Lesson 1, Topic 1
In Progress

Disorder of the Penis and Scrotum

July 2, 2023

Penis disorders

Infection, cancer, and structural disorders

The penis is subject to cancerous tumors and is affected by numerous sexually transmitted diseases, or STDs (see Table 23-4). Development of herpes vesicles; genital warts; and various lesions of the foreskin, glans, and penile shaft are common.

Structural abnormalities such as phimosis and paraphimosis, discussed in the box on the opposite page, can obstruct the flow of urine or result in urinary tract infections.

The term hypospadias describes a congenital condition that is characterized by the opening of the urethral meatus on the underside of the glans or penile shaft. Surgical correction 626is performed if the defect is likely to cause urological or reproductive problems.

The term epispadias refers to a much less common congenital defect that involves the opening of the urethral meatus on the dorsal or top surface of the glans or penile shaft.

Erectile dysfunction

Failure to achieve or maintain an erection of the penis adequate enough to permit sexual intercourse is called erectile dysfunction (ED) or impotence. ED affects men of all ages but is experienced most often after age 65. Impotence does not affect sperm production but infertility often results because normal intercourse may not be possible.

In the past, psychological problems such as anxiety, depression, and stress were often cited as the most important causes of impotence in sexually active men. There is no doubt that such conditions contribute to ED. However, current research suggests that purely psychological problems probably account for far fewer cases of impotence than previously thought.

We now know that ED is frequently caused by medical problems related to abnormal vascular or neural control of penile blood flow. Arteriosclerosis, diabetes, alcohol abuse, numerous medications, radiation therapy, tumors, spinal cord trauma, and surgery, especially if pelvic organs such as the prostate are involved, may all contribute to ED.

Treatment options for ED include use of drugs that increase blood flow to the spongy cavernous tissue of the penis causing it to stiffen and become erect. Oral medications such as Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil), and Uprima (apomorphine) are generally preferred by men who do not have medical conditions that preclude their use.

A drug called Muse (alprostadil) is available as a tiny soft pellet that is inserted into the urethra using a small applicator. A similar drug available in solution, Caverject, is injected directly into the penis.

As a result of multiple options, even moderate to severe erectile dysfunction occurring in sexually active men can be treated with considerable success.

Scrotum disorders

Swelling of the scrotum can be caused by a variety of conditions. One of the most common causes of scrotal swelling is an accumulation of fluid called a hydrocele. Hydroceles may be congenital, resulting from structural abnormalities present at birth.

In adults, hydrocele often occurs when fluid produced by the serous membrane lining the scrotum is not absorbed properly. The cause of adult hydrocele is not always known, but in some cases, it can be linked to trauma or infection.

Swelling of the scrotum may also occur when the intestines push through the weak area of the abdominal wall that separates the abdominopelvic cavity from the scrotum. This condition is a form of inguinal hernia. If the intestines protrude too far into the scrotum, the digestive tract may become obstructed, resulting in death.

In adults, inguinal hernia often occurs while lifting heavy objects, because of the high internal pressure generated by the contraction of abdominal muscles. Inguinal herniation also may be congenital (Figure 23-8). Small inguinal hernias may be treated with external supports that prevent organs from protruding into the scrotum; more serious hernias must be repaired surgically. Although less common, inguinal hernias also occur in females.

FIGURE 23-8​Inguinal hernia. ​Congenital inguinal hernia in infant male.

QUICK CHECK

  1. What duct leads from the epididymis?
  2. Which organs produce the fluid in semen?
  3. What is the function of the erectile tissue?
  4. Identify the treatments for benign prostatic hypertrophy.