• when penis enlarges, blood comes into cavernosus spaces
• then, the dorsal V. is collapsed, so no blood can drain away from the sinusoidal spaces

• efferents from:
  • dorsal N. of penis
  • pudendal N.
  • hypogastric plexus
  • pelvic plexus

• symp.: T11-L2
• parasymp.: S2-S4

• hypothalamus function is needed for normal sexual response
  • medial preoptic nucleus
  • paraventricular nucleus
• amygdala
• temporal lobe
• neurohypophysis
• subcollosal area
• cortex (role in fantasy, desire)

1. spermatogonium undergo mitosis to form primary spermatocyte (2nD)
2. primary spermatocyte undergoes meiosis I to form secondary spermatocyte (1nD)
3. secondary spermatocyte undergoes meiosis II to form spermatids (1ns)
4. spermatids undergo cell differentiation and growth to form mature spermatozoa

Takes one month

1. seminiferous tubules- produce sperm
2. collecting ducts- transport and storage
3. epididymis- transportation, maturation, ejaculation
4. vas deferens- transport and ejaculation
5. accessory glands
   • seminal vesicles- secrete thick liquid and transport sperm
   • prostate gland- secrete thin alkaline solution to neutralize urine and female system
   • cowper's gland- secretions may lubricate, flush out urine or form a gelatinous plug
6. urethra- passage of urine and sperm
7. penis- copulation

1. libido (desire)
2. erection (arousal)
3. ejaculation/orgasm
4. satisfaction/resolution

• diminished sexual interest
• excessive sexual interest

disorders of erection

• ED
• prolonged erection
• erectile deformity

• premature (rapid) ejaculation
• delayed ejaculation
• anejaculation
• retrograde ejaculation
• anorgasmia

• chronic pelvic pain syndrome
• Peyronie's disease

• CNS disorders
• psychological/psychiatric disturbances
  • depression
  • socio-cultural problems
  • gender ID problems

• CNS disorders (ex: Kluver Bucy syndrome)
• manic states
• depression

• DM
• HTN
• effect of alcohol and illicit drugs
• effects of prescription drugs
  • SSRI's
  • trauma to nerves
  • MS
  • prolonged ejaculation usually due to medication
    • trazodone
    • sildenafil

• psychological problems
  • anxiety
  • effects of prescription drugs
  • trauma to nerves
  • MS

• Peyronie's disease
• psychological syndrome

• primary hypogonadism
• central hypogonadism
  • gonadotropic deficiency
  • chronic illness
  • hyperPRL
• hypothyroidism
• hyperthyroidism

• anti HTN
• anti depressants
• anti histamines
• anti androgens
• H2 blockers
• 5 alpha reductase inhibitors
• potentially lipid lowering agents

• psychogenic (MAJOR)
• anatomical/structural
• drug induced
• hormonal
• neurogenic
• vascular

• definition- curved penis
• pathogenesis
  • accumulation of fibrous plaque in one area of the penis
  • this leads to curving of penis
  • it causes pain during intercouse and ED

• prostatitis
• epidydymitis
• balanitis/blanoposthitis

malignancies of male sexual anatomy

• prostate cancer
• testicular CA
• penile CA

• comprehensive history and physical examination
• sexual history
  • pt own description of problem vs. partner's
  • partner related questions (with whom, how frequent, relationship status)
  • generalized or situational
  • generalized attitudes about sexual health

• tx cause
• ED- may symptomatically tx with sildenafil or similar drugs after consultation with urologist and/or endocrinologist
• premature ejaculation- relaxation techniques, stop/squeeze technique