1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Language, Second Edition Susan Turley CHAPTER Medical Language Second Edition Male Reproductive Medicine 12

2. Male Reproductive Medicine The medical specialty that studies the anatomy and physiology of the male genitourinary system and uses diagnostic tests, medical and surgical procedures, and drugs to treat male reproductive diseases.

3. Figure 12-1 Male genitourinary system

4. Anatomy and Physiology External Genitalia – Scrotum – Testes – Epididymides – Penis – Urethra

5. Anatomy and Physiology (cont’d) Internal Genitalia – Vas deferens – Seminal vesicles – Ejaculatory ducts – Prostate gland – Bulbourethral glands

6. Anatomy and Physiology (cont’d) The male genitourinary system shares the urethra with the urinary system and is also known as the urogenital system.

7. Anatomy of the Male Genitourinary System Scrotum – Soft pouch of skin behind the penis and in front of the legs – Few degrees cooler than the core body temperature – Muscles in wall of the scrotum contract or relax to move the scrotum closer to, or farther away from, the body to adjust to temperature changes

8. Figure 12-2 External and internal male genitalia

9. Anatomy of the Male Genitourinary System (cont’d) Scrotum (cont’d) – Perineum is the area between the anus and the scrotum Testis – The scrotum contains the testes or testicles. – Egg-shaped glands about 2 inches in length. – Testes are the gonads, or sex glands.

10. Testis (cont’d) – Function as part of the male genitourinary system and the endocrine system – Contains the seminiferous tubules that produce spermatozoa, or sperm – Acts as a gland and secretes the hormone testosterone Anatomy of the Male Genitourinary System (cont’d)

11. Epididymis – A long, coiled tube (over 20 feet) that is attached to the outer wall of each testis. – Within the epididymis, the head of each spermatozoon is given a cap-like layer of enzymes that helps it penetrate and fertilize the ovum of the female. – Destroys defective spermatozoa Anatomy of the Male Genitourinary System (cont’d)

12. Figure 12-3 Structures of the testis and penis.

13. Figure 12-4 Descent of the testes

14. Vas Deferens, Seminal Vesicles, and Ejaculatory Duct – The vas deferens is a long duct that receives spermatozoa from the epididymis. – Spermatozoa can be stored in the vas deferens for several months in an inactive state. – The vas deferens goes behind the urinary bladder, where it merges with a seminal vesicle. Anatomy of the Male Genitourinary System (cont’d)

15. Vas Deferens, Seminal Vesicles, and Ejaculatory Duct (cont’d) – The seminal vesicles produce seminal fluid, which makes up most of the volume of semen. – The ejaculatory duct is a large collecting duct that holds spermatozoa and seminal fluid. – The ejaculatory duct enters the prostate gland, then joins the urethra within the prostate gland.

16. Prostate Gland – A round gland at the base of the bladder that produces prostatic fluid. – Prostatic fluid contains an antibiotic substance that kills bacteria and also contains acid phosphatase, an enzyme that breaks the deposit of semen apart and releases the spermatozoa in the woman’s vagina. Anatomy of the Male Genitourinary System (cont’d)

17. Bulbourethral Glands – Small, bulblike glands about the size of peas, located on either side of the urethra just below the prostate gland – Produce thick mucus that makes up some of the volume of the semen and neutralizes the acidity of any urine remaining in the urethra at the time of ejaculation Anatomy of the Male Genitourinary System (cont’d)

18. Penis – Functions as an organ of the male genitourinary system and the urinary system – In uncircumcised males, the urethral meatus is covered by the prepuce, or foreskin, of the penis. – Three columns of erectile tissue fill with blood during sexual arousal, causing the penis to become firm and erect. Anatomy of the Male Genitourinary System (cont’d)

19. Physiology of Spermatogenesis, Sexual Maturity, and Ejaculation Spermatogenesis – At the onset of puberty, the anterior pituitary gland in the brain begins to secrete follicle- stimulating hormone (FSH) and luteinizing hormone (LH) to stimulate the testes. – FSH stimulates spermatocytes in the testes to begin dividing. – LH stimulates the interstitial cells to begin to secrete testosterone.

20. Physiology of Spermatogenesis, Sexual Maturity, and Ejaculation (cont’d) Sexual Maturity – Testosterone causes the male sexual characteristics to develop: enlargement of the external genitalia; development of large muscles; deepening of the voice; growth of body hair on the face, chest axillae, and genital areas; development of the sexual drive

21. Figure 12-5 Testosterone

22. Physiology of Spermatogenesis, Sexual Maturity, and Ejaculation (cont’d) Ejaculation – Thoughts or sensations initiate sexual arousal. – Smooth muscle relaxes in the wall of arteries in the penis, and vasodilation increases blood flow within the penis. – The corpora cavernosa and the corpus spongiosum distend with blood and produce an erection.

23. Ejaculation (cont’d) – Muscles at the base of the penis contract – Spermatozoa mix with seminal fluid, move into the urethra, and are mixed with mucus from the bulbourethral glands. – A series of contractions cause semen to be expelled from the penis through the urethral meatus. Physiology of Spermatogenesis, Sexual Maturity, and Ejaculation (cont’d)

24. Diseases and Conditions – Infertility spermatozoa motility. sperm count. Oligospermia spermatozoa morphology.

25. Figure 12-6 Oligospermia Custom Medical Stock Photo, Inc.

26. Diseases and Conditions (cont’d) Testis and Epididymis (cont’d) – Orchitis swelling (inflammation) of one or both of the testicles – Testicular cancer Seminoma- germ cell cancer – Varicocele is a widening of the veins along the cord that holds up a man's testicles (spermatic cord).

28. Diseases and Conditions (cont’d) Prostate Gland – Benign prostatic hypertrophy (BPH) is an increase in size of the prostate – Cancer of the prostate gland – Prostatitis a painful infection of the prostate gland

30. Diseases and Conditions (cont’d) Penis – Balanitis is swelling (inflammation) of the foreskin and head of the penis – Dyspareunia Painful intercourse – Chordee is a condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis

32. Diseases and Conditions (cont’d) Penis (cont’d) – Erectile dysfunction (ED) is when a man has trouble getting or keeping an erection; Impotence – Phimosis is a condition where, in men, the foreskin cannot be fully retracted over the glans penis. – Premature ejaculation occurs when a man has an orgasm sooner during intercourse than he or his partner wishes

33. Diseases and Conditions (cont’d) Penis – Priapism is a potentially painful medical condition, in which the erect penis or clitoris does not return to its flaccid state – Sexually transmitted disease (STD) are infections that you can get from having sex with someone who has the infection

34. Diseases and Conditions (cont’d) VDRL Venereal Disease Research Laboratory Chancre – typical skin lesion of the primary stage of infectious syphilis, usually appearing on the penis, labia, cervix, or anorectal region

35. Diseases and Conditions (cont’d) Gynecomastia Enlargement of male breasts

36. Table 12-1 Sexually Transmitted Diseases (STDs)

37. Table 12-1 (cont’d) Sexually Transmitted Diseases (STDs)

42. Diseases and Conditions (cont’d) Male Breast – Gynecomastia

43. Laboratory and Diagnostic Procedures Blood Tests – Acid phosphatase – Hormone testing – Prostate-specific antigen (PSA) – Syphilis testing

44. Laboratory and Diagnostic Procedures (cont’d) Semen Tests – Acid phosphatase – DNA analysis – Semen analysis

45. Figure 12-8 Spermatozoa John Walsh/Photo Researchers, Inc.

47. Laboratory and Diagnostic Procedures (cont’d) Radiologic Tests – ProstaScint scan – Ultrasonography

48. Medical and Surgical Procedures Medical Procedures – Digital rectal examination (DRE) – Newborn genital examination – Testicular self-examination (TSE)

49. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Biopsy – Circumcision – Orchiectomy – Orchiopexy

50. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Penile implant – Prostatectomy – Transurethral resection of the prostate (TURP) – Vasectomy

51. Figure 12-10 Transurethral resection of the prostate (TURP)

52. Figure 12-11 Laser for prostate surgery Custom Medical Stock Photo, Inc.

53. Drug Categories These categories of drugs are used to treat male genitourinary Diseases and Conditions: – Androgen drugs – Antiviral drugs – Drugs for benign prostatic hypertrophy – Drugs for erectile dysfunction

54. Abbreviations