(a) Male external sex organs are the penis and the scrotum containing two testicles.
(b) Internal sex organs are testicles, epididymis, ductus deferens, seminal vesicles, prostate, and bulbo urethral glands.
The penis is built of three parallel cylinders. Two occupy the upper part of shaft and are called corpora cavernosa, which are thick cylindrical of spongy, fibro- elastic erectile tissue bound together side by side. Each is enclosed in a thick layer of tough fibrous tissue- tunica albuginea. The proximal end is attached to ischio pubis ramus. The distal end is fused to the distended part of the corpus spongiosum at the glans penis.
The lower one corpora spongiosum, lies between and inferior to the corpora cavernosa in the body of penis. Through the centre runs the urethra. The proximal end of spongiosum is distended and forms the bulb of penis.
The normal length of the penis varies from 9 cm to 15 cm.
The penis has two functions: to perform urination in the flaccid condition and sexual intercourse in the erectile state.
The arteries of the penis are 1/3 the size of coronary arteries. Blood fills the cavernous space when deep arteries are dilated under pressure and from para sympathetic stimulation, and thus make the corpora cavernosa rigid inside the dense tunica albuginea. The shaft of the penis and the glans penis have separate blood supplies. The dorsal vein of the penis ends in prostatic plexus.
The dorsal nerve of the penis is a branch of the pudental nerve which arises from the sacral plexus (S1, S2, S3, S 4).
Bladder, prostate, seminal vesicle and ductus deferens are supplied by inferior hypo gastric plexus. These contain parasympathetic, sympathetic and sensory fibers
The main centre of sexual energy is the brain. It sends messages to the lower spinal center. External genitalia are very sensitive to touch. Physical stimulation such as genital manipulations can initiate enjoyment. Tip of tongue, lips, back part of ears, finger tips, skin of closed eyelids, skin of shoulder, back of neck, hairless parts are the other sensitive parts. Sexual sensitiveness can be reduced by applying anesthetic ointments.
Erection is caused by filling blood in the spongy tissues of the penis. The blood flow through the deep artery must have more than the deep vein for persistent erection. Transverse perineal muscles, Ischiocavernosus muscle, and Bulbospongiosus muscle (press the urethra) assist the erection by impending the venous drainage from cavernous tissue.
Testis size varies from 4 cm long, 2.5 cm antero-posterorly and 2cm transversely. They are oval shaped and each weighs 20 Gms.
Epididymis: This comma shaped structure overlies the superior and postero-lateral surface of the testis. It is 5cm long and 1/2cm wide. Lengthwise it is 6 meters long when spread. Sperm produced in the testicles undergo a maturing process in the epididymis.
Seminal vesicle: This is a sacculated tube, 15 cm long. It does not store sperm, but rather gives food to the sperm. It produces a secretion which mixes with the spermatozoa from vas deferens. It contracts simultaneously with vas deferens on ejaculation. Its alkaline secretion contains fructose, mucus and coagulation enzymes.
Ejaculatory duct: This is formed by the union of the seminal vesicle and vas deferens. It is 2cm long.
Smooth muscles are present in testis (dartos), ductus deferens, seminal vesicles, ejaculatory duct, prostate and urinary bladder.
Bulbo urethral glands lie postero-lateral to the membranous urethra. Glands are two in number and its long ducts open to the spongy part of the urethra. The length of the prostatic urethra is about 3cm, and length of membranous part is about 1cm (Total length of male urethra is about 20 cm).
The word prostate (Greek) means “one standing before”. This male accessory sex organ arises by the 9th week of embryonic life. The prostate is the only exocrine organ located in the midline in humans and similar animals.
Anatomy: It is a walnut-sized firm gland that resembles as inverted compressed cone. Its size varies 3 cm from apex to base, 2 cm antero-posteriorly and 3.5 cm across the base. The normal weight of the prostate usually ranges between 7 and 16 grams. It is composed plain muscle, fibro elastic tissue and mucosal glands.
The prostate contains some smooth muscles that help expel semen during ejaculation. It has a thin capsule of fibro muscular tissues (true capsule) but is also enclosed in a loose sheath of visceral pelvic fascia (false capsule), which is separated from the capsule at the front and sides by the prostatic venous plexus.
The prostate gland lies behind the lower part of the symphysis pubis and in front of the rectum. It lies between the neck of the bladder and upper surface of perineal membrane where it surrounds the proximal portion of the urethra.
The urethra and ejaculatory duct traverse the prostate and divide it into 5 lobes.
The Lateral lobe lies on each side of the urethra. It contains enough of glandular tissues, where adenoma may form in old age.
The Anterior lobe is a small isthmus connecting the two lateral lobes in front of the urethra. It contains little glandular tissue.
The Median lobe lies behind the upper part of the urethra and in front of the ejaculatory duct and just below the neck of the bladder. It contains much glandular tissue and is a common site of adenoma.
The Posterior lobe connects the two lateral lobes behind the urethra. Adenoma never occurs here. But Primary carcinoma is said to begin in this part.
Valveless communication between the prostatic and vertebral venous plexus exists through which the prostatic cancer can spread to the vertebral column and the skull. The lymph of prostate drains into the internal iliac and sacral nodes, and partly into the external iliac nodes.
The secretion of the prostatic gland increases the volume of semen. It secretes watery opalescent fluid which acts as nutrient fluid for the male gametes. It contributes 20% of total volume of human semen. It is discharged out in jets into urethra by contraction of muscular stroma when the muscle of ductus deferens and seminal vesicles contract.
In human prostatic secretions, the protein content is less than 1% and includes acid phosphatase, spermine, fibrinolysin, fibrinogen, and prostate- specific antigen. Other items are fructose, citric acid, cholesterol, cephalin, thromboplastin, fibrinoginase, WBC, epithelial cells, etc. The secretions also contain zinc with a concentration 500-1000 times the concentration in blood. Ph is < 6.4.
|AUTONOMOUS NERVE SYSTEM AND SEXUAL DYSFUNCTION|
|Dilate deep penile arteries, and promote erection.|
Contract detrusor and other muscles, and promote emptying.
|Relax smooth muscle, and promote erection,|
Promote prostatic hypertrophy. Relax detrusor.
Contract sphincters, and thus promotes urine retention.
Reduce secretion (except renal, liver, breast)
|Sympathetomimic through beta fibers (Adrenaline & nor adrenaline)|
|Relax the smooth muscle, thus promote prostatic congestion and erection.|
Diminish bronchial mucus secretion; dilate coronary and skeletal muscle arteries, increase heart rate and work.
Relax bronchi and detrusor;
Contract the bladder sphincter (bladder filling).
Contract smooth muscle of skin and cause standing of hair Increase systolic blood pressure.
|Sympathetomimic through alpha fibers (nor adrenaline)|
|Promote penile vasospasm|
Contract the smooth muscle (prostatic shrinkage)
Contract muscle of skin- arrectores pili
Contract intestinal sphincter and bladder sphincter
Contract the blood vessels of skin and viscera
Increases both systolic and diastolic blood pressure
Dilate coronary arteries (minimally)
Promote cerebral circulation
Promote urine retention
Ergot (small doses) andephedra are alpha mimic
|Beta adrenergic inhibitor|
|Promote prostatic shrinkage|
Promote coronary constriction, promote heart failure
Reduce heart rate and work, reduce hypertension
Induce asthma; carcinogenic
|Nor adrenergic inhibitors |
|Promote penile vascular dilation, and erection|
Relax the smooth muscles of prostate
Ergot high doses
Prostate gland problems and erectile dysfunctions often increase as a man advances in age.
Impotence can affect men of all ages. A man is termed impotent when his sexual capacity has been altered to the degree that he is unable to achieve and maintain an erection sufficient to accomplish a coital connection successfully.
Primary impotence: A man has never experienced an erection.
Secondary impotence: A man with previously adequate sexual function who is no longer able to achieve erection for coitus.
Etiology: The causes of impotence are Psychological, organic and iatrogenic.
Stress at work or home, nervousness related to sex, performance anxiety, juvenile depression, religious, moral and social inhibition etc
Martial disharmony-frigidity, negative attitude, dishonesty, physical and mental ugliness, emotional upset, argument nature, and acting personality etc of partner.
Congenital deformities, micro penis, phimosis, hypospadias, epispadias, peyronie’s disease (penis curved and plastic indurations like),
Genito urinary tract inflammations, prostatic disorders-benign hyperplasia, prostatic cancer, prostatitis,
Hypogonadism-testicular or pituitary origin; failure of dihydrotestosterone secretion from adrenal gland, feminizing adrenal tumor; juvenile myxeodema,
Physical illness, lymphoedema, obesity, Hypotension, diabetes mellitus, chronic proteinuria, renal failure, hepatic cirrhosis (through oestrogen metabolism) Atherosclerosis of aorta or iliac artery,
Peripheral neuropathy due to mal absorption syndrome involving nerves supplying deep and dorsal artery of penis,
Spinal cord lesion- (sympathetic L 2, L 3; para sympathetic S2, S3, S4),
Temporal lobe lesion, multiple sclerosis, tabes dorsalis, syringomyelia etc
Anti hypertensive Atenolol, Metopronol, Reserpine
Anti hypertensive, diuretic Spironolactone, Hydro chlorothiazide
Lipid lowering agent Bezafibrate, Gemfibrozil, Pravastain
Antidepressant Imipramine, phenothiazine, Dosulepin, Thioridazine
Anti diabetic Rosiglitazone
The presence of full erection upon rising in the morning or erection during sleep indicates some mechanism for erection is intact. If such an individual fails to develop erection during foreplay or if he develops adequate erection but then loses the erection upon or shortly after vaginal intromission, it is likely that he has functional impotence.
If one does not have an erection under any circumstance, either during sleep, or during masturbation, in the morning or in company with a sexual partner other than his wife, it is very likely that he is suffering from organic impotence.
Clinical feature of erectile dysfunctions
Loss of desire, premature ejaculation, absence of emission, absence of orgasm, failure of tumescence, Loss of erection
The common diseases affecting the prostate are prostatitis, benign hypertrophy of the prostate, senile atrophy, prostatic calculi, tuberculosis and carcinoma. These conditions usually occur in men over 50 years of age.
Prostatitis is common in men after the age of 30. Acute prostatitis is usually due to infections. Secondary symptoms like arthritis, iritis, neuritis, fibrositis, phlebitis etc are seen in chronic prostatitis. Prostatic hyperactivity or hyperplasic metastasis to osseous tissues can be suspected, if serum acid phosphatase is > 10 KA units.
BENIGN PROSTATIC HYPERTROPHY
Benign prostatic hyperplasia (BPH) or hypertrophy is a common part of aging. It also develops due to stimulation by dihydrotestosterone (DHT), a substance derived from testosterone in the adrenal gland.
Pathogenesis: Glandular enlargement commonly occurs in the middle and lateral lobes. Enlargement also causes the formation of pouch on bladder. This promotes urine stagnation which favor to infections, phosphatic stone formation and retrograde ureteric reflux.
Glandular hyperplasia and overgrowth of fibro muscular tissues results in formation of dense nodules. This mostly occurs in old age.
Risk factors: Higher proportion of oestrogen and dihydro testosterone. Oestrogen can cause early degeneration of glandular portion but it may promote benign non- glandular hypertrophy. The inner zone of prostate is susceptible to oestrogen and outer zone is more susceptible to androgens.
Cancer of prostate is mainly due to androgens.
Stress (adrenal over activity – dihydrotestosterone)
Consumption of excess alcohol, an acid diet, tea, spices
Deficiency of zinc or essential fatty acid
Poor flow of lymph and blood
Toxicity of blood, exposure to cold
Central obesity, poor abdominal tone, poor bowel tone
Gonorrhea, other secondary infection
Clinical feature of prostatic hypertrophy
As the prostate enlarges, the bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, and cause more frequent urination.
Incontinence of urine, delay in starting, poor stream, inability to empty bladder fully, desire to urinate, increase urinary frequency at night, painful micturition, impotence, back pain, perineal congestion, painful defecation etc.
Overflow and dribbling are seen in connection with chronic retention.
Acute retention may suddenly occur from alcohol or cold.
When hydronephrosis commences there may be a dull pain in the loins.
Middle lobe enlargement cannot be felt on rectal examination.
Investigation: Blood Test: Prostate-specific antigen, Alkaline phosphatase; Digital rectal examination, Urine flow study, Cystoscopy, Rectal ultrasound and prostate biopsy.
Complication of prostatic hypertrophy
Recurrent urinary infections, painful retention of urine, chronic urine retention, cystitis, phosphatic stone, chronic renal failure (Symptoms: anorexia, headache, thirst, constipation, lethargy, dry tongue, and hypertension etc), and chronic hyperplasia etc.
Carcinoma of the prostate is the common malignant condition in men over the age of 65 years. Carcinoma occurs in glandular or connective tissue. It occurs more in the posterior lobe. It may metastasize to pelvic and lower lumbar vertebra through the prostatic venous plexus.
Vasectomy is the one of risk factors for prostate cancer.
Symptoms: Sudden onset of painful micturition in old age is a common symptom. Other features are pain in perineum, genitals or near inner aspects of thigh; haematuria, anemia, acid phosphatase > 8 K.A units, prostate specific antigen (PSA), stony irregular nodule on rectal palpation, and enlargement of regional lymph nodes.
Metastasis signs are bilateral sciatica, anemia, bleeding tendency, oedema of one or either legs, paraplegia, spontaneous fracture, and various symptoms due to urethral obstruction. Other symptoms depend on the organ involved in metastasis.
TREATMENT FOR IMPOTENCE
Take medical treatment early. The plan of medical treatment must be rational always.
Counseling, frank discussion, encouragement and reassurance.
Take zinc 15-30 mg per day along with a copper supplement.
Take water-soluble fiber. Take walnut, avocado, chocolates, fig, honey, almond, pomegranate, liquorices, carrot, milk, fruits, vegetables, lemon juice, onions, anise seed, coriander, ginger, mustard, choline (Soya, fenugreek, egg yolk) etc.
Eat foods rich in vitamin A.
Change your life style. Take sufficient sleep.
Take sufficient abstinence.
Live a stress free life and feel relaxed.
Alcohol in small quantities may help by depressing business stress.
Take daily exercise.
Promote sweating by exercise with clothes or drinking pepper tea.
Hip bath promotes blood stagnation at lower trunk, thus helps erection.
Take smooth muscle relaxants and deep penile artery dilators.
|Smooth muscle relaxants (promotes erection and prostatic hypertrophy)|
|Ginkgo biloba, Ammi visnaga (khellin), Arsenic, Nicotinic acid, Chocolate, Tea, Vitamin E, Nitrites, Opium, Pituitarin|
|Indirect||Yohimbinum (sympatholytic) Alcohol, Hydrastis, Valerian, Viburnum, Opium|
|Indirect||Belladonna (anticholinergic & sensory penile vaso inhibitor)|
|Indirect||Sympathomimetic (Alcohol, cold -beta)|
|Indirect||Sympathomimetic(Ephedra, low doses of ergot-alpha) sphincter constriction|
|Vasomotor centre||Ergot, Rauwolfia (small dose)|
Sympathomimetic (Alcohol, cold -beta; Ephedra, low doses of Ergot -alpha) are beneficial for erectile dysfunction, but may cause acute urine retention and prostatic congestion. Urine retention may also develop by long periods of immobility.
Taking excess of carbohydrates, habit of cigarette smoking, Excess caffeine
TREATMENT FOR BENIGN PROSTATIC HYPERTROPHY
Prostatic Hypertrophy is treated with medicines or, a minimally invasive procedure or, in extreme cases, surgery that removes the prostate.
Change the life style. Reduce the strain and effort of daily life.
Consume fiber diet, barley, butter, ghee made from cow’s milk, chicken (glycine) etc
Take moderate quantity of wine regularly.
Take diet high in protein and raw green vegetables.
Take zinc rich food (oysters, meat, eggs, all kinds of sea food, wheat, pumpkin seeds, beans, carrots, onions, and brown rice).
Take apple juice four times daily for several days.
Increase the use of tomatoes. Take fenugreek tea also.
Consume cod liver oil, sesame oil, evening primrose oil.
Take Magnesium sulphate (1gm /day).
Prefer garlic, asafetida, coriander, turmeric, ginger, and cinnamon.
Apply the oil of wintergreen on lower lumbar area.
Take hot compresses, ice cold retention enema, or alternate cold and hot hip baths for ten minutes a day.
Take abdominal breathing exercise, lumbar and thigh muscle exercises, drill exercises. Massage on lower abdomen at regular intervals to reduce prostatic congestion.
Take smooth muscle contractors.
|Smooth muscle contractors (promote prostatic shrinkage and impotence)|
|Direct||China, Ergot, (low dose) Barium, Digitalis, Plumbum, Veratrum|
|Direct||Fish brain, Sabina|
|Indirect||Cholinergic (plain muscles & Bladder spasm)|
|Indirect||Nor adrenergic (Ephedra, low dose of Ergot -sphincter constriction) Spartium scoparium|
|Vasomotor centre||Belladonna, Coffea, Digitalis, Nux vomica|
|Aloes, Cascara sagrada, Rhubarb, Senna; Colocynth, Croton tiglium, Ipomea, Jalapa, Podophylum, Phenolphthalein and Ricinus communis|
Sympathomimetics like Coffea, Ephedra and Lobelia, and are helpful for retrograde ejaculation.
Overweight, sedentary life, sitting on a hard stool for long periods
Frequent excitation, prolonged intercourse
Dry climax, coitus interruptus
Abstinence, suppressing the urge to urinate
Massage locally at acute infection
Take a diet high in fat, red meat, sour and fried things.
Treatment: other procedures
Transurethral microwave thermotherapy (TUMT)
Transurethral needle ablation of prostate (TUNA)
Insertion of a temporary Prostatic stent in the urethra
High-intensity focused ultrasound waves
Laser surgery through the urethra
Photo selective vaporization of the prostate (PVP)
Interstitial laser coagulation
Transurethral resection of the prostate (TURP)
Trans vesical Prostatectomy
LIST OF MEDICINES, TINCTURES & DILUTIONS
Chorea, Epilepsy, Nerve & Brain stimulant
Diabetes mellitus, Gastric atony
Acorus calamus *
, Feeble mindness
Aegle folia *
Diabetes mellitus, Growth disorder, Oedema, Pituitary disorder,
Agnus castus **
Allium cepa *
Acrid rhinitis, Hypercholesterolemia, Impotence
Allium sativa *
Gastric atony, Hypercholesterolemia, Hypertension, Mandibular arthritis,
Aloes socotrina **☺
Arthritis, Cancer, Hypercholesterolemia, Immune deficiency, Pain
Alstonia constricta □
Anti oxidant, Diabetes mellitus, Geriatrics
Ampelopsis quin □
Hydrocele, Renal dropsy
Autonomic neuropathy, Flatulence, Oesophagitis
Aesculus hippocastan □
Back ache, Venous congestion
Asparagus officinalis *
Calculus, Chest pain, offensive urine, Shoulder rheumatism
Avena sativa □
Baptisia tinctoria *
Enteric fever, Hair loss, Pox, Toxic fever
Low back pain, Gall stone, Urolithiasis
Boerhavia diffusa **
Arthritis, Constipation, Dropsy, Hypertension,
Hair falling, Loss of memory, Geriatrics
Cactus grandiflorus □
Atherosclerosis, Mood disorder
Caladium seguinum *
Pruritus, Asthma, Impotence
Angina, Geriatrics, Impotence, Night emission, Splenic Fever
Cannabis Indica ***
Geriatric complaints, Migraine
Cannabis sativa **
Colitis, Geriatric complaints, Impotence
Burns, Dysuria, Hair loss, Impotence
Capsicum annum *
Delirium tremens, Fibrositis, Gastric atony, Sore throat
Cascara sagrada *☺
Constipation, Portal hypertension, Hepatic cirrhosis
Diabetes mellitus, Neuritis
Dysuria, Perineum discomfort, Prostatism
Cinchona officinalis *♠
Anemia, Arthritis, A.V Block, Atrial flutter, Chronic eczema,
Coffea toasta *
Conium maculatum ☺☺ ♠
Carcinoma, Geriatric tonic
Colon cancer, Hemorrhages, Hepatitis
Cucurbita pepo *
Digitalis purpurea **
Cardiac failure, Impotence, Irregular pulse, Oedema, Portal
Embelica officinalis ♠
Diabetes mellitus, Cadmium poisoning, Geriatrics, Stones, Visual
Constipation, Hypercholesterolemia, Vitiligo, Worms
Asthma, Enuresis, Hyperthyroidism, Sympathomimic
Polyuria, Diabetes mellitus, Nephritis
Ficus religiosa □
Diabetes mellitus, Haematuria
Ficus Indica □
Diabetes mellitus, Haematuria, Ulcer, Sterility
Impotence, para sympathomimic, malnutrition
Anti oxidant, Cardiac tonic, dementia, Geriatric myalgia, Migraine,
Geriatric rheumatism, Sexual asthenia
Geriatric dropsy, Ureteric calculus
Anorexia, Cancer, Gastric and Bowel atony, Geriatrics, Mouth ulcer
Eczema, Filariasis, Geriatric dementia, Lymphoedema
Hyoscyamus niger * *
Labyrinthal vertigo, Para sympatholytic, Psychosis, Rheumatism
Cancer, depression, Hypochondriasis, Neuritis, Pain
Alopecia, Diabetes mellitus, Impotence, Parasympathatomimic,
Jacaranda caroba *
Acne, Dermatosis, Impotence
Kali bromatum □
Sleep disturbance, Somnambulism
Lactuca virosa □
Lobelia inflata ** ♠
Medicago sativa ♠*
Diabetes insipidus, Neurasthenia
Gastric atony, Glycosuria, Rheumatism, Sore throat
Herpes, Orchitis, Peripheral neuralgia
Myristica sebifera **
Nupher lutea □
Nux vomica *☺
Amblyopia, dementia, Diabetes mellitus, Gastric atony, Hypotension,
Geriatrics, Sexual asthenia, Irritable bowel syndrome
Oleum animale □
Migraine, Prostatic hypertrophy
Oleum santali □
Offensive expectoration, Urethritis
Geriatrics, Low susceptibility, Psychosis
Depression, frigidity, Sexual neurasthenia
Pareira brava ☺ □
Petroselinum sativum □
Hypertension, Impotence, Para sympathomimic
Pichi fabiana □
Calculus, Gout, Urethritis
Pilocarpus microphyllus ☺
Diabetes mellitus, dropsy, Impotence, Pupil constricted,
Cough. Gastric atony, Rheumatism, Thrombosis
Populus tremuloides □
Rauwolfia serpentiana ♠
Depression, Diabetes mellitus, Hypertension,
Rhus aromatica □
Geriatric cystitis, Glycosuria
Black face, Bowel atony, Cannitis, Spinal fibromyalgia
Ruta graveolens □
Orbital contusion, Procto -colitis , Insect Bite, Radiation disorder
Sabal serrulata ☺☺
Prostatism, Sexual atony
Arthritis, High ESR, Hyperpyrexia, High fibrinogen, Thrombosis
Prostatism, Sexual atony
Hodgkin’s disease, Lymph adenoma