Anatomy of Penis and Mechanism

of Erection
Content at a Glance ………………………………..
Anatomy of Penis- The basic construction
1. The corpora cavernosa penis
2. Corpus cavernosum urethrae
3. Corpus spongiosum
4. Glans Penis
5. Sperm and their storage
6. Haemodynamics (Blood Supply)
6.1 Arterial (oxygenated) blood supply to the penis-
6.2 Venous (Deoxygenated blood) drainage of the penis
6.3 Lymphatic drainage (removal of unwanted elements)
7. Neuroanatomy (Nerve supply)–
Mechanism of erection
a) Neurologic origin
b) Role of neurotransmitters
c) Sustenance of erection
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Anatomy of Penis- The basic construction
The penis is an organ that is responsible for excretion of urine and reproduction. It is
positioned be front and side of the pubic arch, anterior to the body. It remains in two
conditions, flaccid and erect. In the flaccid condition it is cylindrical shape, but when
erect, assumes the form of triangular prism with rounded angles. It is composed of a pair
of corpora cavernosa penis and corpus cavernosum urethrae which is tucked between the
two corpora cavernosa penis. Corpora cavernosa penis are laterally located and are made
of spongy tissues that are composed of smooth muscles, fibrous tissues, spaces, veins,
and arteries and covered by a membrane called tunica albuginea. Corpus cavernosum
urethrae which is medially located, is covered by corpus spongiosum.
1. The corpora cavernosa penis- Corpora cavernosa penis are laterally (left and right
side) located, lying on the dorsal (front) side and are made of spongy tissues that are
composed of smooth muscles, fibrous tissues, spaces, veins, and arteries and are lined by
an epithelium. The Corpora cavernosa penis is covered by a membrane called tunica
albuginea and separated by connective tissue septa. It constitutes the major part of the
penis, with the anterior (from head to end) three fourth being closely attached to one
another but at their proximal (opposite) end, they diverge in the form of crura. The crura
are attached to rami of the pubic arch. The distal part of corpora cavernosa ends a
hemisphere like structure called as the glans penis.
2. Corpus cavernosum urethrae- Corpus cavernosum urethrae which is medially
located, is covered by corpus spongiosum which lies on the underside of the penis. The
urethra, which is the last part of the urinary tract, traverses the corpus spongiosum and
ends at an opening called as the known as the meatus which marks the tip of the glans
penis. It is serves the purposed of excretion of urine and is also a passage for the
ejaculation of semen.
3. Corpus spongiosum-The spongiosum is composed of sinusoidal spaces of larger
dimensions than those of the corpora cavernosa and with less smooth muscle.
Comparing to corpora cavernosa penis, the tunica albuginea surrounding the
spongiosum is fragile, but despite that spongiosum is capable of an erectile response.
4. Glans Penis- The distal part of the corpus spongiosum is an enlarged cone shaped
structure called glans penis. In the flaccid (relaxed) state, the glans penis is partially or
completely covered by the foreskin or prepuce, unless the penis is circumcised. During
erection, the foreskin retracts to expose the glans.
5. Sperm and their storage
The production of sperms takes place in the testes which are located below the penis.
Epididymis acts as a store house for them. During ejaculation, vas deferens propels the
sperms ahead. Seminal vesicles add fluid and along with vas deferens turn into
ejaculatory ducts and join the urethra inside the prostrate gland. There are more
secretions added by the prostrate and the bulbourethral glands before the semen is
expelled through the penis.
6. Haemodynamics (blood supply)
6.1 Arterial (oxygenated) blood supply to the penis-
Internal iliac artery provides blood to both the corpus

cavernosum. The arterial blood supply

systems are
divided into two, the deeper and the superficial. The
internal pudendal artery is a deeper arterial system that
supplies blood to the erectile tissues. In the pelvis, it
passes under the sacrospinous ligament, crosses over the
sacrotuberous ligament, and gives off the perineal artery
in Alcock’s canal, where it runs under the superficial
transverse perineal muscle and the symphysis pubis. It passes through the pelvic floor
adjacent to the inferior ramus of the ischium near the bulb of the urethra and gives off
four branches which are the artery to the bulb of the penis, the urethral artery, the deep
artery of the penis and the dorsal artery of the penis which play a key role in supplying
blood. After this it reaches the corpus cavernosum to form one element of the paired
dorsal arteries. The superficial system arises from the lateral inferior pudendal artery
supplies blood to the tissues around the erectile organ.
6.2 Venous (Deoxygenated blood) drainage of the penis
The deoxygenated (venous) blood recedes from the penis in three planes: superficial,
intermediate and deep.
• Superficial venous system- multiple superficial veins--->. Superficial dorsal vein
---> left external branch of the internal saphenous vein.

• Intermediate venous system- Blood from glans, corpus spongiosum and the distal
two-thirds of the corpora----> deep dorsal vein-->dorsal venous complex.
• deep dorsal vein- cavernosal vein---> internal pudendal vein
6.3 Lymphatic drainage (removal of unwanted elements)
Lymph’s are clear fluids that pass through a network of lymph vessels and along the way
remove infection, cellular debris and toxins from every part of the body. The lymph
fluids finally drain into the liver for disposal and get broken down in the gall bladder.
From most of the penis, lymph drains into the superficial inguinal lymph nodes and the
vessels from the glans penis drain into the deep inguinal lymph nodes.

7. Neuroanatomy – Involvement of the nerves in erection

The neuroanatomy of the penis place a significant role in getting the penis erect as it
passes stimulus to the peripheral nerves involved. For penile erection to take place, there
are three sets of peripheral nerves involved.
• Parasympathetic nerves from the second to fourth sacral (S2–S4) segments
• Sympathetic nerves from the tenth thoracic to the second lumbar (T10–L2)
thoracolumbar outflow
• Somatic fibers through the pudendal nerves
The dorsal nerve of the penis is one of the two terminal branches of the pudendal nerve
which arises in the pudendal canal and passes anteriorly into the deep perineal space. It
then runs to the dorsum of the penis where it passes lateral to the arteries. It supplies both
the skin and glans penis. The penis is richly innervated with sensory nerve endings,
especially the glans and is innervated with sensory nerve endings, especially the glans.
The cavernous nerves from the inferior hypogastric plexus pass through the urogenital
diaphragm to reach the penis. The skin covering the root of the penis is supplied by the
ilioinguinal nerve and the posterior scrotal branches of the perineal nerve.
Anatomy/ Mechanism of erection
Erection is assumed to be a part of sexual arousal, though in a healthy meal, it can occur
otherwise also. Besides its primary function of represent sexual arousal, it can also occur
due to friction, retraction of the prepuce or due to pressure from a filled urinary bladder.
In healthy males, erection occurs several times per night during the REM phases of sleep.
There are some who also experience morning erections. These are called an "unprovoked
erection" and take place 2 to 3 times in a week. It signifies healthy functioning of the
erection pathways. Erections are also observed in infant boys, and in utero. The
physiological process of erection is initiated in the brain and involves the nervous and
vascular systems.

a) Neurologic origin: The control of the smooth muscle tissue of the corpora cavernosa
is done by the autonomic system which is controlled by reflex centers in the cord or
cortical centers that are accessible to multiple (visual or sensory) stimuli. This results in
relaxation of the corpora cavernosa. The perineal muscles are controlled by the somatic
system. The vessel engorgement resulting in the swelling due to a reduction in the
alphasympathetic
tonus of the cavernous tissue permitting influx of arterial blood, and also due
to decreased venous flow from compression of the subalbugineal venous network against
the tunica albuginea of the corpus cavernosurn. The rigidity is maintained due to an
increase in intracavernous arterial pressure which is simultaneous with contraction of the
perineal muscles (ischiocavernosus) under the somatic control of the pudendal nerve.
b) Role of neurotransmitters: Neurotransmitters such as epinephrine, acetylcholine and
nitric oxide are some of the chemicals for initiating this relaxation. When there is
stimulation from the brain it sends impulses to the nerves to release nitric oxide. Nitric
oxide is released from nonadrenergic noncholinergic (NANC) nerves and endothelial
cells. This neurotransmitter stimulates the guanylate cyclase enzyme system in penile
smooth muscle. This result in increase in the level of cyclic guanosine monophosphate
(cGMP) .The cGMP causes the smooth muscles of the corpora cavernosa to relax and
dilates the blood vessels of the penis which allows rapid inflow of blood.At this point, the
two corpora cavernosa and corpus spongiosum can hold seven times their normal amount
of blood. The incoming blood fills the corpora cavernosa, making the penis expand due to
engorgement of vessels.
c) Sustenance of erection: The function of tunica albuginea is to keep the blood trapped
in the corpora cavernosa which sustains the erection. Reversal in erection occurs when
cGMP levels in the corpora cavernosa fall, causing the smooth muscles of the corpora
cavernosa to contract, stopping the inflow of blood and opening veins that drain blood
away from the penis. The falling of the levels of the cGMP in the corpora cavernosa is
attributed to the enzyme phosphodiesterase type 5 (PDE5) that destroys it with the help of
the nerves from the sympathetic nervous system. Any defect in this complex flow of
events can result in erectile dysfunction.
Erectile dysfunction as a result of abnormality in the system are illustrated below-
• Cerebral vascular accidents such as multiple sclerosis, Parkinson's disease, and
spinal cord injury can cause neurogenic erectile dysfunction.
• Erectile dysfunction due to neurovascular abnormalities due to vascular disease
and diabetes.
• Diseases such as peyronie’s disease, traumatic perineal and penile injuries can
harm the neurovascular and anatomical structures which can produce erectile
dysfunction.
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