined immediately by x-ray, computed tomography (CT) scan, and tests for various markers seen in the blood. Treatment of these tumors includes surgery, radiation, and chemotherapy. Survival rates vary greatly and depend upon the cancer type. Cancer of the prostate and other male genital organs is not clearly understood and may have hormonal and chemical bases. It is believed that periodic self-examination is the most valuable preventive methodology.

Common disorders of the male genital organs include priapism, and spermatocele, testicular torsion, and varicocele. Priapism is persistent, painful erection not accompanied by sexual arousal. It is caused by a poorly understood mechanism and is characterized by both pain and much-thickened blood in the corpora cavernosa. Priapism often occurs after prolonged sexual activity and may accompany prostate problems, genital infections such as syphilis, and addictive drug use. Treatment of priapism includes draining blood from the penis following local anesthetic, administration of a medication called an alpha-adrenergic sympathomimetic, and surgery. In the absence of prompt, effective treatment, priapism may end male sexual function permanently.

A hydrocele is a swelling of the . The problem is caused by fluid accumulation resulting from testis inflammation. A hydrocele is not painful and is removed surgically only if excessive in size. Closely related in appearance is a spermatocele, which contains sperm and occurs adjacent to the epididymis. Testicular torsion is a twisting of the vas deferens, which causes pain and swelling; surgery is required to return blood flow to the testis. Varicocele describes varicose of the testis, which is common and usually harmless.

Sexually transmitted diseases can also affect the male genitals. These diseases include herpes, gonorrhea, syphilis, chlamydia, and genital warts. For the prevention of sexually transmitted diseases, abstention, the careful choice of sexual partners, and the use of male or female condoms are useful.

Perspective and Prospects

Treatment of the various types of male genital disorders and diseases has evolved greatly. Particularly valuable are the strides made in the treatment of impotence. It has been realized that such sexual dysfunction is often a consequence of organic problems that may be remedied by the cessation of causative medication use or by minor surgery. In addition, the utilization of inflatable penis implants in the cases where insoluble psychogenic or organic problems occur has been a milestone in the treatment of this emotionally devastating male genital problem.

Wide examination of the entire spectrum of male genital problems has led to numerous advantageous treatments and to an understanding that withholding unneeded medical treatments can be beneficial. For example, information regarding spermatoceles, hydroceles, and many related nonacute male genital problems has decreased the incidence of unnecessary male genital surgery, and its related risks, for patients.

Another important concept is that of frequent self-examination of the male genitals. This practice has led to a shortening of the time lag between the appearance of a suspicious mass in the scrotum, testes, or other male sex organ and medical attention from professionals (such as urologists) trained both to evaluate their seriousness and to treat them. Early detection has diminished the severity of many genital cancers and facilitated their treatment. Moreover, several clinical tests for such lesions have become more available and more widely used by the public.

It is hoped that these avenues and others, as well as further advances in both diagnostic techniques and treatment possibilities, will eventually eradicate male genital diseases and disorders. Two areas in need of advancements are priapism and prostate cancer, which is an effective killer.

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