640 Continuance of the Species jt Human semen can be frozen and stored in sperm banks for future artificial insemination. In this procedure, the semen is diluted with 10%, glycerol, monosaccharide, and distilad water buffer and frozen in liquid nitragen, ‘The freezing process destroys defective and abnormal sperm. For some unknown reason, however, not all human sperms sultabie for freezing, 1. Define the terms erection, emission and ejaculation 2. Explain the statement that male sexual function is an autonomic synergistic action 3. Compose a flow chart to explain the physiological and physical events of erection, emission, and ejaculation, 4. Describe the components at a normal ejaculate Clinical Considerations Sexual dysfunction is a broad area of medical concern that in= cludes developmental and psychogenic problems as well as con- ditions resulting from various diseases. Psychogenic problems of the reproductive system are extremely complex, poorly understood, and beyond the scope of this book. Only a few of the principal developmental conditions, functional disorders, and diseases chat affect the physical structure and function of the male reproductive system will be discussed, Developmental Abnormalities The reproductive organs of both sexes develop from similar embryonic tissue that follows a consistent pattern of formation well into the fetal period. Because an embryo has che potential to differentiate into a male or a female, developmental errors can result in various degrees of intermediate sex, or her~ maphroditism (her-maf'ro-di-tizm''). A person with undiffer- entiated or ambiguous external genitalia is called a her- maphrodite. Truc hermaphroditism—in which both male and female gonadal tissues are present, in either the same or opposite gonads—is a rare anomaly. True hermaphrodites usually have a forry-six, XX chromosome constitution. Male pseudoher- maphroditism occurs more commonly and generally results from hormonal influences during early fetal development. This condition is caused either by inadequate amounts of androgenic hormones being secreted or by the delayed development of the reproductive organs after the period of tissue sensitivity has passed. ‘These persons have a forty-six, XY chromosome con- stitution and male gonads, but the genitalia are intersexual and variable, The treatment of hermaphroditism varies, depending on the extent of ambiguity of the reproductive organs. These persons are sterile but may marry and live a normal life fol- lowing hormonal therapy and plastic surgery. Chromosomal anomalies result from the improper sepa- ration of the chromosomes during meiosis and are usually ex- pressed in deviations of the reproductive organs. The two most hermaphrodite: Gk. (myinology) Hermaptvodites, son of Hermes (Mercury) frequent chromosomal anomalies cause Turner's syndrome and Klinefelter’s syndrome. Turner's syndrome occurs when only one X chromosome is present. About 979% of embryos lacking an X chromosome die; the remaining 3% survive and appear to be females, but their gonads are rudimentary or absent, and they do not mature at puberty. A person with Klinefeleer's syndrome has an XXY chromosome constitution, develops breasts and male genitalia, but has underdeveloped seminif- erous tubules and is generally retarded. ‘A more common developmental problem than genetic ab- normalities, and fortunately less serious, is cryptorchidism, Cryptorchidism (krip-tor ki-dizm) means hidden testis and is characterized by the failure of one or both testes to descend into the scrotum. A cryptorchid testis is usually located along the path of descent but can be anywhere in the pelvic cavity (Ag, 20.22), Tt occurs in about 3% of male infants and should be treated before the infant is five years old to reduce the chance of infertility or other complications. Functional Considerations Functional disorders of the male reproductive system include impotence, infertility, and sterility. Impotence (im'po-ens) is the inability of a sexually mature male to achieve penile erec- tion or to achieve ejaculation. The causes of impotence may be physical, such as abnormalities of the penis, vascular irregular- ities, neurological disorders, or the result of diseases. Generally, however, the cause of impotence is psychological, and the pa- tient requires skilled counseling by a sex therapist Infertility isthe inability ofthe sperm to fertilize the ovum and may be the fault of the male or female, or both, ‘The term impotence should not be used when referring to infertility. In- fertility in males may be caused by a number of things, the most ‘common of which is the inadequate production of viable sperm. Some of the causes of infertility in males ate alcoholism, dietary deficiencies, local injury, varicocele, excessive heat, or exposure to X rays. A hormonal imbalance may also contribute to infer- tility, Many of the causes of infertility can be treated through proper nutrition, gonadotrophic hormone treatment, or micro= surgery. If corrective treatment is not possible, however, it may be possible to concentrate the sperm obtained through mastur~ bation (in males, selfstimalation to the point of ejaculation) and use this concentrate to artificially inseminate the wornan, Sterility is similar to infertility except that itis a perma- nent condition. Sterility may be genetically caused, or it may be the result of degenerative changes in che seminiferous tu- bles (for example, slumps in a mature male may secondarily infect the testes and cause irreversible tissue damage). Voluntary sterilization of the male in a procedure called a vasectomy is a common technique of birth contcol. In this procedure, a small section of each ductus deferens neat the ep- Tuners syndrome: from Henry H, Tuer, American andocrinoiogst, 1892 “970 Kinefoter’s syndrome: fom Hary F Kinelellar, Je, American physician, . 1912 ryplorehiiem: Gk. eryata, hidden orchis, ests, impotence: L. im, nt; potens patent Stenity: L. ster, eaten vasaciomy: vas, vassel, Gk ektome, excisionOo} o Figure 20.22 Cryplorchicism (a) incomplete descent ofa testis may involve four separate regions: (7) in the pelvic cavity, (2) nthe inguinal ‘canal, (3) a the superfeial nguinal ring, (4) the Upper scrotum. (0) 8 ‘ectopic testis nay be (7) in the superical fascia of the anterior pelvic wall (2) at the root of he penis (3) in the perineum, in the thigh alongside the Temoral vessels ididymis is surgically removed, and the cut ends of the ducts are tied (fig, 20.23). A vasectomy interferes with sperm trans- port but does not directly affect the secretion of androgens from interstitial cells in the interstitial tissue. Since spermatogeriesis continues, the sperm cannot be drained from the testes and in- stead accumulate in the crypts that form in the seminiferous tubules and ductus deferens. These crypts present sites of in- Male Reproductive System 644 flammatory reactions in which spermatozoa are phagocytosed and destroyed by the immune system. Diseases of the Male Reproductive System Sexually Transmitted Diseases Sexually transmitted diseases, frequently called venereal diseases (VD), are contagious dis- ceases that affect the reproductive systems of both the male and the female (table 20.5) and are transmitted during sexual ac- tivity. The frequency of sexually transmitted diseases in the United States is regarded by health authorities as epidemic. ‘These diseases have not been eradicated, mainly because humans cannot develop immunity to them and increased sexual pro- miscuity increases the chances of reinfection. Gonorrhea (gon'c-r'ah), commonly cilled clap, is caused by the bacterium gonococcus, or Neisseria gonorrhoeae, Males with this disease suffer inflammation of the urethra, accompanied by painful urination and frequently the discharge of pus. In fe~ males, the condition is usually asymptomatic, and therefore ‘many women may be unsuspecting carriers of the disease, Ad- vanced stages of gonorrhea in females may infect the weerus and the uterine tubes. A pregnant woman with gonorrhea that is not treated may transmit the disease to the eyes of her newborn, causing blindness Syphilis (sifi-tis) is caused by the bacterium Treponema pallidum, Syphilis is less common than gonorrhea but is the more serious of the two diseases. During the primary stage of syphilis, a lesion called a chancre develops at the point where contact was ‘made with a similar sore from an infected person. The chancre isan ulcerated sore that has hard edges and endures for ten days to three months. It is only during the primary stage that sy- philis can be spread to another sexual partnes. The chancre will heal with time, but if not treated, it will be followed by sec- ondary and tertiary stages of syphilis. During the initial con- tact, the bacteria enter the bloodstream and spread throughout the body. The secondary stage of syphilis is expressed by lesions ora rash of the skin and mucous membranes, accompanied by fever (ig. 20.24). This stage lasts from two weeks to six months, and the symptoms disappear of their own accord. The tertiary stage occurs ten to twenty years following the primary infec- tion. The cicculatory, integumentary, skeletal, and nervous sys- tems are particularly vulnerable to the degenerative changes caused by this disease. The end result of untreated syphilis is blindness, insanity, and eventual death. AIDS, or acquired immune deficiency syndrome, is a viral disease that is transmitted primarily through coitus and drug abuse (by sharing contaminated syringe needles), Addi- sional information about this fatal disease, for which there is no known cure, is presented in table 20.5. Disorders of the Prostate Gland ‘The prostate gland is subject to several disorders, most of which are common in older men. The four most frequent prostatic problems are acute prostatitis, chronic prostatitis, benign prostatic hyperplasia, and carcinoma of the prostate ‘Varerear” L (rinology) trom Venus, the goddess of love gonorrnea: L gonoe, seed: mova, @ tow Chancre Fr chenere, nivectly fem L cancer, a orsbFigure 20.24 The secondary stages of syphilis as expressed by lesions cf th skin of this young woman Acute prostatitis is common in sexually active young men through infections acquired from a gonococcus bacterium. The symptoms of acute prostatitis are a swollen and tender prostate gland, painful urination, and in extreme conditions, pus drip- ping fom the penis. I is ereated with penicillin, bed rest, and increased fluid intake. Chronic prostatitis is one of the most common afflictions of middle-aged and elderly men. The symptoms of this con- dition vary considerably from irritation and slight difficulty in urination to extreme pain and urine blockage, which com- monly causes secondary renal infections. In this disease, several kinds of infectious microorganisms are believed to be harbored in the prostate gland and are responsible for inflammations else- where in the body, such as in the nerves (neuritis), the joints (arthritis), he muscles (mayosits), and the iris (itis) Prostatic hyperplasia, or an enlarged prostate gland, coccuts in approximately one-third of all males over the age of sixty. In this condition, an overgrowth of granular material compresses the prostatic urethra. The cause of prostatic hyper- plasiais not known. As the prostate enlarges, urination becomes painful and difficult. Ifthe urinary bladder is not emptied com- pletely, cystitis eventually occurs. Persons with cystitis may become incontinent and dribble urine continuously. Prostatic hypertrophy is usually treated by the surgical removal of por- tions of the gland through transurethral curetting (cutting and Male Reproductive System 643 removal of a small section) or the removal of the entire prostate gland, called prostatectomy. Prostatic carcinoma, or cancer of the prostate gland, is the second leading cause of death from cancer in males in the United States, It is common in males over sixty and accounts for 19,000 deaths annually. When prostatic cancer is confined to the prostate gland, it is generally small and asymptomatic. But as the cancer grows and invades surrounding nerve plex- uses, it becomes extremely painful and easly detected. The me- tastases of this cancer to the spinal column and brain are generally what kills che patient, ‘As prostatic carcinoma develops, it has symptoms nearly identical to prostatic hyperplasia—painful urination and cys- titis, When examined by rectal palpation with a gloved finger, however, a hard cancerous mass can be detected in contrast to the enlarged, soft, and tender prostate diagnostic of prostatic hypertrophy. Prostatic carcinoma is treated by prostatectomy and frequently by the removal of che testes (called orchiec« tomy) as well. An orchiectomy inhibits metastases by climi- nating testosterone secretion, Disorders of the Testes and Scrotum A hydrocele (/i'dro-@l) is a benign fluid mass within the tunica vaginalis that causes swelling of the scrotum. [tis frequent, minor disorder in infant boys as well as in adults. The cause is unknown. ‘An infection in the testes is called orchitis. Orchitis may develop from a primary infection from a tubercle bacterium or as. secondary complication of mumps contracted after puberty. If orchitis from mumps involves both testes, it usually causes sterility. ‘Trauma to the testes and scrotum is common because of their pendent position. The testes are extremely sensitive to pain, and a male responds reflexively to protect the groin area he tubular structures that are apparently absent in our patient are the ductus deferentia. This condi: tion, known as congenital bilateral absence of the duct deferentia, prevents spermatozoa from being trans ported from the testes to the ejaculatory ducts. Thi: explains the absence of spermatozoa in the patient’ jaculate since the accessory reproductive glands tha contribute to che production of seminal fluid add their secre tions at a point in the reproductive tract distal to the absen duct. The accessory reproductive glands include the semina vesicles (which in many cases are also absent or nonfunctiona in this deformity) and the prostate gland. Until recently, thi condition would have categorically prevented our patient fron becoming a father. Microsurgical extraction of spermatozo from the epididymes is now possible, however, and has allowe: many afflicted men to father children.