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Male reproductive organs (Male reproductive system)

Summary

The male reproductive system consists of the penis, testes, epididymis, ejaculatory ducts, prostate, and accessory glands. These organs
function together to produce sperm and deliver semen from the testes via ejaculation. For more information on the embryological development
of the male reproductive system, see development of the reproductive system.

Penis

Function
Urination and release of semen

Gross anatomy [1][2]

Primarily composed of erectile tissue, blood vessels, nerves, and connective tissue

Structure
Root: composed of the bulb of the penis and two crura
Two crura anchor the corpora cavernosa to the pubic arch.
The bulb is a continuation of the corpus spongiosum.
Body (shaft): contains the erectile tissue
Corpus spongiosum
Location: lies ventrally between the corpora cavernosa
Function: keeps the urethra open during erection
Corpora cavernosa (paired)
Location: dorsal and proximal to the corpus spongiosum
Function: enable erection
Glans penis: the distal end of the corpus spongiosum
Attached to the frenulum and covered by foreskin
Corona: margin of the glans penis
Contains the external urethral meatus
Fossa navicularis: opening of the external urethra
Urethral glands (glands of Littre)
Muscles
Bulbospongiosus muscle (paired)
Cover the bulb of the penis
Empty the urethra of residual semen/urine and contribute to erection
Ischiocavernosus muscle (paired)
Cover the crura of the penis
Compress the crura to move blood into the body of the penis and maintain erections

Arteries[2][3][1]

Course Supplies

Internal pudendal artery Branch of the internal iliac artery External genitalia
Exits the pelvis through the greater sciatic foramen
Enters the perineum through the lesser sciatic foramen

Bulbourethral artery
Branch of the internal pudendal artery Bulb of the penis
Travels between superior and inferior fascia of the urogenital Bulbourethral gland
diaphragm
Exits the inferior fascia
Travels to the bulb of the urethra and the posterior corpus
spongiosum

Deep artery of the penis
Branch of the internal pudendal artery Erectile tissue
Travels between superior and inferior fascia of the urogenital
diaphragm
Exits the inferior fascia
Enters the crus penis
Travels to corpus cavernosum penis

Dorsal artery of the Branch of the internal pudendal artery Glans penis
penis Travels between the crus penis and pubic symphysis Prepuce
Exits inferior fascia of the urogenital diaphragm
Travels in the suspensory ligament of the penis
Runs on the dorsum of the penis to the glans

Urethral artery Travels through the corpus spongiosum Glans of the penis

External pudendal Branch of the femoral artery Skin above the pubis, penis, and
artery Enters through the saphenous ring scrotum

Veins
Vein Anatomy Drains into

Deep dorsal vein of the penis Single vein on the midline, in the dorsum of the Prostatic and pelvic venous plexuses
penis
Travels deep to Buck fascia of the penis
Superficial to the tunica albuginea

Superficial dorsal vein of the Travels along the superficial and deep fascia → External pudendal veins → greater saphenous
penis vein

Lymphatics
Structure Lymph nodes Course

Perineum, penis, and scrotum Superficial inguinal lymph nodes → external iliac nodes → para-aortic nodes

Glans penis Deep inguinal lymph nodes → internal iliac nodes → common iliac nodes → para-aortic nodes

Corpora cavernosa Internal iliac nodes → common iliac nodes → para-aortic nodes

Innervation
Innervation Structures Function

Parasympathetic Pelvic splanchnic nerves (S2-S4) Erection (see below)

Sympathetic Hypogastric nerve (T11-L4) Emission (see below)

Sensory Dorsal nerve of the penis (a branch of the pudendal nerve) Innervates the skin, prepuce, and glans

”Point and Shoot": Parasympathetic Points it up (erection), Sympathetic Shoots out the semen (ejaculation).

Microscopic anatomy [1][2]

Tunica albuginea: thick fibrous layer of connective tissue surrounding the corpora cavernosa and the corpus spongiosum
Corpora cavernosa: composed of connective tissue and smooth muscle
Corpus spongiosum: composed of connective tissue (primarily elastic fibers) and smooth muscle

Embryology [1]
Genital tubercle → glans penis, corpora cavernosa, corpus spongiosum
Urogenital folds → ventral shaft of the penis
See development of the reproductive system.

Testes, scrotum, and spermatic cord

The testes are paired organs composed of seminiferous tubules, the site of spermatogenesis. They are also responsible for the secretion of
male sex hormones.
The scrotum encases the testes and is connected to the abdominal wall via the spermatic cord.

Gross anatomy

[1][2][4]
Structure

Testes
Ellipsoid-shaped
Composed of ∼ 600 seminiferous tubules, which connect to the rete testis
Surrounded by a thick capsule (tunica albuginea)
Connect to the abdominal wall via the spermatic cord
Testicular lobules
Interlobular septa divide the testis into testicular lobules.
Each testicular lobule contains 1–4 seminiferous tubules.
Spermatic cord: extension of the abdominal wall into the scrotum
Contents of the spermatic cord
Three arteries: testicular artery, ductus deferens artery, cremasteric artery
Three nerves: genital branch of genitofemoral, cremasteric nerve, sympathetic nerve fibers
Three other structures: ductus deferens, pampiniform plexus, lymphatic vessels

Remember the spermatic cord layers with “TIE turns into ICE”:
- Transversalis fascia → Internal spermatic fascia
- Internal oblique → Cremasteric muscle and fascia
- External oblique → External spermatic fascia

Scrotum: distal sac-like end of the spermatic cord that is continuous with the anterior abdominal wall
Layers of the scrotum (from internal to external)
Tunica albuginea: highly vascular, fibrous layer of connective tissue
Tunica vaginalis: visceral layer; derived from peritoneum
Internal spermatic fascia: derived from the transversalis fascia
Cremasteric fascia and cremaster muscle: originates from the internal oblique muscle
External spermatic fascia: derived from the aponeurosis of the external oblique muscle
Dartos fascia and dartos muscle: contraction causes skin wrinkles → regulates temperature
Scrotal skin: wrinkles → ↑ skin thickness → ↓ heat loss

Vasculature, lymphatics, and innervation of the testes and scrotum [4]

Testes Scrotum

Arteries Testicular arteries (a branch of the abdominal aorta) Anterior scrotal arteries (a branch of the external pudendal
Pass through the inguinal canal artery)
Posterior scrotal arteries (a branch of the internal pudendal
artery)

Veins Pampiniform venous plexus drains to testicular vein → Scrotal veins drain to external pudendal vein
renal vein (left) and inferior vena cava (right)

Lymphatics Lumbar lymph nodes drain to para-aortic lymph nodes Drain to superficial inguinal nodes

Autonomic Abdominal aortic plexus Sympathetic fibers from the genital branch of the
Innervation T10 → testicular plexus genitofemoral nerve → dartos muscle contraction

Motor None Genital branch of the genitofemoral nerve → cremasteric

innervation muscle contraction
See cremasteric reflex

Sensory Genitofemoral nerve → genital branch (L2) → tunica Anterior scrotal nerves (genital branch of the genitofemoral
innervation vaginalis of the testes nerve and ilioinguinal nerve)
Posterior scrotal nerves (perineal branch of the internal
pudendal nerve and posterior femoral cutaneous nerve)

See lymphatic drainage for an overview of the lymphatic system.

Microscopic anatomy

Microscopic anatomy [1][2]

Spermatogonia
Description: Undifferentiated germ cells lining the seminiferous tubules
Type A (dark): do not undergo mitosis
Type A (pale): form type B spermatogonia
Type B: undergo mitosis → mature into primary spermatocytes
Function: site of primary spermatocyte production

Sertoli cells
Description
Columnar epithelial cells lining seminiferous tubules (non-germ cells)
Homologous to granulosa cells in females
Connected to one another via tight junctions
Form the blood-testis barrier: separation of gametes in seminiferous tubules from the immune system
Sensitive to temperature: ↑ temperature (e.g., due to cryptorchidism) → ↓ inhibin B secretion and ↓ production of spermatozoa
Function
In response to FSH → secrete inhibin B→ negative feedback for FSH release
Contain aromatase → conversion of testosterone to estrogen [5]
Secrete androgen-binding protein
Produce Mullerian inhibitory factor
Provide protection and nourishment during spermatogenesis

Leydig cells
Description
Interstitial cells with cytoplasm rich in cholesterol (used for testosterone production)
Homologous to theca interna cells in females
Not affected by temperature
Function
Testosterone production: LH release → testosterone production → diffuses into Sertoli cells → decreases LH secretion (negative
feedback)
Secrete androgens during the embryonic period
During puberty, testosterone production increases → start/maintenance of full spermatogenesis
Conversion of testosterone to estrogen via aromatase [5]

Sperm
Head: formed by the acrosome and the nucleus
Tail: formed by the midpiece (mitochondria and microtubules), principal piece (flagellum), and the end piece

Blood-testis barrier
Formed by tight junctions between Sertoli cells
Separates gametes in seminiferous tubules from the immune system
Divides seminiferous tubules into:
Basal compartment
Contains spermatogonia and immature primary spermatocytes
In contact with blood and lymph
Adluminal compartment
Contains mature spermatocytes and spermatids
Not in contact with blood and lymph

Spermatogenesis and spermiogenesis

Spermatogenesis and spermiogenesis [1][2]

Spermatogenesis
Process by which spermatogonia become spermatids
Occurs in the seminiferous tubules
As spermatogonia mature, they move from the basal layer of the seminiferous tubules → lumen of the seminiferous tubules
Begins in puberty
Spermatogonia (2n, diploid) cross the blood-testis barrier → primary spermatocytes (2n, diploid) → secondary spermatocytes (1n, haploid)
→ spermatids (1n, haploid)
Duration: ∼ 2 months

Spermiogenesis
Process by which spermatids become spermatozoa
Requires testosterone
Formation of the acrosome
Derived from the Golgi apparatus
Contains acid phosphatase, neuraminidase, and hyaluronidase
Loss of cytoplasmic content
Condensation of genetic material
Spermatid elongation
Development of the flagellum

GONIUM is GOING be sperm: speramtogonia → spermatid. ZOON ZOOMS to the egg: mature spermatozoon travel to the egg.

Embryology

Embryology [1]
Testes: SRY gene on Y chromosome encodes for testis determining factor → primitive sex cords develop → form testes
Testes develop in the retroperitoneum, then descend into the scrotum
Begins during week 7; ends just prior to birth
Testes descend through the inguinal canal, along with their associated vasculature, nerves, and ductus deferens.
Completes formation of the spermatic cord
Play a role in further sexual development
Mullerian inhibitory factor (Sertoli cells) suppresses the development of the paramesonephric ducts
Androgens (Leydig cells) stimulate the development of the mesonephric ducts
Scrotum: derived from the labioscrotal swelling (driven by dihydrotestosterone, or DHT)
See development of the reproductive system.

Epididymis, ductus deferens, and accessory glands

Epididymis [1]
Gross anatomy: long, coiled duct along the posterior aspect of the testis → distal end is continuous with ductus deferens
Function
Storage and maturation of spermatozoa
Propulsion of spermatozoa into the ductus deferens
Embryology: derived from the mesonephric duct (differentiation requires testosterone)

Ductus deferens [1]

Gross anatomy
Long, muscular duct that enters the pelvis at the deep inguinal ring (lateral to inferior epigastric artery)
Crosses the umbilical artery and obturator nerve → passes superior to the ureter → expands at the distal end to form the ampulla → joins
ejaculatory duct
Function: transports spermatozoa from the epididymis to the ejaculatory duct and provides fructose to the spermatozoa
Embryology: derived from the mesonephric duct (differentiation requires testosterone)

Ejaculatory ducts [1]

Gross anatomy: formed by the ductus deferens and seminal vesicle ducts → open into the prostatic urethra
Function: propel spermatozoa with seminal fluid into the urethra
Embryology: derived from the mesonephric duct (differentiation requires testosterone)

Accessory glands
Prostate (see below)
Seminal vesicles [2]
Gross anatomy
Paired glands located on the inferoposterior surface of the bladder
Connect with the ductus deferens to form the ejaculatory ducts → empty into the prostatic urethra
Microscopic anatomy
Lobulated glandular tissue
Lined with pseudostratified columnar epithelium
Contain secretory granules
Function: secrete alkaline fluid that makes up the greater part of seminal fluid
Contains sorbitol dehydrogenase; converts sorbitol into fructose → provides energy for spermatozoa motility
Contains citrate, fructose, prostaglandins, and other proteins
Embryology: derived from the mesonephric duct (differentiation requires testosterone)

Bulbourethral gland (Cowper gland) [2]

Gross anatomy: located in the deep perineal pouch within the urogenital diaphragm
Function: secretes mucus into the bulbar urethra for lubrication during ejaculation
Embryology: derived from the pelvic portion of the urogenital sinus (differentiation requires DHT)

Prostate gland

An accessory gland of reproduction located at the base of the bladder and composed primarily of glandular, fibrous, and smooth muscle tissue.

Function [2]
Secretion of:
Components of semen
Proteolytic enzymes (regulated by DHT) to maintain the fluidity of semen
Acid phosphatase, citric acid, prostaglandins, fibrinolysins, lipids, amylase
Prostate-specific antigen (PSA)

Gross anatomy [1][2]

Location: posterior to pubic symphysis, inferior to bladder, anterior to rectum, superior to perineal membrane
Base wraps around the neck of the urinary bladder
Apex surrounds the proximal urethra (prostatic urethra)

Structure
Capsules
External: continuation of the pelvic fascia (false capsule)
Internal: true capsule
Five anatomic lobes: Lobe location is described relative to the urethra (e.g., anterior = anterior to the urethra).
Anterior (isthmus): anterior to the urethra
Does not contain glandular tissue
Posterior: below the ejaculatory ducts and behind the urethra
Contains glandular tissue
Most common anatomic location of malignant transformation → prostate cancer [2]
Middle (median): between the ejaculatory ducts and the urethra
Lateral (paired; right and left lobe): on both sides of the urethra
Most common anatomic site of benign prostatic hyperplasia (BPH) → causes obstruction of urinary flow [3][6]

Vasculature, lymphatics, and innervation of the prostate gland [3][6]

Arteries Prostatic arteries (branches of the internal iliac artery)

Veins Prostatic venous plexus → internal iliac vein → internal vertebral plexus (Batson plexus)
Located between the true and false capsule
Covered by the anterior prostatic fascia and the endopelvic fascia

Lymphatics Periprostatic subcapsular network → internal iliac nodes → para-aortic lymph nodes [7]

Sympathetic innervation Superior hypogastric plexus: contraction of smooth muscle during ejaculation

Parasympathetic Pelvic splanchnic nerves (sacral levels S2–S4) → pelvic plexus → cavernous nerves (located within the
innervation lateral prostatic fascia)
Prostatic secretion
Pelvic plexus and cavernous nerves are at risk of damage during radical prostatectomy.

Because of the prostate's lymphatic drainage to the para-aortic lymph nodes, prostate cancer often metastasizes to the lumbar spine.

Microscopic anatomy [8][9]

General
Composed of glandular, fibrous, and smooth muscle tissue
Glandular epithelium contains foamy cytoplasm and abundant secretory granules, RER, and lysosomes
The fibrous capsule forms septae that penetrate the gland and divide it into lobes.
Functional zones
Peripheral zone
Largest area of glandular tissue with some smooth muscle
Palpable on digital rectal examination (DRE)
Most common site of prostate cancer
Central zone (periurethral zone)
Fibromuscular tissue
Surrounds the ejaculatory ducts
Accounts for 20–25% of the prostate's tissue
Site of origin for 1–5% of prostate cancer
Location: from the base of the prostate to the seminal colliculus (verumontanum)
Surrounds the ejaculatory ducts
Transitional zone
Smallest area of glandular tissue: tubuloalveolar glands with columnar epithelium
Surrounds the urethra
Most common site of benign prostatic hypertrophy
Accounts for 10% of the prostate's tissue
Site of origin for 20% of prostate cancer
Location: proximal to the seminal colliculus (verumontanum)
Contains two lateral lobes and a median lobe
Urethral crest → on the posterior midline
Surrounds the distal end of the preprostatic urethra
Prostatic ducts: drain into the prostatic sinus, a groove on the sides of the urethral crest
Ejaculatory ducts: open into the prostatic urethra, on the seminal colliculus
Glands: there are ∼ 30–50 branched tubuloalveolar glands
Main prostatic glands are located peripherally
Periurethral submucosal glands

Embryology [8]
Prostate derives from the urogenital sinus (differentiation depends upon the presence of DHT)
See development of the reproductive system.
References:[10][11]

Male sexual response

There are three parts of the male sexual response: erection, emission, and ejaculation.

Erection [12][2][13]
Description: The penis becomes rigid as its corpora cavernosa fill with blood due to sensory and/or mental stimulation of primarily
parasympathetic nerves.
Autonomic control
Parasympathetic: pelvic splanchnic nerves (S2–S4) → cavernous nerves → nitric oxide (NO) release → ↑cGMP → cavernous muscle
relaxation → vasodilation → erection [14]

Sympathetic: superior hypogastric plexus (T11–L2) → fibers travel along pelvic plexus → norepinephrine release → ↑ calcium influx →
cavernous muscle contraction→ vasoconstriction → antagonizes erection (detumescence)
Types of erection
Reflex erection (mostly sensory stimulation)
Genital stimulation → pudendal nerve afferents → sacral erection center S2–S4 (parasympathetic nervous system) → erection
Injuries to the cervical or thoracic spinal cord may result in an erection.
Psychogenic erection (mostly mental stimulation)
Cortical stimulation via visual, auditory, and sensory stimuli or fantasy → impact on the thoracolumbar erection center T11–L2
(sympathetic nervous system) → inferior mesenteric plexus and superior hypogastric plexus → some sympathetic neurons act
synergistically with sacral parasympathetic signals (S2–S4) to increase blood flow to corpora cavernosa → erection
Sympathetic innervation to smooth muscle of vas deferens, seminal vesicle, and internal sphincter of bladder
Nocturnal penile tumescence
Spontaneous erection while sleeping or upon waking up
Cause is not entirely understood
Nocturnal tumescence monitoring serves as a means of differentiating psychological from physiological erectile dysfunction.

PDE-5 inhibitors (e.g., sildenafil) inhibit hydrolysis of cGMP → ↑ NO → vasodilation → prolonged erection

Ejaculation [12][2][15]
Emission
During the first phase of ejaculation, sperm and secretions from the reproductive glands are transported through the reproductive ducts
(epididymis, vas deferens, and ejaculatory duct) into the internal urethra.
Ejaculate consists of prostatic secretion, seminal vesicle fluid, and spermatozoa
Secretion of fluid from accessory glands promotes sperm survival.
Stimulated primarily by the sympathetic nervous system (hypogastric nerve T11–L2) → closure of the bladder neck and contraction of
reproductive glands (seminal vesicle, bulbourethral, and prostate glands)

Expulsion
During the second phase of ejaculation, the semen is transported through the urethra and expelled from the body.
Stimulated by
Sympathetic nervous system (hypogastric nerve T11–L2)
Pudendal nerve → rhythmic contraction of the bulbocavernosus muscle → expels semen from the urethra

Remember the ejaculatory pathway of sperm with SEVEn UP: Seminiferous tubules → Epididymis → Vas (ductus) deferens → Ejaculatory
duct → Urethra → Penis

Innervation of male sexual response: Point, Squeeze, and Shoot

1. Parasympathetic → Point (erection)
2. Sympathetic → Squeeze (ejaculation)
3. Somatic (pudendal nerve) → Shoot (emission)

Clinical significance

Penis
Priapism
Erectile dysfunction
Phimosis
Paraphimosis
Balanitis
Carcinoma of the penis
Penile fracture
Sexually transmitted infections
Peyronie disease

Testes and scrotum

Testicular tumors
Testicular torsion
Hydrocele
Varicocele
Cryptorchidism

Prostate
Benign prostatic hyperplasia
Prostate cancer
Prostatitis

Other
Epididymitis
Anterior urethral injury
Posterior urethral injury

Sources last updated 02/25/2020

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