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DISORDER OF THE PENIS

The penis is one of the external structures of the male reproductive system. The penis has three parts: the root, which attaches to the wall of the abdomen; the body, or shaft; and the glens penis, which is the cone-shaped end (head). The opening of the urethra, the tube that transports semen and urine, is at the tip of the glens penis.

The body of the penis is cylindrical in shape and consists of three internal chambers. These chambers are made up of special, sponge-like erectile tissue. This tissue contains thousands of large caverns 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 (the male reproductive cells), is expelled through the end of the penis when the man reaches sexual climax (orgasm). Disorders of the penis can affect a man's sexual functioning and fertility.

Penis

The penis (plural penises or penis) or phallus is the male popularity organ, and in mammals, the male organ of urinary excretion. It is homologous to the female clitoris, as it develops from the same embryonic structure. the male sexual organs comprise both the penis and the testes. The penis is capable of erection for use in sexual intercouse.  

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Structure

 

The human penis is built of three columns of erectile tissue:

  • the two corpora cavernosa and
  • one corpus spongiosum which lies below them.

The end of corpus spongiosum is enlarged and cone-shaped and forms the glans penis. The glans supports the foreskin or prepuce, a loose fold of skin that can retract to expose the glans. It aids in sexual insertion, keeps the glans moist and provides a gliding action which is said to increase sexual pleasure for the man and his partner as well. For various culturual, religious, and more rarely medical reasons, the foreskin is sometimes partly or completely removed; this is called circumcision. Removal of the same tissue in females is considered a genital mutilation and is outlawed in many countries. The area on the underside of the penis, where the foreskin attaches, is called the fermium (or frenulum). The inner portion of the foreskin near the sulks is a highly innervated area known as the ridged band. Removal of the foreskin by circumcision also usually removes the ridged band and injures or removes the frenelium.

 The urethra, which is the last part of the urinary tract, traverses the corpus sponges and its end lies on the tip of the glens penis. It is both a passage for urine and for the ejaculation of semen. Sperm is produced in the testes and stored in the attached epidermis. During ejaculation, sperm are propelled up the vas deferens, two ducts that pass over and behind the bladder. Fluids are added by the seminal vesicles and the vas deferens turns into the ejaculatory ducts which join the urethra inside the prostate gland. The prostate as well as the bulb urethral glands add further secretions, and the semen is expelled through the penis.

Erection

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A man gets an erection when the penis enlarges and stiffens.

It is a complex process that happens as a result of changes within the muscles, nerves and blood vessels of the penis.

The regulation of blood flow into and out of the penis is what makes an erection possible.

1. Specialized tissues in the shaft of the penis trap blood. This      increases the pressure within the penis and causes it to lengthen and then become firm.

2. Following orgasm or the withdrawal of sexual stimulation, the process is reversed. Blood flows out of the penis and back into your circulation so the penis becomes soft. 

How an Erection Happens

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1. Touch, sights, sounds, erotic memories, fantasies etc, cause sexual excitement.

2. These stimuli increase signal output from a part of the brain called the Para-ventricular nucleus.

3. These signals then pass through special autonomic nerves in the spinal cord, the pelvic nerves and the cavernous nerves that run along the prostate gland to reach the corpora cavernous and the arteries that supply them with blood.

4. In response to these signals, the muscle fibers in the corpora relax, allowing blood to fill the spaces between them.

5. Muscle fibers in the arteries that supply the penis also relax, and there is an eight-fold increase in blood flow to the penis. The increased blood flow expands the corpora, then stretches the surrounding sheath (the tunica).

6.  As the tunica stretches, it blocks off the veins that take blood away from the corpora cavernous. This traps blood within the penis, the pressure becomes very high and the penis becomes erect.

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7. During an erection pressure in the penis is at least twice the pressure of blood in the main circulation. This is possible because the muscles of the pelvic floor contract around the base of the corpora cavernous.

8. At orgasm, the signaling from the brain changes dramatically. There is a sudden increase in noradrenalin production from nerves in the genitalia. This seems to both trigger orgasm and contract the muscle fibers in the corpora cavernous and their supplying arteries.

9. The pressure within the corpora drops, which also relaxes the tunica and so allows blood to flow out of the penis

A semi erect penis

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Erection is a stiffening and hardening of the penis which occurs in the sexually aroused male. Erection enables sexual intercourse, though it is not essential, and some other sexual activities.

Size

In comparison to body size, the human male penis is among the largest of the primates. From polling, the average human male penis is 5 1/2 inches (14 cm) in length when fully engorged with blood during arousal, though this varies quite a bit. The size of a flaccid human penis has an even greater variation in both length and width that often does not predict the size of a fully aroused member. For example, a man with a relatively small flaccid penis may have an above average length penis when fully aroused. The opposite is also true. 

Penile Disorders

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During growth and development, the penis growths in length and width. At the end of puberty, the average erect penis is about six inches long, while the flaccid or non-erect penis may be much smaller. Many teen males worry about their penis size often noticing the differences while showering with others after sports. In fact, penis size is not related to masculinity, fertility or ability to give or obtain sexual gratification. Some males are concerned about the shape of the penis since some are straight and others have a slight curve. These are normal variations and have absolutely no effect on function.

All males are born with a foreskin. This skin covers the glans or head of the penis as well as the shaft of the penis. An adolescent male should be able to retract the foreskin away from the glans so that he can clean smegma which is a substance secreted by the foreskin. Many males are circumcised at birth either due to custom, religious belief or a medical concern   

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There are some medical issues that could occur with an uncircumcised male. If the foreskin cannot be retracted away from the glans, then the patient may have phimosis or a tight foreskin. By the time males enter grade school, about ninety percent of those who are uncircumcised are able to retract the foreskin. By adolescence, if the foreskin cannot be retracted, then circumcision is probably indicated since phimosis may cause discomfort during urination or sexual activity.

Occasionally a tight foreskin is forcibly retracted and becomes stuck behind the head of the penis. This causes pain and swelling which further inhibits the boy’s ability to place the foreskin back into its natural position. This could occur when a male with phimosis has his first sexual intercourse. A physician should be consulted immediately for care. An emergency circumcision may be indicated.

In uncircumcised males, the end of the foreskin, which is called the prepuce, covers the head of the penis. The prepuce secretes smegma and provides a warm and moist environment, which could allow for infection under certain conditions. Uncircumcised males can be infected with yeast from their female sexual partner. The yeast produces an infection termed balanitis around the head of the penis. The symptoms include burning, itchiness and swelling of the head of the penis. Treatment includes good hygiene and the application of an antifungal cream. The sexual partner should also be treated.

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The penis may be subject to injury during sexual activity or sports. In uncircumcised males, a bacterial balanitis can occur. This usually will respond to good hygiene and topical antibiotics. All males could be subject to bacterial or viral infection of the penis that could occur from sexual activity. Human bites to the penis can transmit bacteria, or chafing from sex combined with poor hygiene could lead to local skin infection. Treatment could include topical or oral antibiotics. In contact sports, teens should be sure to wear an athletic cup to protect the penis from injury.

Contact allergies may affect the penis. The symptoms will include itchiness, burning and redness. Probably the most common contact allergy is a reaction to latex condoms. If this occurs, then discontinuing latex condoms and substituting natural skin condoms will be helpful. During sex, males also could react to lubricant jellies or nonoxynol-9 from condoms, other spermicides, feminine sprays or douches. It is important to find out the cause of the reaction and then avoid that substance.

Males who urinate in the outdoors could be subject to poison ivy dermatitis affecting the penis. This will also cause itchiness, blisters and redness. Males need to recognize poison ivy, oak and sumac plants. Topical anti-itch preparations including calamine lotion or over the counter hydrocortisone should give relief to the symptoms.

It is very rare in adolescents, but a malignant skin cancer called melanoma could occur on the penis. The amount of sunburn a child has sustained during his preadolescent years could affect the likelihood of developing a melanoma. Since most males do not sunbathe without a bathing suit or shorts, sunburn to the penis is less likely. Nonetheless, a male should utilize sunscreen on his genitals if he sunbathes in the nude. If a male develops a suspicious appearing mole on his penis, he should notify his physician.

Many male adolescents are worried about sexually transmitted infection (STI). The penis is a likely site for STI’s to appear. A yellow mucoid discharge from the urethra associated with painful urination can occur with gonorrhea while a scant almost painless discharge occurs with chlamydia urethritis.

Other STI’s can cause skin changes on the head and shaft of the penis. Genital herpes produces painful blisters that can remain for several weeks. A painless smooth ulcer characterizes syphilis while chancroid has a painful and irregular ulcer. Genital warts occur more commonly along the shaft of the penis and occasionally around the urethra. They are usually fleshy colored in appearance and painless and are likely to be transmitted to a sexual partner unless a condom is used. One should be certain to contact a physician for further advice. Warts should be differentiated from pink pearly penile papules, which many adolescents develop around the head of the penis. These small one- to three-millimeter bumps are totally harmless, are not a sign of STI and cannot be transmitted to a sex partner.

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An insect called the mite causes scabies, which produces an itchy red bumpy rash in the genitals including the penis. This is different from crab lice, which are insects that bite the skin around a pubic hair to obtain blood, and then lay their eggs called nits, which are attached to the pubic hair. Lice also cause itchiness and a clinician should be contacted for treatment.

The human immunodeficiency virus (HIV) may enter the body through cuts in the penis that could occur during sexual activity. There are no telltale symptoms on the penis if an adolescent has been infected with HIV. A condom would protect the male from acquisition of HIV as well as other STI’s including hepatitis B.

A few adolescents develop a painful condition called priapism, which is a prolonged involuntary erection that is not associated with sexual stimulation. Although most adolescents who develop priapism do not have any disease producing the problem, a few teens with sickle cell disease or other blood problems can acquire a tendency for priapism. A physician should be consulted for treatment. It is perfectly normal for male adolescents to awaken with an erection, which usually subsides after urination. Some adolescents develop impotence of the inability to attain an erection under sexual stimulation. In most cases this is not due to a medical disease, rather it is due to anxiety.

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