Physiologyoferectionandejaculation

Physiologyoferection
Vascularmechanismoferection:
- Flaccidity: the smooth muscle of the corpora cavernosa (CC) contracts tonically and
bloodflowisminimal,onlyfortissuenourishment.
- Erection: arterial vasodilation occurs along with the relaxation of smooth muscle and
expansionoftheCC.Thereisalsocompressionofthesubalbuginealvenousplexusand
emissaryveins,reducingthevenousoutflow(corporalvenoocclusivemechanism).
Neurologicalpathwaysoferection:
- Autonomous peripheral pathways: the T11L2 sympathetic fibers (which produce
detumescence) and the S2S4 parasympathetic fibers (which produce erection) are
channeledthroughthecavernousnerves.
- Somatic peripheral pathways: the dorsal penile nerve (a branch of the pudendal nerve)
andthemotorfibersoftheOnufnucleus(S2S4)conductpenilesensitivitytotheischio
cavernosusandbulbocavernosusmuscles,necessaryforrigiderectionandejaculation.
- Highercenters:themedialpreopticareaandparaventricularnucleusofthehypothala
mus,hippocampus,andcerebralcortex.Thesecentersregulatethe3typesoferection:
Psychogenicerections:triggeredbyimpulsesfromthebrain.
Reflexogenicerections:inresponsetotactilegenitalstimulation.
Nocturnalerections:duringREMsleep.
Neurotransmitters:
- Flaccidity:duetotonicsmoothmusclecontractionoftheCC, adrenergicneurotransmis
sion,andendothelialfactors(angiotensinII,PGF2,andendothelins).
- Erection:themainneurotransmitteroferectionisnitricoxide(NO),whichtheproduc
tion ofcGMP, a relaxant of CC smoothmuscle. Other neurotransmitters implicated are
parasympatheticcholinergicsandthosemediatedbyVIP(vasoactiveintestinalpeptide).
The erection ceases when NO release stops, phophodiesterases (especially phopho
diesterase5)degradecGMP,andthesympatheticdischargeofejaculationoccurs.
Sexualhormones:testosteronemaintainslibido,butitsdoesnotalwaysproduceED.

Physiologyofejaculation

Pathwaysandcentersofejaculation:
- Afferentpathway:sensorystimulifromtheglansascendalongthepudendalnervetothe
hypogastricplexusandthesympatheticgangliaT10L2.FromtheretheyrisetotheCNS.
- Ejaculationcenters:thereare3centersintheCNSthatregulateejaculation:
Themedialpreopticareaofthehypothalamus.
Theparaventricularnucleusofthehypothalamus.
Periaqueductalgraymatter.
- Efferent pathway: this dopaminergic route conducts the motor stimulus to the T10L2
sympatheticgangliaandfromtheretotheS2S4fibersofthepudendalnerve.Thispath
way is centrally and peripherally modulated by the serotoninergic neurons of the pa
ragigantocellularnucleus,whichinhibitsejaculation.SSRIdrugsserotoninlevels.
Phasesofejaculation:
- 1st phase (emission): smooth muscle contraction of the prostate, seminal vesicles, vas
deferens,andepididymisproducesemissionofsementotheposteriorurethra.Herea
pressurechamberformsbetweentheinternal(bladderneck)andexternalsphincters.
- 2nd phase (ejaculation): rhythmic contractions of the pelvic floor and bulbocavernosus
andischiocavernosusmusclescausethepressurechambertoopen.
- 3rdphase(orgasm):sensorystimulustransmittedtotheCNS.