Reproductive+Pathology

Back to Home Page Reproductive Pathology Unit VII Female Reproductive System/Male Reproductive System
 * Structures and Functions of the Reproductive Systems Chapter 22

Female Reproductive System Outline by Kim J.** At around 7 to 8 weeks of embryonic development the difference in male and female genitalia becomes evident, until this time the reproductive organs of males and females are the same. The structure and function of the reproductive systems are controlled by the hypothalamic-pituitary-gonadal axis. Production of female ova occurs only during fetal life with one ova maturing per menstrual cycle.
 * Development of the Female Reproductive System**


 * Puberty** - exactly what triggers puberty is unknown in girls the steroids dehydroepiandrosterone and its sulfate start to rise in the blood beginning around 6-8 years of age, the gonads begin to produce sex hormones at around 8-12 years of age initiating puberty.(McCance, 2006)


 * The Female Reproductive System**


 * External Genitalia

Vulva** - the external female genitalia are known collectively as the vulva. The **vestibule** also contains the opening to the **urethra.** The structures of the **vestibule** are lubricated by two pairs of glands called the **Skene glands and Bartholin glands.** The **Skene glands** open on both sides of the urinary meatus. The ducts of the **Bartholin glands** open on either side of the introitus. Mucus secreted from these glands facilitate coitus. (McCance, 2006).
 * Mons pubis** - a layer of fatty tissue over the pubic symphysis.
 * Labia majora** - "are two folds of skin that arise at the monspubis and extend back to the fourchette, forming a cleft." (McCance, 2006) The embryological derivations of the labia majora and the scrotum are homologous.
 * Labia minora** - two folds of skin between the labia majora, extending from the clitoris backward on both sides of the vagina.
 * Clitoris** - an erectile organ rich in nerves that lies anterior between the labia minora. The clitoris is homologous to the male penis.
 * Vestibule** - an area protected by the labia minora and contains the external opening of the vagina, which is called the **introitus**, or vaginal orifice. (McCance,2006)
 * Hymen** - a thin perforated membrane which may cover the introitus.
 * Perineum** - "the less hairy skin and subcutaneous tissue that lies between the vaginal orifice and the anus." (McCance,2006)


 * Internal Genitalia**


 * **HOW THE SYSTEM FITS TOGETHER** ||
 * [[image:http://www.healthsquare.com/fgwh/wh1c1701.jpg width="476" height="313"]] ||


 * Vagina** - "an elastic, fibromuscular canal, 9 to 10 cm long which extends up and back from the **introitus** to the lower portion of the **uterus**. Mucosal secretions from the upper genital organs, menstrual fluids, and products of conception leave the body through the vagina, which also receives the penis during coitus." (McCance, 2006)


 * Uterus** - "a hollow pear-shaped organ whose lower end opens into the **vagina**. The functions of the uterus are to anchor and protect a fertilized ovum, provide an optimal environment while it develops, and push the fetus out at birth." (McCance, 2006)


 * Fallopian Tubes** - there are two fallopian tubes their function is to conduct ova from the spaces around the ovaries to the uterus.


 * Ovaries** - the female gonads and the primary female reproductive organs, their main function is to secrete female sex hormones and development and release of ova.


 * Cervix** - the opening of the **uterus** which dilates slightly during sexual excitement in order to receive sperm.


 * Rectum** - a portion of the large intestine approximately 12 cm long, where solid waste leaves the body.


 * Bladder** - the muscular membranous sac in the pelvis that stores urine for discharge through the **urethra.** (Mosby, 1994)


 * Urethra** - a small tubular structure that drains urine from the **bladder**.

This web site gives a quick review of the female reproductive system and it is where I obtained my nifty picture above. http://www.healthsquare.com/fgwh/wh1ch17.htm


 * Female Sex Hormones

Estrogen's** - generic term for three similar hormones: estradiol, estrone, and estriol, estradiol is the most potent and plentiful of the three and is principally produced by the ovaries.(McCance, 2006)


 * Progesterone** - is a hormone released by the ovaries with the ova when stimulated by the lutenizing hormone, it is the second major female sex hormone, **progesterone** is sometimes referred to as the hormone of pregnancy.


 * Androgens** - this hormone is primarily a male sex hormone but is secreted in small amounts by the ovary and the adrenal cortex, this hormone activates the sebaceous glands accounting for some acne during puberty and plays a role in the libido. (McCance, 2006)

THE NORMAL MENSTRUAL CYCLE




This web site contains an overview of the menstrual cycle and is where I obtained the graphs above.

http://www.mydr.com.au/default.asp?article=3041


 * The Menstrual Cycle**


 * Menarche** - first menstrual cycle usually starts between 9-17 years of ages seems to be related to body fat percentage, menstrual cycles vary in length becoming more regular and predictable around the third decade, averaging 28 days.


 * Menopause** - cessation of menstrual flow approximately 2-4 years before menopause menstrual cycles begin to lengthen again.


 * Phases of the Menstrual Cycle**


 * menstruation (menses)** - more ovarian follicles begin to develop, the functional layer of the endometrium disintegrates and is discharged through the vagina, estrogen levels are low minute amount of progesterone secreted.


 * follicular/proliferative phase** - maturation of an ovarian follicle and proliferation of the endometrium, when maturation of the ovarian follicle is achieved and the endometrial lining is restored ovulation occurs.


 * luteal/secretory phase** - ovulation marks the beginning of this phase, during this phase the ovarian follicle begins its transformation into the corpus luteum and the endometrium enters the secretory phase during this time estrogen and progesterone levels begin to rise and the corpus luteum is fully developed and the endometrium is ready for implantation. If implantation does not occur the estrogen and progesterone levels begin to fall sharply and the corpus luteum regresses and the endometrium breaks down triggering menstruation.


 * hormonal controls** - the menstrual cycle depends on complex interactions among the hypothalamus, the anterior pituitary, and the ovaries, hormone levels fluctuate during the menstrual cycle depending on the phase.


 * ovarian cycle** - during this time estrogen levels drop and progesterone levels begin to rise, feedback to the hypothalamus and the anterior pituitary are negative and inhibitory, ovulation occurs 1-2 hours before the final progesterone surge, this is the peak time for conception.


 * uterine phases** - proliferative, secretory, and ischemic/menstrual phases involve cyclic endometrial changes controlled by estrogen and progesterone. Cervical mucus undergoes changes during this phase, changes in cervical mucus can be used to identify fertile intervals.
 * vaginal response** - vaginal endothelium also responds to cyclic hormonal changes, with epithelial cells of the vagina growing maximally during the follicular/proliferative phase.


 * body temperature** - undergoes characteristic biphasic changes during menstrual cycles in which ovulation occurs, during the follicular phase the body basal temperature fluctuates around 98 degrees Fahrenheit during the luteal phase the temperature increases by 0.4 - 1.0 degrees the shift in temperature is related to ovulation. These changes are used to document ovulatory cycles but are not useful to predict exact time of ovulation. (McCance, 2006)


 * Structure and Function of the Breast

breast** - "are modified sebaceous glands that lie on the ventral surface of the thorax, within the superficial fascia of the chest wall." (McCance, 2006)


 * The Female Breast** - "is composed of 15 to 20 pyramid-shaped lobes that are separated and supported by Cooper ligaments. Each lobe contains 20 - 40 lobules which divide further into many functional units called acini. Each acinus is lined with a layer of epithelial cells capable of secreting milk and a layer of sub-epithelial cells capable of contracting to squeeze milk from the acinus." (McCance, 2006)


 * nipple** - a pigmented cylindrical structure on its surface lie multiple openings one for each lobe of the breast.


 * areola** - a pigmented area on the surface of the breast surrounding the nipple has many sebaceous glands also the glands of Montgomery are located within the areola and aid in lubrication of the nipple during lactation.


 * thelarche** - "breast development" is usually the first sign of puberty in girls. A variety of hormones aid in the growth of breast tissue including estrogen, progesterone, prolactin, growth hormone, thyroid and parathyroid hormones, insulin and cortisol. "Because the length of the menstrual cycle does not allow for complete regression of new cell growth, breast growth continues at a slow rate until approximately 35 years of age." (McCance, 2006)


 * Tests of Reproduction Function**

Diagnostic tests are performed on male and female reproductive systems to determine the cause of infertility, to detect the presence of sexually transmitted infections and the presence of cancerous lesions. These test include laboratory tests, such as cultures, tests, stains, biopsies, serological testing, and hormonal assays. Radiographic procedures maybe performed to identify growths and reproductive organs maybe observed directly by laparoscopy or colposcopy. (McCance,2006)


 * Aging and the Female Reproductive System**

The transition from fertility to menopause starts about 5 years before the last menstrual period and ends the following year. During this time the ovaries produce erratic and high levels of estrogen women may experience hot flashes, breast tenderness and migraines. Menstrual cycles shorten and become irregular, menopause actually begins 1 year after the cessation of menstruation. Reduced levels of the female sex hormones cause the reproductive organs to atrophy continued sexual activity and orgasm reduce vaginal changes. Reduced estrogen levels may increase the risk of osteoporosis and coronary artery disease. (McCance, 2006)


 * Alterations of the Reproductive Systems Chapter 23**


 * Alterations of Sexual Maturation**

"The process of sexual maturation, or puberty is marked by the development of secondary sexual characteristics, rapid growth, and, ultimately the ability to reproduce." (McCance, 2006) Sexual maturation can be disrupted by congenital and endocrine disorders these disorders can cause puberty to occur to soon **(precocious puberty)** or to late **(delayed puberty)**.


 * precocious puberty** -occurs in three different forms Isosexual precocious puberty is the premature development of appropriate sex characteristics for the child's sex, Heterosexual precocious puberty causes the child to develop some secondary sex characteristics of the opposite sex, and Incomplete precocious puberty is the partial development of appropriate secondary sex characteristics. Treatment for all forms of precocious puberty includes identifying and removing the underlying cause or administering appropriate hormones.


 * delayed puberty** - delayed development of secondary sex characteristics such as breast development by the time a girl is 13 years of age and testicular enlargement by the time a male is 14 to 14.5 years of age. Through physical exam, careful questioning and laboratory testing are necessary to determine the cause of the delay. Treatment is dependent upon underlying cause and may consist of hormone therapy.

This site has great information on a level for pre-teens and teenagers to gain an understanding about what is happening with their bodies. http://www.coolnurse.com/puberty.htm


 * Disorders of the Female Reproductive System**


 * Hormonal and Menstrual Alterations**


 * Primary dysmenorrhea -** painful menstruation associated with the release of prostoglandins in the ovulatory cycles, but not with pelvic disease. (McCance, 2006)


 * Primary amenorrhea** - "is the failure of menarche and the absence of menstruation by age 14 years without the development of secondary sex characteristics or by age 16 regardless of the presence of secondary sex characteristics." (McCance, 2006)


 * Secondary amenorrhea** - "the absence of menstruation for the time equivalent to three or more cycles of 6 months in women who have previously menstruated." (McCance, 2006)


 * Abnormal uterine bleeding** - is usually experienced by women who are perimenopausal and postmenopausal, other causes include intrinsic uterine pathologic conditions, including malignancy, pregnancy and its complications, and hematologic disorders. Dysfunctional **uterine bleeding** is heavy or irregular bleeding and a diagnosis of exclusion. If all the routine cause of uterine bleeding are excluded as the cause of bleeding then the diagnosis of DUB is given. DUB accounts for 25% of gynecologic surgeries. (McCance, 2006)


 * Polycysitc ovary syndrome** - an abnormal condition characterized by anovulation, amenorrhea, hirsutism, and infertility. It is caused by an endocrine imbalance with increased levels of testosterone, estrogen, and luteinizing hormone and decreased secretion of follicle stimulating hormone.


 * Premenstrual Syndrome** - "the cyclic recurrence during the luteal phase of the menstrual cycle of distressing physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities" (McCance, 2006)


 * Infection and Inflammation**


 * Pelvic inflammatory disease** - acute inflammatory process caused by sexually transmitted microorganisms that migrate from the vagina to the uterus, fallopian tubes, and ovaries.


 * Vaginitis** - infection of the vagina the major causes of vaginitis are sexually transmitted pathogens.


 * Cervicitis** - a nonspecific term used to describe an inflammation of the cervix until a pathogen can be identified/


 * Vulvitis** - inflammation of the vulva can be caused by contact with soaps, detergents, lotions, hygienic sprays, shaving, menstrual pads etc. may also be caused by vaginal infections that spread to the labia.


 * Bartholinitis** - inflammation of one or both of the ducts that lead from the vaginal opening to the Bartholin glands, usually caused by microorganisms that infect the lower female reproductive tract such as streptococci, staphylococci, and sexually transmitted pathogens. (McCance, 2006)


 * Pelvic Relaxation Disorders** - result when the endopelvic fascia and the perineal muscles lose their tone and strength this occurs with aging, this progression can result in the failure to maintain the pelvic organs in the proper position. When the organs are not in the proper position they can prolapse through the vaginal opening.


 * Benign Growths and Proliferative Conditions**


 * Benign ovarian cysts** - are produced when a follicle or a number of follicles are stimulated but no dominant follicle develops and completes the maturity process. These cyst generally occur during the reproductive years.(McCance, 2006)


 * Endometrial polyps** - "a benign mass of endometrial tissue and contains a variable amount of glands, stoma, and blood vessels." Endometrial polyps are a common cause of intermenstrual or excessive bleeding. (McCance,2006)


 * Leiomyomas** - comminly called uterine fibroids, are benign tumors that develop from smooth muscle cells in the myometrium, usuallu benign, remain small and are asymptomatic. (McCance,2006)


 * Adenomyosis** - "is the presence of islands of endometrial glands surrounded by benign endometrial stroma within the uterine myometrium." (McCance, 2006) This tissue does not respond to cyclic homonal changes.


 * Endometriosis** - "is the presence of functioning endometrial tissue or implants outside the uterus. Like normal endometrial tissue, the ectopic endometrium responds to the hormonla fluctuations of the menstrual cycle." (McCance, 2006)


 * Cancer**


 * Cervical cancer** - cancer of the cervix is the most common cancer of women worldwide, because of increased rates of pap test the rates of invasive cervical cancer have declined, most causes of cervical cancer are attributed to the human papilloma virus.


 * Vaginal cancer** - rarest form of female genital cancer, starts with intraepithelial lesions and is associated with HPV infection.


 * Vulvar cancer** - responsible for approximately 0.4% of gynecological cancers, afflicted women generally have a history of HPV or squamous dysplaisa of the vagina or cervix.


 * Endometrial cancer and uterine sarcoma** - "arise within the grandular epithelium of the uterine lining, the primary risk factor is unopposed estrogen exposure with resultant hyperplasia." (McCance, 2006)


 * Ovarian cancer** - accounts for 3% of all cancers among women and causes more deaths than any other female cancers. Ovarian cancer risks include early menarche, late menopause, nulliparity, and use of fertility drugs. Factors that suppress ovulation decrease the risk of ovarian cancer and include multiple pregnancies, prolonged lactation, and the use of oral contraceptives. (McCance, 2006)


 * Sexual Dysfunction** - can be cause by both organic and psychological disorders. There is the disorder of desire which may be a biological manifestation of depression, substance abuse, prolactin secreting pituitary tumors, or testosterine deficiency. Vaginismus is an involuntary muscle spasm in reponse to attempted penetration. Anorgasmia the inability of the woman to reach orgasm. Rapid orgasm once orgasm occurs there is little interest in further sexual activity. Dyspareunia occurs when women experience pain during arousal, at the time of orgasm, at the initiation of intercourse, midway during intercourse, or after intercourse. (McCance, 2006)


 * Infertility** - "affects approximately 15% of all couples and is defined as the inability to conceive after 1 year of unprotected intercourse with the same partner" (McCance, 2006)


 * Fertility tests** -are performed on the male and female partners whem infertility exsists. The man is evaluated for number, amount, structure and motility of sperm and obstructon along the reproductive tract. Tests for women determine whether the reproductive tract is obstructed, ovulation is normal, the endometrium is reponding normally to hormones and reproductive tissues are free of tumors or infections. (McCance, 2006)


 * Disorders of the Female Breast**


 * Galactorrhea** - "is the persistent and sometimes excessive secretion of a milky fluid from the breastsof a woman who is not pregnant or nursing an infant." (McCance, 2006)


 * Benign breast conditions** - numerous benign alterations in ducts and lobules occur in the breat. The most common symptoms reprted by women are pain, palpable amss, or nipple discharge. Benign epthelial lesions can be broadly classified according to their future risk of developing breast cancer as (1) nonproliferative breast lesions (no increased risk), (2) proliferative breast disease (slightly increased risk), and (3) atypical (atypia) hyperpalsia (moderately increased risk).(McCance, 2006)


 * Breast cancer** - the most common cancer in American women, leading cause of death in women 40-44 years of age and the second most common cause of death after lung cancer of women of all ages. Risk fators and possible causes of breast cancer can be classisfied as reproductive, hormonal, environmental, lfestyle and familial. Although hig-risk populations can be identified 75% of breast cancer occurs in women whose only risk factor is gender and age.

This site has some informative information about diseases of the breast: http://www.stayinginshape.com/3osfcorp/libv/w28.shtml


 * Sexually Transmitted Infections Chapter 24

Sexually Transmitted Urogenital Infections

Bacterial Infections

Gonorrhea** - a sexually transmitted disease caused by the **gonococci** bacteria can affect the genitourinary tract and occasionally the pharynx, conjuctiva and rectum. Infection results from contact with an infected person or by contact with secretions containing the causative organisim. Gonorrhea can also be passed from mother to fetus.


 * Syphillis** - is caused by an anaerobic bacteria known as Treponema pallidum, syphillis is transmitted through sexual contact and can be passed from mother to fetus. Sypillis has 4 stages: Primary syphillis (Stage I) local invasion with the T. pallidum bacteria multiplying and a chancre forms. Secondary syphillis (Stage II) systemic disease with blood borne bacteria spreading to all major organs, immune system suppresses infection and symptoms regress spontaneously. Latent syphillis (Stage III) silent infection: transmission of infection possible even though there are no clinical signs of infection. Tertiary syphillis (Stage IV) noninfectious disease: significant morbidity and mortality occur. (McCance, 2006)


 * Chancroid** - a soft chancre that is an acute infection diffrentiated from syphillis in 1852, caused by a gram negative bacteria known as Haemophilus ducreyi. Usually seen in underdeveloped or developing tropical countries.


 * Granuloma inguinale** - a chronic, progressively destructive bacterial infection caused by Calymmatobacterium granulomatis, recently classified as Klebsiella granulomatis, is transmittable via sexual contact but generally repeated exposure is necessary, many times individuals with this disease also have syphillis. (McCance, 2006)


 * Bacterial vaginosis** - caused by the bacteria Haemophilus, Corynebacterium, or Gardnerella, is associated as being sexually transmitted but is not considered a sexually transmitted infection (STI).

STI in the United States with approximatley 3 million cases each year. This infection is also responsible for several other syndromes nongonococcal urethritis, mucopurulent cervicitis, and pelvic inflammatory disease (PID). Sevety-five persent of women infected with this disease are asymptomatic. Can be transmitted from mother to infant through the birth canal. (McCance, 2006)
 * Chlamydial Infections** - commonly known as Chlamydia is caused by Chlaymidia trachomatis, this is the most common


 * Urogenital infections

Lymphogranuloma venereum** - infection caused by C. trachomatis invasive serovars of strains L1, L2, or L3 is a chronic STI can be confused with syphillis, herpes or chancroid, is rare in the United States is endemic in Asia and Africa. (McCance, 2006)


 * Nongonococcal or nonspecific urethritis** - a nonreportable STI caused by C.trachomatis and Ureaplasma urealyticum.


 * Viral infections

Genital herpes** - "which causes blisters, is the most common infectous genital ulceration in the United States. In fact, genital infection with herpes simplex virus (HSV) is an epidemic in the United States." (McCance, 2006) It can be caused by HSV-type 1 or HSV-type 2, this is not a reportable disease so therefore national statistics are not available. Can be transmitted to the fetus from the mother, can be transmitted to intimate partners even when individual is asymptomatic.


 * Human papillomavirus infection** - (HPV) is the most common symptomatic viral STI in the United States, an estimated 75% of the reproductive population is infected with HPV. High risk types of HPV 16 and 18 are implicated in half the cases of cervical dysplasia. HPV types 6 and 11 cause genital warts. Infants can be infected in utero and during passage through the birth canal.


 * Molluscum contagiosum** - a benign viral infection of the skin in children and adults, presents as papules. With children can be passed through skin-to-skin contact during activiteis such as swimming or physical education. Most commonly passed between adults during sexual contact.


 * Parasitic Infections

Trichomoniasis** - caused by a microorganisim known as T. vaginalis causes lower genital tract infection and urethritis. This is a non-reportable disease so therefore the number of cases diagnosed each year is unknown.Usually both sexual partners will be infected.


 * Scabies** - benign common parasitic infection which can be spread through skin-to-skin contact or sexual contact. In order to be passed from person -to-person the skin must be in contact for a prolonged amount of time.


 * Pediculosis pubis** - pubic louse, adolescents and children are most commonly infected. Transmitted primarily by intimate sexual contact or contact with infected bed linens or clothing. Highly contagious 95% chance of contracting the disease during a single sexual encounter with an infected individual. (McCance, 2006)


 * Sexually Transmitted Infections of Other Body Systems

Gastrointestinal Infections

Shigellosis and Campylobacter enteritis** -bacteria that are transmitted thorugh contact with infected feces anal-oral route, spreads easily through household contacts by improper handwashing and anal-oral sexual practices. Contact with even a few mocrooraginisims can cause transmission.


 * Giardiasis and amebiasis** - "two enteric protozoa that are sexually transmitted, primarily among homosexual men. Although the principal route of transmission is contaminated drinking water, giardiasis and amebiasis are transmitted also by anal-oral or genital-anal contact." (McCance, 2006)


 * Hepatitis B** - is an infection of the liver, this infection can be transmitted via sexual contact, homosexual men are highly suseptible to hepatitis B virus (HBV) infection, This infection can be transmitted to the fetus from the infected mother. This infection also has a high incidence in IV drug users.


 * Systemic Disease

Epstein-Barr virus** - this virus which is transmitted orally is also capable of being harbored within the male and female genital tracts and transmitted sexually. (McCance, 2006)


 * Acquired Immunodeficiency Syndrome** - a disease involving a defect in cell-meidated immunity that has a long incubation period, follows a protracted and debilitating course, is manifested by various opportinistic infections. Was orginally found in homosexual men but now increasingly occurs in female sex partners of bisexual men. (Mosby, 1994)


 * Cytomegalovirus infection** - (CMV) is a sexually transmissible herpesvirus, causes serious illness in individuals with AIDS, in newborns, and in people being treated with immunosuppressive drugs and therapy, especially after organ transplant.

This is an excellent site to give you information on STD's such as symptoms, causes, prevention and treatment. http://www.4woman.gov/faq/stdsgen.htm

References:

Anderson, K. (1994). Mosby's Medical, Nursing, and Allied Health Dictionary. Mosby, St.Louis, Missouri, 4th Ed.

McCance, K.L. & Huether, S.E. (2006) Pathophysiology: The biologic basis for disease in adults and children. Elseiver Mosby, St.Louis, Missouri, 5th Ed. Chapters 22-24.

http://www.healthsquare.com/fgwh/wh1ch17.htm http://www.mydr.com.au/default.asp?article=3041 http://www.coolnurse.com/puberty.htm http://www.stayinginshape.com/3osfcorp/libv/w28.shtml http://www.4woman.gov/faq/stdsgen.htm

This is my contribution to the Wiki Assignment hope it is of some use to those who view it. Male Reproductive System – Chapter 22-24

McCance K. L. & Huether, Sue E. (2006). Pathophysiology: the biologic basis for disease in adults and children. Elsevier Mosby, St. Louis, MO. 5th Ed. [|www.webmd.com/content/article/46/2953_507-510.html] [|www.training.seer.cancer.gov/module_anatomy/images/ilu_repdt_male.jps] [|www.kidshealth.org/parent/medicalbody_basics/male_reproductive.html]

The purpose of the organs of the male reproductive system is to perform the following functions: · To produce, maintain and transport sperm (the male reproductive cells) and protective fluid (semen) · To discharge sperm within the female reproductive tract during sex · To produce and secrete male sex hormones responsible for maintaining the male reproductive system The male gonads, testes, or testicles, begin their development high in the abdominal cavity, near the kidneys. During the last two months before birth, or shortly after birth, they descend through the inguinal canal into the scrotum, a pouch that extends below the abdomen, posterior to the penis. Although this location of the testes, outside the abdominal cavity, may seem to make them vulnerable to injury, it provides a temperature about 3° C below normal body temperature. This lower temperature is necessary for the production of viable sperm.The scrotum consists of skin and subcutaneous tissue. A vertical septum, or partition, of subcutaneous tissue in the center

divides it into two parts, each containing one testis. Smooth muscle fibers, called the dartos muscle, in the subcutaneous tissue contract to give the scrotum its wrinkled appearance. When these fibers are relaxed, the scrotum is smooth. Another muscle, the cremaster muscle, consists of skeletal muscle fibers and controls the position of the scrotum and testes. When it is cold or a man is sexually aroused, this muscle contracts to pull the testes closer to the body for warmth.

Structure
Each testis is an oval structure about 5 cm long and 3 cm in diameter. A tough, white fibrous connective tissue capsule, the tunica albuginea, surrounds each testis and extends inward to form septa that partition the organ into lobules. There are about 250 lobules in each testis. Each lobule contains 1 to 4 highly coiled seminiferous tubules that converge to form a single straight tubule, which leads into the rete testis. Short efferent ducts exit the testes. Interstitial cells (cells of Leydig), which produce male sex hormones, are located between the seminiferous tubules within a lobule.

Spermatogenesis
Sperm are produced by spermatogenesis within the seminiferous tubules. A transverse section of a seminiferous tubule shows that it is packed with cells in various stages of development. Interspersed with these cells, there are large cells that extend from the periphery of the tubule to the lumen. These large cells are the supporting, or sustentacular cells (Sertoli's cells), which support and nourish the other cells. Early in embryonic development, primordial germ cells enter the testes and differentiate into spermatogonia, immature cells that remain dormant until puberty. Spermatogonia are diploid cells, each with 46 chromosomes (23 pairs) located around the periphery of the seminiferous tubules. At puberty, hormones stimulate these cells to begin dividing by mitosis. Some of the daughter cells produced by mitosis remain at the periphery as spermatogonia. Others are pushed toward the lumen, undergo some changes, and become primary spermatocytes. Because they are produced by mitosis, primary spermatocytes, like spermatogonia, are diploid and have 46 chromosomes. Each primary spermatocytes goes through the first meiotic division, meiosis I, to produce two secondary spermatocytes, each with 23 chromosomes (haploid). Just prior to this division, the genetic material is replicated so that each chromosome consists of two strands, called chromatids, that are joined by a centromere. During meiosis I, one chromosome, consisting of two chromatids, goes to each secondary spermatocyte. In the second meiotic division, meiosis II, each secondary spermatocyte divides to produce two spermatids. There is no replication of genetic material in this division, but the centromere divides so that a single-stranded chromatid goes to each cell. As a result of the two meiotic divisions, each primary spermatocyte produces four spermatids. During spermatogenesis there are two cellular divisions, but only one replication of DNA so that each spermatid has 23 chromosomes (haploid), one from each pair in the original primary spermatocyte. Each successive stage in spermatogenesis is pushed toward the center of the tubule so that the more immature cells are at the periphery and the more differentiated cells are nearer the center. Spermatogenesis (and oogenesis in the female) differs from mitosis because the resulting cells have only half the number of chromosomes as the original cell. When the sperm cell nucleus unites with an egg cell nucleus, the full number of chromosomes is restored. If sperm and egg cells were produced by mitosis, then each successive generation would have twice the number of chromosomes as the preceding one. The final step in the development of sperm is called spermiogenesis. In this process, the spermatids formed from spermatogenesis become mature spermatozoa, or sperm. The mature sperm cell has a head, midpiece, and tail. The head, also called the nuclear region, contains the 23 chromosomes surrounded by a nuclear membrane. The tip of the head is covered by an acrosome, which contains enzymes that help the sperm penetrate the female gamete. The midpiece, metabolic region, contains mitochondria that provide adenosine triphosphate (ATP). The tail, locomotor region, uses a typical flagellum for locomotion. The sperm are released into the lumen of the seminiferous tubule and leave the testes. They then enter the epididymis where they undergo their final maturation and become capable of fertilizing a female gamete. Sperm production begins at puberty and continues throughout the life of a male. The entire process, beginning with a primary spermatocyte, takes about 74 days. After ejaculation, the sperm can live for about 48 hours in the female reproductive tract.

Unlike the female reproductive system, most of the male reproductive system is located outside of the body. These external structures include the penis, scrotum, and testicles. · **Penis:** This is the male organ used in sexual intercourse. It has 3 parts: the root, which attaches to the wall of the abdomen; the body, or shaft; and the glans, which is the cone-shaped part at the end of the penis. The glans, also called the head of the penis, is covered with a loose layer of skin called foreskin. (This skin is sometimes removed in a procedure called [|circumcision].) The opening of the urethra, the tube that transports semen and urine, is at the tip of the penis. The penis also contains a number of sensitive nerve endings. The body of the penis is cylindrical in shape and consists of 3 circular shaped chambers. These chambers are made up of special, sponge-like tissue. This tissue contains thousands of large spaces that fill with blood when the man is sexually aroused. As the penis fills with blood, it becomes rigid and erect, which allows for penetration during sexual intercourse. The skin of the penis is loose and elastic to accommodate changes in penis size during an erection. Semen, which contains sperm (reproductive cells), is expelled (ejaculated) through the end of the penis when the man reaches sexual climax (orgasm). When the penis is erect, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm.



· **Scrotum:** This is the loose pouch-like sac of skin that hangs behind the penis. It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum acts as a "climate control system" for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than body temperature. Special muscles in the wall of the scrotum allow it to contract and relax, moving the testicles closer to the body for warmth or farther away from the body to cool the temperature. · **Testicles (testes):** These are oval organs about the size of large olives that lie in the scrotum, secured at either end by a structure called the spermatic cord. Most men have two testes. The testes are responsible for making testosterone, the primary male sex hormone, and for generating sperm. Within the testes are coiled masses of tubes called seminiferous tubules. These tubes are responsible for producing sperm cells. The internal organs of the male reproductive system, also called accessory organs, include the following: · **Epididymis:** The epididymis is a long, coiled tube that rests on the backside of each testicle. It transports and stores sperm cells that are produced in the testes. It also is the job of the epididymis to bring the sperm to maturity, since the sperm that emerge from the testes are immature and incapable of fertilization. During sexual arousal, contractions force the sperm into the vas deferens. · **Vas deferens:** The vas deferens is a long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind the bladder. The vas deferens transports mature sperm to the urethra, the tube that carries urine or sperm to outside of the body, in preparation for ejaculation. · **Ejaculatory ducts:** These are formed by the fusion of the vas deferens and the seminal vesicles (see below). The ejaculatory ducts empty into the urethra. · **Urethra:** The urethra is the tube that carries urine from the bladder to outside of the body. In males, it has the additional function of ejaculating semen when the man reaches orgasm. When the penis is erect during sex, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm. · **Seminal vesicles:** The seminal vesicles are sac-like pouches that attach to the vas deferens near the base of the bladder. The seminal vesicles produce a sugar-rich fluid (fructose) that provides sperm with a source of energy to help them move. The fluid of the seminal vesicles makes up most of the volume of a man's ejaculatory fluid, or ejaculate. · **Prostate gland:** The prostate gland is a walnut-sized structure that is located below the urinary bladder in front of the rectum. The prostate gland contributes additional fluid to the ejaculate. Prostate fluids also help to nourish the sperm. The urethra, which carries the ejaculate to be expelled during orgasm, runs through the center of the prostate gland. · **Bulbourethral glands:** Also called Cowper's glands, these are pea-sized structures located on the sides of the urethra just below the prostate gland. These glands produce a clear, slippery fluid that empties directly into the urethra. This fluid serves to lubricate the urethra and to neutralize any acidity that may be present due to residual drops of urine in the urethra. The entire male reproductive system is dependent on hormones, which are chemicals that regulate the activity of many different types of cells or organs. The primary hormones involved in the male reproductive system are follicle-stimulating hormone, luteinizing hormone, and testosterone. Follicle-stimulating hormone is necessary for sperm production (spermatogenesis) and luteinizing hormone stimulates the production of testosterone, which is also needed to make sperm. Testosterone is responsible for the development of male characteristics, including muscle mass and strength, fat distribution, bone mass, facial hair growth, voice change and sex drive. \ The male sexual response includes erection and orgasm accompanied by ejaculation of semen. Orgasm is followed by a variable time period during which it is not possible to achieve another erection. Three hormones are the principle regulators of the male reproductive system. Follicle-stimulating hormone (FSH) stimulates spermatogenesis; luteinizing hormone (LH) stimulates the production of [|testosterone]; and testosterone stimulates the development of male secondary sex characteristics and spermatogenesis. Priapism is a persistent, often painful erection lasting more than 4 hours in duration. The priapism erection is not associated with sexual activity and is not relieved by orgasm. It occurs when blood flows into the penis but is not adequately drained. Common causes of priapism include: Treatment for priapism is a medical emergency, because a prolonged erection can scar the penis and result in a long term complication of erectile dysfunction if if not treated. The goal of treatment is to relieve the erection and preserve normal penile function. In most cases, treatment involves draining the blood using a needle placed in the side of the penis. Medications that help shrink blood vessels, which decreases blood flow to the penis, also may be used. In rare cases, surgery may be required to avoid permanent damage to the penis. If the condition is due to sickle cell disease, a blood transfusion may be necessary. Treating any underlying medical condition or substance abuse problem is important to preventing priapism.
 * Priapism?**
 * Alcohol or drug abuse (especially cocaine)
 * Certain medications, including some antidepressants and blood pressure medications
 * Spinal cord problems
 * Injury to the genitals
 * Anesthesia
 * Penile injection therapy (a treatment for [|erectile dysfunction])
 * Blood diseases, including leukemia and sickle cell anemia

Peyronie's disease is a condition in which a plaque, or hard lump, forms on the penis. The plaque may develop on the upper (more common) or lower side of the penis, in the layers that contain erectile tissue. The plaque often begins as a localized area of irritation and swelling (inflammation), and can develop into a hardened scar. The scarring reduces the elasticity of the penis in the area affected. Peyronie's disease can occur in a mild form that heals without treatment in six to 18 months. In these cases, the problem does not progress past the inflammation phase. In severe cases, the disease can be permanent. The hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In addition to the bending of the penis, Peyronie's disease can cause general pain as well as painful erections. It also can cause emotional distress, and affect a man's desire and ability to function during sex. The exact cause of Peyronie's disease is unknown. In people whose disease develops quickly, lasts a short time and goes away without treatment, the likely cause is trauma (hitting or bending) that causes bleeding inside the penis. However, in some people, Peyronie's disease develops slowly and is severe enough to require surgical treatment. Other possible causes of Peyronie's disease include: There are two ways in which Peyronie's disease can be treated: surgery or non-surgical treatment. Because the plaque of Peyronie's disease often shrinks or disappears without treatment, most doctors suggest waiting one to two years or longer before attempting to correct it with surgery. In many cases, surgery produces positive results. But because complications can occur, and because many of the problems associated with Peyronie's disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on men with curvatures so severe that sexual intercourse is impossible. There are two surgical techniques used to treat Peyronie's disease. One method involves the removal of the plaque followed by placement of a patch of skin or artificial material (skin graft). With the second technique, the surgeon removes or pinches the tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis. [|Penile implants] can be used in cases where Peyronie's disease has affected the man's ability to achieve or maintain an erection. A non-surgical treatment for Peyronie's disease involves injecting medication directly into the plaque in an attempt to soften the affected tissue, decrease the pain, and correct the curvature of the penis. Vitamin E pills have also been shown to benefit some men with Peyronie's disease. Another, less invasive option is laser treatment to thin the plaques of Peyronie's disease.
 * Peyronie's Disease?**
 * **Vasculitis.** This is an inflammation of blood or lymphatic vessels. This inflammation can lead to the formation of scar tissue.
 * **Connective tissue disorders.** According to the National Institutes of Health, about 30% of men with Peyronie's disease also develop disorders that affect the connective tissue in other parts of their bodies, such as the hands and feet. These conditions generally cause a thickening or hardening of the connective tissue. Connective tissue is specialized tissue -- such as cartilage, bone and skin -- that acts to support other body tissues.
 * **Heredity.** Some studies suggest that a man who has a relative with Peyronie's disease is at greater risk for developing the disease himself.

Balanitis is an inflammation of the head of the penis. A similar condition, //balanoposthitis//, refers to inflammation of the head of the penis and the foreskin. Symptoms of balanitis include redness or swelling, itching, rash, pain and a foul-smelling discharge. Balanitis most often occurs in men and boys who have not been [|circumcised] (had their foreskin surgically removed), and who have poor hygiene. Inflammation can occur if the sensitive skin under the foreskin is not washed regularly, allowing sweat, debris, dead skin and bacteria to collect under the foreskin and cause irritation. The presence of tight foreskin may make it difficult to keep this area clean and can lead to irritation by a foul-smelling substance (smegma) that can accumulate under the foreskin. Other causes of balanitis may include: In addition, men with diabetes are at greater risk for balanitis. Glucose (sugar) in the urine that is trapped under the foreskin serves as a breeding ground for bacteria. Treatment for balanitis depends on the underlying cause. If there is an infection, treatment will include an appropriate antibiotic or antifungal medication. In cases of severe or persistent inflammation, a [|circumcision] may be recommended. Taking appropriate hygiene measures can help prevent future bouts of balanitis, such as retracting the foreskin daily and adequately cleaning and drying the head of the penis. In addition, it is important to avoid strong soaps or chemicals, especially those known to cause a skin reaction. Phimosis is a condition in which the foreskin of the penis is so tight that it cannot be pulled back (retracted) to reveal the head of the penis. Phimosis, which is seen most often in children, may be present at birth. It also can be caused by an infection, or by scar tissue that formed as a result of injury or chronic inflammation. Another cause of phimosis is balanitis, which leads to scarring and tightness of the foreskin. Immediate medical attention is necessary if the condition makes urination difficult or impossible. Treatment of phimosis may include gentle, manual stretching of the foreskin over a period of time. Sometimes, the foreskin can be loosened with medication applied to the penis. Circumcision, the surgical removal of the foreskin, often is used to treat phimosis. Another surgical procedure, called preputioplasty, involves separating the foreskin from the glans (head of the penis). This procedure preserves the foreskin and is less traumatic than circumcision.
 * Balanitis?**
 * **Dermatitis/allergy.** Dermatitis is an inflammation of the skin, often caused by an irritating substance or a contact allergy. Sensitivity to chemicals in certain products -- such as soaps, detergents, perfumes and spermicides -- can cause an allergic reaction, including irritation, itching and a rash.
 * **Infection.** Infection with the yeast //candida albicans// (thrush) can result in an itchy, red, spotty rash. Certain sexually transmitted diseases -- including gonorrhea, herpes and syphilis -- can produce symptoms of balanitis.
 * Phimosis?**

Paraphimosis occurs when the foreskin, once retracted, cannot return to its original location. It is a medical emergency that can cause serious complications if not treated. Paraphimosis may occur after an erection or sexual activity, or as the result of injury to the head of the penis. With paraphimosis, the foreskin becomes stuck behind the ridge of the head of the penis. If this condition is prolonged, it can cause pain and swelling, and impair blood flow to the penis. In extreme cases, the lack of blood flow can result in the death of tissue (gangrene), and amputation of the penis may be necessary. Treatment of paraphimosis focuses on reducing the swelling of the glans and foreskin. Applying ice may help reduce swelling, as may applying pressure to the glans to force out blood and fluid. If these measures fail to reduce swelling and allow the foreskin to return to its normal position, an injection of medication to help drain the penis may be necessary. In severe cases, a surgeon may make small cuts in the foreskin to release it. [|Circumcision] also may be used as a treatment for paraphimosis. Penile cancer is a rare form of cancer that occurs when abnormal cells in the penis divide and grow uncontrolled. Certain benign (non-cancerous) tumors may progress and become cancer. The exact cause of penile cancer is not known, but there are certain risk factors for the disease. A risk factor is anything that increases a person's chance of getting a disease. The risk factors for cancer of the penis may include the following: Symptoms of penile cancer include growths or sores on the penis, abnormal discharge from beneath the foreskin, and bleeding. Surgery to remove the cancer is the most common treatment for penile cancer. A doctor may take out the cancer using one of the following operations: Radiation, which uses high-energy rays to attack cancer, and chemotherapy, which uses drugs to kill cancer, are other treatment options.
 * Paraphimosis?**
 * Penile Cancer?**
 * **Uncircumcision.** Men who are not circumcised at birth have a higher risk for getting cancer of the penis.
 * **[|Human papilloma virus (HPV) infection].** HPV includes more than 100 types of viruses that can cause warts (papillomas). Certain types of HPV can infect the reproductive organs and the anal area. These types of HPV are passed from one person to another during sexual contact.
 * **Smoking.** Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs.
 * **Smegma.** Oily secretions from the skin can accumulate under the foreskin of the penis. The result is a thick, bad-smelling substance called smegma. If the penis is not cleaned thoroughly, the presence of smegma can cause irritation and inflammation.
 * **Phimosis.** This is a condition in which the foreskin becomes constricted and difficult to retract.
 * **Treatment for psoriasis.** The skin disease psoriasis is sometimes treated with a combination of medication and exposure to ultraviolet light, which may increase a person's risk for penile cancer.
 * **Age.** Over half of the cases of penile cancer occur in men over age 68.
 * **Wide local excision** takes out only the cancer and some normal tissue on either side.
 * **Electrodessication and curettage** removes the cancer by scraping the tumor with a curette (thin, long instrument with a scraping edge) and applying an electric current to the area to kill cancer cells.
 * **Cryosurgery** uses liquid nitrogen to freeze and kill the cancer cells.
 * **Microsurgery** (Moh's surgery) is an operation that removes the cancer and as little normal tissue as possible. During this surgery, the doctor uses a microscope to look at the cancerous area to make sure all the cancer cells are removed.
 * **Laser surgery** uses a narrow beam of light to remove cancer cells.
 * **Circumcision** is an operation that removes the foreskin.
 * **Amputation of the penis (penectomy)** is an operation that removes the penis. It is the most common and most effective treatment of cancer of the penis. In a partial penectomy, part of the penis is removed. In a total penectomy, the whole penis is removed. Lymph nodes in the groin may be taken out during surgery.
 * **Testicular trauma.** Even a mild injury to the testicles can cause severe pain, bruising, or swelling. Most testicular injuries occur when the testicles are struck, hit, kicked, or crushed, usually during sports or due to other trauma. Testicular torsion, when 1 of the testicles twists around, cutting off the blood supply, is also a problem that some teen males experience - although it's not common. Surgery is needed to untwist the cord and save the testicle.
 * **Varicocele.** This is a varicose vein (an abnormally swollen vein) in the network of veins that run from the testicles. Varicoceles commonly develop while a boy is going through puberty. A varicocele is usually not harmful, although in some people it may damage the testicle or decrease sperm production, so it helps for you to take your child to see his doctor if he is concerned about changes in his testicles.
 * **Hydrocele.** A hydrocele occurs when fluid collects in the membranes surrounding the testes. Hydroceles may cause swelling of the testicle but are generally painless. In some cases, surgery may be needed to correct the condition.
 * **Inguinal** [|**hernia**]. When a portion of the intestines pushes through an abnormal opening or weakening of the abdominal wall and into the groin or scrotum, it is known as an inguinal hernia. The hernia may look like a bulge or swelling in the groin area. It can be corrected with surgery.

Within the scrotum, the testicles are secured at either end by a structure called the [|spermatic cord]. Sometimes, this cord gets twisted around a testicle, cutting off the blood supply to the testicle. Symptoms of testicular torsion include sudden and severe pain, enlargement of the affected testicle, tenderness, and swelling. This condition, which occurs most often in young males less than 25 years of age, can result from an injury to the testicles or from strenuous activity. It also can occur for no apparent reason. Testicular torsion requires immediate medical attention. Treatment usually involves correction of the problem through surgery. Testicular function may be saved if the condition is diagnosed and corrected immediately. If the blood supply to the testicle is cut off for a long period of time, the testicle can become permanently damaged and may need to be removed.
 * Testicular Torsion**


 * Testicular Cancer**

Testicular cancer occurs when abnormal cells in the testicles divide and grow uncontrolled. In some cases, certain benign (non-cancerous) tumors may progress and become cancer. Testicular cancer can develop in one or both testicles in men or young boys. Symptoms of testicular cancer include a lump, irregularity or enlargement in either testicle; a pulling sensation or feeling of unusual heaviness in the scrotum; a dull ache in the groin or lower abdomen; and pain or discomfort (which may come and go) in a testicle or the scrotum. The exact causes of testicular cancer are not known, but there are certain risk factors for the disease. A risk factor is anything that increases a person's chance of getting a disease. The risk factors for cancer of the testicles include: Testicular cancer is a rare form of cancer, and is highly treatable and usually curable. Surgery is the most common treatment for testicular cancer. Surgical treatment involves removing one or both testicles through an incision (cut) in the groin. In some cases, the doctor also may remove some of the lymph nodes in the abdomen. Radiation, which uses high-energy rays to attack cancer, and chemotherapy, which uses drugs to kill cancer, are other treatment options. Removing the testicle should not lead to problems with having sex or children. The remaining testicle will continue making sperm and the male hormone testosterone. To re-establish a normal appearance, a man may be able to have a testicular prosthesis surgically implanted in the scrotum which looks and feels like a normal testicle. The success of treatment for testicular cancer depends on the stage of the disease when it is first detected and treated. If the cancer is found and treated before it spreads to the lymph nodes, the cure rate is very high, greater than 98%. Even after testicular cancer has spread to the lymph nodes treatment is highly effective, with a cure rate greater than 90%. To prevent testicular cancer, all men should be familiar with the size and feel of their testicles, so they can detect any changes. Most doctors feel that recognizing a lump early is an important factor in the successful treatment of testicular cancer and recommend monthly testicular [|self-examinations] in combination with routine physical exams for all men after puberty. Testicular self-exam is a way that men can examine themselves to look for signs of cancer of the testicles. To do a self-exam, follow these steps. 1. Do the exam after a warm shower or bath. The warmth relaxes the skin of the scrotum, making it easier to feel for anything unusual. 2. Use both hands to examine each testicle. Place your index and middle fingers underneath the testicle and your thumbs on top. Roll the testicle between your thumbs and fingers. (It's normal for testicles to be different in size.) 3. As you feel the testicle, you may notice a cord-like structure on top and in back of the testicle. This structure is called the epididymis. It stores and transports sperm. Do not confuse it with a lump. 4. Feel for any lumps. Lumps can be pea-size or larger and are often painless. If you notice a lump, contact your doctor. Also check for any change in size, shape or consistency of the testes. 5. You should also get a physical exam once a year.
 * **Age.** Testicular cancer can occur at any age, but most often occurs in men between the ages of 15 and 40.
 * **Undescended testicle.** This is a condition in which the testicles do not descend from the abdomen, where they are located during fetal development, to the scrotum shortly before birth. This condition is a major risk factor for testicular cancer.
 * **Family history.** A family history of testicular cancer increases the risk.
 * **Race and ethnicity.** The risk for testicular cancer in white men is more than five times that of black men and more than double that of Asian-American men.

Epididymitis is inflammation of the epididymis. The epididymis is the coiled tube that lies on and around each testicle. It functions in the transport, storage and maturation of sperm cells that are produced in the testicles. The epididymis connects the testicles with the vas deferens (the tubes that carry sperm). Epididymitis often is caused by infection or by the sexually transmitted disease [|chlamydia]. In men over 40 years of age the most common cause is due to bacteria in the urinary tract. Symptoms of epididymitis include scrotal pain and swelling. Discharge from the penis, painful urination and painful intercourse or ejaculation may also be present. In severe cases, the infection can spread to the adjacent testicle, causing fever and abscess (collection of pus). Treatment for epididymitis includes antibiotics (drugs that kill the bacteria causing the infection), bed rest, ice to reduce swelling, the use of a scrotal supporter and anti-inflammatory medicines (such as ibuprofen). Partners will need to be treated if the epididymitis is due to a sexually transmitted infection to prevent re-infection. If left untreated, epididymitis can produce scar tissue, which can block the sperm from leaving the testicle. This can cause problems with fertility, especially if both testicles are involved or if the man has recurring infections. The use of condoms during sex can help prevent epididymitis caused by chlamydia or gonorrhea. One function of the testes is to secrete the hormone testosterone. This hormone plays an important role in the development and maintenance of many male physical characteristics. These include muscle mass and strength, fat distribution, bone mass, sperm production, and sex drive. Hypogonadism in men is a condition that occurs when the testicles (gonads) do not produce enough testosterone. Primary hypogonadism occurs when there is a problem or abnormality in the testicles themselves. Secondary hypogonadism occurs when there is a problem with the pituitary gland in the brain, which sends chemical messages to the testicles to produce testosterone. Hypogonadism can occur during fetal development, at puberty or in adult men. When it occurs in adult men, hypogonadism may cause the following problems: There are various causes of hypogonadism, including: Treatment for hypogonadism depends on the cause. Male hormone replacement (testosterone replacement therapy or TRT) often is used to treat disorders of the testicles. If the problem is related to the pituitary gland, pituitary hormones may help increase testosterone levels and sperm production.
 * Epididymitis**
 * What Is Hypogonadism**
 * Erectile dysfunction (the inability to achieve or maintain an [|erection])
 * Infertility
 * Decreased sex drive
 * Decrease in beard and growth of body hair
 * Decrease in size or firmness of the testicles
 * Decrease in muscle mass and increase in body fat
 * Loss of bone mass (osteoporosis)
 * Enlarged male breast tissue
 * Mental and emotional symptoms similar to those of menopause in women (hot flashes, mood swings, irritability, depression, fatigue)
 * **Klinefelter's syndrome.** This syndrome involves the presence of abnormal sex chromosomes. A male normally has one X chromosome and one Y chromosome. The Y chromosome contains the genetic material with the codes that determine the male gender, and related masculine characteristics and development. Males with Klinefelter's syndrome have an extra X chromosome, which causes abnormal development of the testicles.
 * **Undescended testicles.**
 * **Hemochromatosis.** This condition is marked by too much iron in the blood, and can cause the testicles or the pituitary gland to malfunction.
 * **Testicular trauma.** Damage to the testicles can affect the production of testosterone.
 * **Cancer treatment.** Chemotherapy or radiation therapy, common treatments for cancer, can interfere with testosterone and sperm production by the testicles.
 * **Normal aging.** Older men generally have lower levels of testosterone, although the decline of the hormone varies greatly among men.
 * **Pituitary disorders.** Problems affecting the pituitary gland, (a small organ in the middle of the brain) including a head injury or tumor, can interfere with the gland's ability to send hormonal signals to the testicles to produce testosterone.
 * **Medications.** Certain drugs can affect testosterone production. These include some commonly used psychiatric drugs.

Sexual Problems in Men A sexual problem, or sexual dysfunction, refers to a problem during any phase of the [|sexual response cycle] that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution. While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor. Sexual dysfunction can be a result of a physical or psychological problem. · **Physical causes:** Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function. · **Psychological causes:** These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma. Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the geriatric population, which may be related to a decline in health associated with aging. The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire. There are different types of ejaculation disorders, including: · **Premature ejaculation** -- This refers to ejaculation that occurs before or soon after penetration. · **Inhibited or retarded ejaculation** -- This is when ejaculation is slow to occur. · **Retrograde ejaculation** -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis. In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back. Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility. Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (hardening of the arteries); nerve disorders; psychological factors, such as stress, depression, and performance anxiety (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie's disease (scar tissue in the [|penis]) also can cause erectile dysfunction. Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses, such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties. Several tests can be used to evaluate the causes and extent of sexual problems. They include: · **Blood tests** -- These tests are done to evaluate hormone levels. · **Vascular assessment** -- This involves an evaluation of the blood flow to the penis. A blockage in a blood vessel supplying blood to the penis may be contributing to erectile dysfunction. · **Sensory testing** -- Particularly useful in evaluating the effects of diabetic neuropathy (nerve damage), sensory testing measures the strength of nerve impulses in a particular area of the body. · **Nocturnal penile tumescence and rigidity testing** -- This test is used to monitor erections that occur naturally during sleep. This test can help determine if a man's erectile problems are due to physical or psychological causes. Many cases of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Treatment strategies may include the following: · **Medical treatment** -- This involves treatment of any physical problem that may be contributing to a man's sexual dysfunction. · **Medications** -- Medications, such as Cialis, Viagra or Levitra, may help improve sexual function in men by increasing blood flow to the penis. · **Hormones** -- Men with low levels of testosterone may benefit from hormone supplementation (testosterone replacement therapy). · **Psychological therapy** -- Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual function. · **Mechanical aids** -- Aids such as vacuum devices and penile implants may help men with erectile dysfunction. · **Education and communication** -- Education about sex and sexual behaviors and responses may help a man overcome his anxieties about sexual performance. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life. The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners. While sexual problems cannot be prevented, dealing with the underlying causes of the dysfunction can help you better understand and cope with the problem when it occurs. There are some things you can do to help maintain good sexual function: · Follow your doctor's treatment plan for any medical/health conditions. · Limit your alcohol intake. · Quit smoking. · Deal with any emotional or psychological issues such as stress, depression, and anxiety. Get treatment as needed. · Increase communication with your partner. Sexually transmitted diseases (STDs) that can affect boys include human immunodeficiency virus/acquired immunodeficiency syndrome ([|HIV/AIDS]), human papillomavirus (HPV, or genital warts), syphilis, chlamydia, gonorrhea, genital herpes, and hepatitis B. They are spread from 1 person to another mainly through sexual intercourse. Chlamydia Chlamydia is one of the most common sexually transmitted diseases in the U.S. This infection is easily spread because it often causes no symptoms and may be unknowingly passed to sexual partners. In fact, about 75% of infections in women and 50% in men are without symptoms. Symptoms are usually noticeable within 1-3 weeks of contact and can include the following: · Small amounts of clear or cloudy discharge from the tip of the penis · Painful urination · Burning and itching around the opening of the penis · Pain and swelling around the testicles There are a few different tests your doctor can use to check for chlamydia. He or she will probably use a swab to take a sample from the urethra in men or from the cervix in women and then will send the specimen to a laboratory to be analyzed. There are also other tests which check a urine sample for the presence of the bacteria. If you have chlamydia, your doctor will prescribe oral antibiotics, usually azithromycin (Zithromax) or doxycycline. Your doctor will also recommend your partner(s) be treated as well to prevent reinfection and further spread of the disease. With treatment, the infection should clear up in about a week or two. It is important to finish all of your antibiotics even if you feel better. Women with severe infection may require hospitalization, intravenous antibiotics (medicine given through a vein), and pain medicine. After taking antibiotics, people should be retested to be sure the infection is cured. This is particularly important if you are unsure that your partner(s) obtained treatment. Do not have sex until you are sure both you and your partner no longer have the disease. If you do not get treated for Chlamydia, you run the risk of several health problems. · **For men.** Chlamydia can cause a condition called nongonococcal urethritis (NGU) - an infection of the urethra (the tube by which men and women pass urine), epididymitis - an infection of the epididymis (the tube that carries sperm away from the testes) or proctitis - an inflammation of the rectum. Gonorrhea Also called the "clap" or "drip," gonorrhea is a contagious disease transmitted most often through sexual contact with an infected person. Gonorrhea may also be spread by contact with infected bodily fluids, so that a mother could pass on the infection to her newborn during childbirth. Both men and women can get gonorrhea. The infection is easily spread and occurs most often in people who have many sex partners. Gonorrhea is caused by //Neisseria gonorrhoeae//, a bacterium that can grow and multiply easily in mucus membranes of the body. Gonorrhea bacteria can grow in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb) and fallopian tubes (egg canals) in women, and in the urethra (the tube that carries urine from the bladder to outside the body) in women and men. The bacteria can also grow in the mouth, throat, and anus. Gonorrhea is a very common infectious disease. In the U.S. each year, about 700,000 people are infected with gonorrhea, and about 75% of all reported gonorrhea is found in younger persons aged 15 to 29. The highest rates of infection are usually found in 15- to 19-year-old women and 20- to 24-year-old men. Not all people infected with gonorrhea have symptoms, so knowing when to seek treatment can be tricky. When symptoms do occur, they are often within 2-10 days after exposure, but can take up to 30 days and include the following: · Greenish yellow or whitish discharge from the penis · Burning when urinating · Burning in the throat (due to oral sex) · Painful or swollen testicles · Swollen glands in the throat (due to oral sex) Your doctor will use a swab to take a [|sample] of fluid from the urethra in men or from the cervix in women. The specimen will then be sent to a laboratory to be analyzed. You also may be given a throat or anal culture to see if the infection is in your throat or anus. There are other tests which check a urine sample for the presence of the bacteria. You may need to wait for several days for your tests to come back from the lab. Gonorrhea and [|chlamydia], another common STD, often occur together, so you may be tested and treated for both. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can sometimes lead to infertility if left untreated. Without prompt treatment, gonorrhea can also affect the prostate and can lead to scarring inside the urethra, making urination difficult. Gonorrhea can spread to the blood or joints. This condition can be life-threatening. Also, people with gonorrhea can more easily contract HIV, the virus that causes [|AIDS]. People with HIV infection and gonorrhea are more likely than people with HIV infection alone to transmit HIV to someone else. Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex. Occasionally, the disease can be passed to another person through prolonged kissing or close bodily contact with an infected person. Although this disease is spread from sores, the vast majority of these sores go unrecognized. The infected person is often unaware of the disease and unknowingly passes it on to their sexual partner. Pregnant women with the disease can spread it to their baby. This disease, called congenital syphilis, can cause abnormalities or even death to the child. Syphilis is caused by the bacteria //Treponema pallidum.// This sexually transmitted disease was once a major public health threat, commonly causing serious long-term health problems such as arthritis, brain damage, and blindness. It defied effective treatment until the late 1940s, when the antibiotic penicillin was first developed. According to the CDC, the rate of new cases of syphilis had plummeted in the 1990's and in the year 2000 it reached an all time low since reporting began in 1941. However, since 2001 new cases are again on the rise. Syphilis can be easily diagnosed with a quick and inexpensive blood test. If you have a chancre, a swab or scraping of the sore will be taken for evaluation. If you've been infected for less than a year, a single dose of penicillin is usually enough to destroy the infection. For those allergic to penicillin, tetracycline or doxycycline can be given instead. If you are in a later stage of disease, more doses will be needed. People who are being treated for syphilis must abstain from sexual contact until the infection is completely gone. Sexual partners of people with syphilis should be tested and, if necessary, treated. Genital Herpes Genital herpes is a highly contagious infection usually spread through intercourse with a person with infected sores, but it can be passed through oral or anal sex as well. It may also be spread even when sores are not visible. Usually, this infection is caused by the herpes simplex virus-2 (HSV-2) although herpes simplex virus-1 (HSV-1), the virus responsible for cold sores, may occasionally cause this disease. It can be spread by an infected partner who does not have any sores and may not even know they have the disease. At least 45 million American adults and adolescents have genital herpes -- that's 1 out of every 4 to 5 people, making it one of the most common sexually transmitted diseases. Since the late 1970s, the number of Americans with genital herpes infection has increased 30%, mostly in teens and young adults. Genital herpes is more common in women than in men. Most people infected with genital herpes have very minimal or no signs or symptoms of their disease. The first attack of herpes usually follows this course: skin on or near the sex organ becomes inflamed. Skin may burn, itch or be painful; blister-like sores appear on or near the sex organs; and sores open, scab over, and then heal. Symptoms that may also be present when the virus first appears include: Swollen glands; fever; headache; burning when passing urine; and muscle aches. Some commonly reported triggers include: stress; illness; surgery; vigorous sex; diet; and monthly period. The first outbreak of herpes can last for several weeks. After the outbreak, the virus retreats to the nervous system, where it remains inactive until something triggers it to become active again. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first episode. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years. How often outbreaks occur depends on the person. On average, people with herpes experience about four outbreaks a year. The first outbreak usually is the most painful and takes the longest to heal. The pain and recovery time often decrease with each outbreak. Diagnosis of genital herpes by visual inspection if the outbreak is typical, and also by taking a sample from the sore(s). But, HSV infections can be difficult to diagnose between outbreaks. Your doctor may check for ulcers internally -- on the cervix in women and the urethra in men. Blood tests that detect HSV-1 or HSV-2 infection may be helpful, although the results are not always easy to interpret. There is no cure for genital herpes, anti-virus medicines, in pill or ointment form, may help the sores heal faster. Trichomoniasis is a sexually transmitted disease caused by a small organism called //Trichomonas vaginalis//. Women are most often affected by this disease, although men can become infected and pass the infection on to their partners through sexual contact. Trichomoniasis is the most common curable STD in young, sexually active women. An estimated 7.4 million new cases occur each year in women and men. Men often do not have symptoms and usually do not know they are infected until their partners need treatment. But when symptoms do occur, they include: irritation inside the penis; mild discharge; and slight burning after urination or ejaculation. To diagnose trichomoniasis, a physical examination and laboratory test is needed. Laboratory tests are performed on a sample of vaginal fluid or urethral fluid to look for the disease-causing parasite. The parasite is harder to detect in men than in women. Usually an oral antibiotic called metronidazole (Flagyl) is given to treat trichomoniasis. Before taking this medication, it is very important to let your doctor know if there is any chance that you could be pregnant, since the drug could harm the baby.
 * Ejaculation Disorders**
 * Erectile Dysfunction**
 * Inhibited Sexual Desire**
 * STDs**
 * Syphilis**
 * Early or primary syphilis.** People with primary syphilis will develop one or more chancre sores. The sores resemble large round bug bites and are often hard and painless. They occur on the genitals or in or around the mouth somewhere between 10-90 days (average 3 weeks) after exposure. Even without treatment they heal without a scar within 6 weeks.
 * The secondary stage** may last 1-3 months and begins within 6 weeks to 6 months after exposure. People with secondary syphilis experience a rosy "copper penny" rash typically on the palms of the hands and soles of the feet. They may also experience moist warts in the groin, white patches on the inside of the mouth, swollen lymph glands, fever, and weight loss. Like primary syphilis, secondary syphilis will resolve without treatment.
 * Latent syphilis.** This is where the infection lies dormant (inactive) without causing symptoms.
 * Tertiary syphilis.** If the infection isn't treated, it may then progress to a stage characterized by severe problems with the heart, brain, and nerves that can result in paralysis, blindness, dementia, deafness, impotence and even death if it's not treated.
 * Trichomoniasis**

Orchitis (or-KITE-iss) is an inflammation of one or both testicles, usually resulting from an infection. The inflammation doesn't affect the production of male hormones, and very rarely results in sterility. The most common causes are urinary tract infections, sexually transmitted infections such as gonorrhea, and cases of mumps contracted after puberty. Pain, swelling, or redness of the testicle is often accompanied by fever. You may feel a lump in the testicle.
 * Orchitis**

Treatment Be careful not to injure the inflamed testicle for 2 or 3 months. When you resume normal activities, wear an athletic supporter (jock strap) or two pairs of briefs.
 * For many types of infection, the doctor can prescribe an antibiotic. If the problem is caused by mumps, however, there are no drugs to speed recovery. Simply follow the instructions below to make area as comfortable as possible.
 * Rest in bed until fever, pain, and swelling go down. Your testicle may stay swollen and hard for several days or even a few weeks.
 * If your doctor prescribes an antibiotic to fight infection, take it exactly as prescribed and be sure to finish the entire the prescription. If you stop taking the drug too soon, some germs may survive and re-infect you.
 * To help relieve pain and swelling, place a rolled-up towel between your legs under the scrotum. This helps support the weight of the scrotum and tender testicles. Wearing briefs (jockey shorts) also provides support.
 * Apply either cold or heat to the swollen area, whichever relieves the pain best. You may use warm or cold compresses, ice packs, an electric heating pad set on low, or a hot water bottle filled with warm water. Sitting in a warm bath for 15 minutes twice a day will help reduce the swelling more quickly. You may also use acetaminophen, aspirin, or ibuprofen
 * Don't drink alcohol, tea, coffee, or carbonated beverages; they irritate the urinary system. Eat foods such as prunes, fresh fruit, whole-grain cereals, and nuts to prevent constipation.
 * If the problem is caused by a sexually transmitted disease, remember that you can pass the infection to a partner; wait at least 1 month after all symptoms disappear before having sex. Using a condom will help to prevent the spread of infection.


 * Prostatitis**

Prostatitis (PRAH-stuh-TIE-tus) is an inflammation and swelling of the prostate (PRAH-state), the donut-shaped gland that sits at the base of the bladder and surrounds the urinary canal (urethra). Prostatitis occurs most often in older men whose prostates have grown larger than normal.

The problem is sometimes the result of infection by bacteria, which can travel up the urethra or reach the prostate through the blood. In some cases, no specific cause can be found.

Typical symptoms include the urge to urinate right away and a burning sensation during urination. Other signs are frequent urination (of only small amounts) and difficulty starting urination, with failure to completely empty the bladder. You may also have a fever and chills, or notice blood in your urine or semen. You may experience pain between the scrotum and the anus, in your lower back, or in your muscles and joints. Bowel movements may also be painful.