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Chapter 3
Male Sexual Anatomy
and Physiology
Chapter Outline
The Testes and Scrotum Male Hormones and the
Male Genital and Testicular Self-Examination Male Climacteric
Disorders of the Testes Testosterone Replacement Therapy
Surviving the Male Climacteric
The Penis
Erection Self-Evaluation: Learning about
Penis Size Sexuality: Past, Present, and Future
Male Circumcision: The Debate
Chapter Summary
Disorders of the Penis
Focus on Health Questions FOH
Internal Male Organs
Prostate Problems
Sperm Production and Ejaculation

I first came to this country as a 12-year-old boy,

and in the gym showers I was almost the only boy
who was not circumcised. In my country
circumcision was never done, and I had never even
seen a circumcised penis before. And there I was,
with my penis looking different from everybody
else’s. . . . Of all my cultural adjustments here, that
was the most difficult.
—from a student essay
61
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62
I n sexuality education, male sex organs have tra-
ditionally been given recognition for their capability of
generating pleasant sexual feelings, while their role in
reproduction has often been seen as a by-product of
that pleasure. As in the female, the external sex organs
of the male (see Figure 3.1) are associated more with
sexual arousal, and the internal structures are associ-
ated more with reproduction (Sonfield, 2002). Men of-
ten are not well informed about their bodies or about
significant issues that can affect their sexual and re-
productive health. Educational efforts are beginning to
pay more attention to male sexuality, particularly the
needs of younger men (Sherrow et al., 2003).
The Testes and Scrotum
The two male sex glands, the testes (or testicles), de-
velop within the abdominal cavity during fetal life. A
few weeks before birth, the testes gradually move
downward through the inguinal canal into an exter-
nal pouch of skin called the scrotum. In a small per-
centage of male infants, the testes do not descend
into the scrotum properly, and a few of these cases
require medical treatment. The testes have two major
functions after puberty. One is the production of the
male sex hormone testosterone, which plays a sig-
nificant role in the development of male secondary
sex characteristics and also may affect behavior to
some degree. The testes also form hundreds of mil-
lions of sperm, the sex cells necessary for human
reproduction.
FIGURE 3.1 External Male Anatomy
The external male sex organs are more visible and accessible
than the female’s. As with the female, the external organs are
the primary source of sexual pleasure while the internal organs
are the source of reproduction, but the distinction is not as
clearly defined in males.
Chapter 3 Male Sexual Anatomy and Physiology
Epididymis
Vasa
efferentia
Vas
deferens
Scrotum
Seminiferous tubules Scrotal skin
FIGURE 3.2 Testes
The testes are the male gonads or reproductive glands. They are
paired structures located in the scrotum, and their purpose is
to produce sperm and the hormone testosterone that controls
male sexual development. The word testis is based on the root
word for “witness”; the ancient custom in taking an oath was
to place a hand on the genitals—to “testify.”
Each testis is subdivided internally into several
lobes (see Figure 3.2). The lobes are filled with a tan-
gled mass of tiny seminiferous tubules, inside of
which the sperm cells are formed. Each threadlike
tubule is 1 to 3 feet long if extended. Between the
tubules are interstitial cells (or Leydig cells) that pro-
duce testosterone. These cells are close to blood ves-
sels so that the hormone is secreted efficiently into
testes (TEST-ees) pair of male gonads that produce
sperm and male hormones.
scrotum (SKROTE-um) pouch of skin in which the testes
are contained.
testosterone (tes-TAHS-ter-one) major male hormone
produced by the testes; it helps produce male secondary
sex characteristics.
sperm reproductive cells produced in the testes; in fer-
tilization, one sperm unites with an ovum.
seminiferous tubules (sem-a-NIF-a-rus) tightly coiled
tubules in the testes in which sperm cells are formed.
interstitial cells (in-ter-STIH-shul) cells between the
seminiferous tubules that secrete testosterone and other
male hormones.
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The Testes and Scrotum
the bloodstream. The seminiferous tubules combine
at their ends to form larger ducts, which empty into a
series of even larger tubes, the vasa efferentia. Im-
mature sperm from the seminiferous tubules are
moved by wavelike contractions into the vasa effer-
entia and then into a coiled tubing network folded
against the back and part of the top of each testis, the
epididymis. It is in this area that the sperm mature
and become ready to leave the body. The epididymis
opens into a large duct that leads up into the abdom-
inal cavity from each testis. This duct, the vas defer-
ens, transports the sperm up to the seminal vesicle
during sexual activity.
Learn more about “The Testes” on
SexSource Online.
The scrotum of a prepubescent male is quite
smooth and light in color. At puberty, the testes and
scrotum grow, and hormonal influences cause the
outer skin to darken and become somewhat wrinkled.
The location of the testes in this external pouch is es-
sential, because sperm production can occur only at
temperatures slightly below inner body temperature.
The cremasteric muscles suspend the testes in the scro-
tum and help regulate their temperature. In cold sur-
roundings (such as swimming in cold water) or stress-
ful situations, these muscles and the scrotal tissue itself
contract, pulling the testes up close to the body to keep
them warmer and protected. In warmer surroundings
(such as a hot bath), the muscles and scrotal tissue re-
lax so the testes are lowered away from the body to
keep them cooler. The adult male testes are about 1.5
inches in length and 1 inch in diameter. They are
FOH slightly movable within the scrotum. One testis usually
hangs slightly lower than the other—in the majority of
men, the left testis is lower, while in left-handed men
the right testis tends to hang lower. There seems to be
no particular significance either way. The scrotal area is
well supplied with nerves, and the testes are very sen-
sitive to pressure or sharp blows. Most men find gentle
stimulation of the testes and scrotum sexually arousing.
Tradition once held that during exercise an athletic
supporter or jockstrap should be worn by males to
hold the testicles up closer to the body, providing sup-
port and a measure of protection. However, historians
know that athletes in ancient times often competed in
the nude. There is now some evidence that during ex-
ercise the cremasteric muscles actually contract, pro-
viding their own natural support. As body temperature
rises, however, they tend to relax, causing the testes to
lower away from the body and making them more
vulnerable to injury. Younger male athletes are not
wearing the traditional jockstrap as much anymore,
opting instead for spandex shorts or compression
63
pants that provide a more natural feeling of support.
Some are even choosing to wear boxer shorts, which
do not provide much support at all. Evidence suggests
that severe testicular injury, causing pain and swelling
for a day or more, may be associated with later infer-
tility. This has caused some sports health experts to
recommend that a hard plastic protective cup be worn
over the male genitals during contact sports.
In various times in history, males have had their
testicles removed in a surgical procedure called cas-
tration. It was believed that castrated males, some-
times called eunuchs, were reliable guards for harems
of women and also tended to be more level-headed
managers and leaders. Some men today fantasize
about being castrated for various reasons, and some
actually go through with the procedure. These men
may be motivated by sexual feelings, a preference to
be female, or a desire to have less powerful sexual
urges. It can be very dangerous to attempt castration
by oneself or to allow someone who is not medically
qualified to attempt the procedure, because it can
lead to permanent disability or even death (Wasser-
sug, Zelenietz, & Squire, 2004).
Male Genital and Testicular
Self-Examination
Men should take time at least monthly to examine their
genital organs. Adequate lighting, and sometimes a
mirror, can help with the self-examination process.
Look through the pubic hair to the skin underneath,
and carefully examine the head and shaft of the penis.
If you are not circumcised, this will require pulling
back the foreskin to expose the penile glans. Check for
any bumps, sores, or blisters anywhere in the region.
These may be reddish or light in color. It is important
to lift up the penis and look underneath, because this
area is often overlooked. Also be alert to any soreness
in the genitals or to any itching or burning sensations
during urination or around the urethral opening. Al-
though many of these symptoms do not indicate seri-
ous conditions, you should have them checked by a
physician or other clinician who specializes in men’s
health concerns.
vasa efferentia larger tubes within the testes, into
which sperm move after being produced in the seminifer-
ous tubules.
epididymis (ep-a-DID-a-mus) tubular structure on each
testis in which sperm cells mature.
vas deferens tube that leads sperm upward from each
testis to the seminal vesicles.
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64
FOH Cancer of the testes is a relatively rare disease, with
fewer than 5,000 new cases diagnosed each year in the
United States. It is primarily a disease of younger men,
especially men between the ages of 20 and 35. When it
is detected and treated early, the chances of survival
are excellent. However, if it is not treated within the
first three months, the survival rate falls dramatically, to
only about 25 percent. Therefore it is crucial for men to
get into the habit of checking their testes regularly for
any lumps or other unusual symptoms.
FOH Here is the best way to proceed with testicular
self-examination. Choose a time after a hot shower or
bath, so that the testes are lowered away from the
body. Roll each testicle gently between the thumb and
fingers, looking especially for any small hard lumps
that might be found directly on the front or side surface
of a testis (see Figure 3.3). Such a lump is usually pain-
less. Do not be alarmed at feeling the epididymis to-
ward the top and back of each testis. Although not all
lumps are malignant, any growth should be reported to
a physician immediately for further investigation. Other
symptoms that a man should consider suspicious and
worth reporting include any “heavy” feeling in a testi-
cle, accumulation of fluid in the scrotum, swelling of
lymph nodes or other discomfort in the groin area, and
any swelling or tenderness in the breasts.
If testicular cancer is diagnosed, the usual treat-
ment involves surgical removal of the entire testis. The
other testis is left in place and can easily produce
enough male hormones on its own. An artificial, gel-
filled testis can be placed in the scrotum for cosmetic
FIGURE 3.3 Testicular Self-Examination
The best time for a man to examine his testes is right after a
hot bath or shower, because the testicles descend and the scro-
tal skin relaxes in the heat. He should place his index and mid-
dle fingers on the underside of each testicle and his thumbs on
top. He should gently roll the testicle between his fingers and
thumb. Any abnormal lump would be most likely to be found at
the front or the side of the testicle.
Chapter 3 Male Sexual Anatomy and Physiology
reasons. Sexual functioning may change for a time in a
proportion of males following treatment for testicular
cancer. The most common complaints are a decrease
in sexual desire and difficulty reaching orgasm, al-
though many men actually report an increase in sexual
satisfaction. Functional problems often improve with
time and further treatment (Jonker-Pool et al., 2001).
Men should become comfortable with this self-exami-
nation procedure as a potentially lifesaving measure.
Disorders of the Testes
There are also several disorders of the testes. In very
rare cases, both testes are completely lacking at birth,
a disorder known as anorchism. A more common
problem is cryptorchidism, in which the testes have
not descended into the scrotum before birth. This con-
dition usually corrects itself within a few years; if it
does not, it must be corrected by the time of puberty
through hormonal or surgical treatment. If only one
testis is present in the scrotum, the condition is termed
monorchidism. However, one testis can easily han- FOH
dle the work of two, producing sufficient quantities of
male hormones and sperm. Occasionally a male suf-
fers from testicular failure, in which the testes do not
produce male hormones or sperm. This condition usu-
ally responds to some form of hormonal therapy.
Several organic problems can affect the internal
organs of the sexual and urinary systems. In men, the
bladder may become infected, and various parts of
the testes may occasionally become inflamed.
Epididymitis, or inflammation of the epididymis at
the top of each testis, is relatively common and is
treated with antibiotics. It can be caused by many dif-
ferent types of bacteria that make their way into the
urethra and eventually back through the vas deferens
to the epididymis. In severe cases, surgical interven-
tion may be necessary.
If a man experiences prolonged sexual arousal
without having an orgasm, the testes may become
anorchism (a-NOR-kiz-um) rare birth defect in which
both testes are lacking.
cryptorchidism (krip-TOR-ka-diz-um) condition in which
the testes have not descended into the scrotum prior to
birth.
monorchidism (ma-NOR-ka-dizm) presence of only one
testis in the scrotum.
testicular failure lack of sperm and/or hormone produc-
tion by the testes.
epididymitis (ep-a-did-a-MITE-us) inflammation of the
epididymis of the testis.
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The Penis
Real People
Roland: Confronting an Embarrassing Situation
Roland is a university sophomore. He has not had
any serious relationships but considers himself a
very sexual person. He thinks and fantasizes about
sexual things frequently and has masturbated regu-
larly since he was 11 years old. Residence-hall living
during his first year reduced the frequency with
which he masturbated, mostly because of the lack of
privacy. He appreciates the greater amount of alone
time he now has in a suite shared with two others.
He often enjoys accessing free pornographic pic-
tures on the Internet and frequently views these
sites during his masturbatory activity. One night re-
cently when he was engrossed in stimulating him-
self with his boxers pulled down, one of his
suitemates returned unexpectedly and found him at
the computer. The suitemate was obviously embar-
rassed, as was Roland, and the other man turned
and left the suite without saying a word.
The next day, Roland made a point of apologizing
to his suitemate, saying that he had not expected
anyone to enter the room. The suitemate told him
that he was really upset by what he had witnessed
and was thinking of asking for a room change. He
swollen, tender, and painful due to their long-term
congestion with blood. The vas deferens also may be-
come irritated, causing pain that extends up through
the pubic area and lower abdomen. In slang, this con-
dition is often called “lover’s nuts,” “blue balls,” or
FOH “stone ache.” It is not dangerous or permanently dam-
aging—merely uncomfortable. It is also much less
common than usually believed.
The Penis
Just above the scrotal sac is the male sex organ called
the penis. The sensitive, smooth, rounded head of the
penis is called the glans. The glans is filled with nerve
endings and is particularly sensitive to sexual stimula-
tion. The two most sensitive areas of the glans are the
frenulum, a thin, tightly stretched band of skin on its
underside connecting the glans with the shaft (body) of
the penis; and the corona, the ridge around the edge
of the glans. The urinary meatus or urethral opening is
found at the tip of the glans. When a male is born, the
65
added that as far as he was concerned, both mastur-
bation and pornography were immoral and disgust-
ing. He told Roland that he understood every male
had difficulty resisting these temptations, but he
didn’t want to risk walking in on the behavior again.
Roland was now even more embarrassed, and while
he didn’t really think masturbation was wrong, he
was not anxious to have university officials find out
about what had happened. He assured his suitemate
that he wouldn’t have to worry about seeing the be-
havior again, and they agreed not to talk about the
incident further. Roland has come away from the sit-
uation feeling negative about himself and wondering
what he should do about cutting down on masturba-
tion or eliminating the behavior completely.
Do you think Roland was wrong for behaving as he
did? What do you think of his suitemate’s reaction?
Was he overreacting? Was he right to be concerned?
If you were in the suitemate’s shoes, what would you
do? Would you want to change rooms? Would you
tell other people what had happened? Is there any
obligation to protect Roland’s privacy?
head of the penis is partly covered by a fold of skin
called the prepuce or foreskin.
The longer body of the penis is called the shaft.
The skin on the shaft is quite loose, allowing erection
to occur. Inside the penile shaft are three cylinders of
penis male sexual organ that can become erect when
stimulated; it leads urine and sperm to the outside of the
body.
glans in the male, the sensitive head of the penis.
frenulum (FREN-yu-lum) thin, tightly drawn fold of skin
on the underside of the penile glans; it is highly sensitive.
corona the ridge around the penile glans.
foreskin fold of skin covering the penile glans; also
called the prepuce.
shaft in the male, the cylindrical base of the penis that
contains three columns of spongy tissue: two corpora
cavernosa and a corpus spongiosum.
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66
Corpora cavernosa
Urethra Corpus spongiosum
FIGURE 3.4 Cross Section of a Penis
The penis is the male organ of urination and copulation. This
cross section shows the three internal structures of the penis,
all cylindrical in shape. The corpus spongiosum contains the
urethra, through which pass semen and urine. All three have
spongelike tissue dotted with small blood vessels.
erectile tissue, each full of nerves and blood vessels
(see Figure 3.4). The two cylinders of tissues lying par-
allel along the top and sides of the penis are called the
corpora cavernosa. The third, slightly narrower cylin-
der that extends along the underside of the penis is
called the corpus spongiosum.
The penis not only is important as the male organ
for sexual activity and reproduction, but also is the or-
gan through which urine is passed from the body. The
tube that carries both sperm and urine in the penis is
the urethra. It is located in the corpus spongiosum,
which extends back to the urinary bladder and con-
nects with the sperm-carrying ducts.
Erection
During sexual arousal, the three cylinders inside the
penis become engorged with blood so that the penis
expands in circumference, becomes longer and harder,
and stands out from the body. This erection is usually
necessary for successful sexual intercourse. It is possi-
ble at times, however, for some men to have an or-
gasm without erection. During erection, the three
cylinders of erectile tissue may be felt distinctly. Penile
erection occurs in several phases, involving increased
blood flow into the erectile tissue and decreased flow
out of the tissue. The penis elongates and expands to
its maximum capacity, eventually becoming highly
rigid as stimulation continues. Sometimes there is a
slight curvature in the erect penis—upward, down-
ward, or to one side. Unless the curvature is caused by
some injury or disease (which is quite rare), it will not
interfere with sexual performance. The angle at which
the penis stands out from the body varies a great deal
Chapter 3 Male Sexual Anatomy and Physiology
as well, most typically ranging from 30 to 90 degrees
from the upright vertical.
Erection of the penis is controlled by a spinal reflex
and is mostly an involuntary reaction (see Figure 3.5).
However, the cerebral cortex and other portions of the
brain also have input and are intricately connected to
the “erection center” of the spinal cord. Therefore, both
reflexive and thought processes can work together to
stimulate or inhibit an erection (McKenna, 2000). It
should be noted that while erections can be generated
solely by medical or mechanical means (such as use of
a specially designed pumping device), there is a sub-
jective difference between a man’s experience of that
type of erection and his experience of one generated
by a sexually arousing stimulus (Delizonna et al.,
2001). In men whose spinal cords have been severed,
which breaks the connection between the erection cen-
ter and the brain, physical stimulation of the penis still
generates erection, although the brain has no aware-
ness of feeling in the penis.
The actual mechanism of erection has only re-
cently begun to be more fully understood. Two mus-
cles in the perineal area (below the scrotum), the
bulbocavernosus muscle and ischiocavernosus muscle,
show bursts of activity just prior to erection. This ac-
tivity apparently is closely related to increases in arte-
rial blood flow into the penis, and the muscles and
circulatory vessels then work together to maintain
erection. It is now known that during sexual arousal
the nervous system stimulates the linings of the penile
blood vessels and the nerve endings to produce a
chemical called cyclic GMP, short for guanosine
monophosphate, a biochemical derived from nitric ox-
ide. The smooth muscles that surround the arteries in-
side the penis normally are contracted when the penis
is nonerect. Cyclic GMP causes the muscle cells to re-
lax, allowing the arteries to open so that blood flows
into the open spaces in the erectile tissues. The rise in
blood pressure within the penis squeezes the veins so
that they do not drain blood out of the organ, and the
penis becomes engorged with blood and erect. It is
common for men to experience some loss of erection
if their mind wanders during sexual arousal. This hap-
pens because nerve signals from the brain are no
longer reaching the penis, and the production of cyclic
GMP decreases. The smooth muscle cells then begin
contracting again, and arterial blood flow is reduced.
urethra (yu-REE-thrah) tube that passes from the
urinary bladder to the outside of the body.
erection enlargement and stiffening of the penis as in-
ternal muscles relax and blood engorges the columns of
spongy tissue.
cyclic GMP a secretion within the spongy erectile tissues
of the penis that facilitates erection.
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The Penis 67

2
Stimulation
signal

1
Erectile Cyclic GMP Blood
tissue flows
Spongy in
Cyclic tissue
GMP
Arteries
partially
dilated
Stimulation
signal Blood
flows
Vein
out
partially
closed

1 When things are working right, sexy

signals from the brain stimulate the release
of a chemical in the penis, cyclic GMP, that
causes muscles in the spongy erectile tissue
to relax and the arteries to expand.
2 Blood rushes into the newly opened
spaces and the penis begins to stiffen. A full
erection occurs, however, only after the veins
that normally drain blood away have been
squeezed shut.

FIGURE 3.5 Penile Erection

Penile erection is achieved primarily by the increase in blood flow through the corpus spongiosum and the corpora cavernosa during
sexual arousal. Other factors, such as spinal reflex and emotion, enter into the physical act of erection.
Source: #1 and #2 from Bruce Handy, “The Viagra Craze,” Time, May 4, 1998, p. 52. Copyright © 1998 Time, Inc. Reprinted by permission.

Erection clearly is a complex phenomenon involving a
carefully balanced interaction of the nervous system,
cyclic GMP production, muscle tissue, and blood ves-
sels (McKenna, 2000).
See “Penile Plethysmography” on
SexSource Online.
FOH Penis Size
Penis size is a nearly universal concern of men, yet it
has not been the subject of very extensive research.
Some evidence shows that men are far more likely to
rate the size of their penis as average or below average
than they are other bodily characteristics, and highly un-
likely to rate their penis as much larger than average.
This underestimation of the comparative size of genitals
may be a response to social pressures and expectations.
Penises clearly vary in length, width, and shape,
all perfectly functional and normal. Although some
men and women prefer larger penises for sexual ac-
tivity, there is no basis for believing that any factors
of penile size affect a man’s ability to be a fully satis-
factory sexual partner. Nevertheless, in a study of 556
women in Croatia, well over half indicated that penis
length and/or girth was somewhat important to their
sexual pleasure, while around 20 percent said these
characteristics were very important. Only one-fourth
of the women responded that penis size was unim-
portant. The more male partners the women in the
study had had, the more important penis size was to
them. To add more fuel to the insecurities such stud-
ies generate for men, over 70 percent of the women
in this study said that the overall aesthetic appear-
ance of men’s penises (undefined beyond that gener-
ality) was also important to their own sexual pleasure
(Stulhofer, 2006). Practically speaking, men can do
little to alter the characteristics of their genitals. There-
fore, learning to become comfortable with one’s body
and learning from sexual partners how to most effec-
tively engage in sexual activities are the most reason-
able goals to pursue.
There is no demonstrated relationship between
height, general body size or the size of other particular
organs, and penis size (Awwad et al., 2005). Although
the research samples have been quite small and the use-
fulness of the conclusions is doubtful, some evidence
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68
Real People
Jake: Concerns about the Male Body
Jake was a senior in college, and his current rela-
tionship seemed to be faltering. He felt depressed
and told his best friend how shy he had always
been with women. He did not talk about the con-
cerns he had with his body. He had been born
with an undescended testicle, and efforts to move
the testis into his scrotum during childhood had
failed. Prior to entering college, he had had a
plastic prosthetic testis surgically implanted in his
scrotum because he was concerned that his lack-
ing testis would be noticed in shower rooms.
However, he had been dissatisfied with the pros-
thesis because in his opinion it did not look or
feel genuine.
exists that there may be significant differences in erect
penis lengths among different ethnic groups (Harding
& Golombok, 2002).
Penis size continues to be an object of curiosity and
comparison, and some research has attempted to docu-
ment information. Studies on penis size have sometimes
been conducted to gather information about how likely
it is for a condom to slip off the penis or break during
sexual activity. As might be anticipated, researchers face
the daunting task of either being allowed by men to
measure their penises or asking men to measure their
own penises and then report the dimensions. The for-
mer technique makes people uncomfortable and may
actually affect penis size, and the latter method could be
prone to exaggeration (Harding & Golombok, 2002).
One study asked gay male couples to measure each
other and report back on two different occasions. The
researchers believed that the reported inconsistencies
rendered the measurements unreliable, while other an-
alysts considered them explainable as random rather
than intentional errors (Hershberger, 2003).
A medical text from 1949 offered some measure-
ments but little description of how they were made. The
work of Kinsey and of Masters and Johnson did not give
definitive results either. Two urologists who performed
standardized penile measurements on a group of men
at San Francisco General Hospital found that the aver-
age nonerect penis was 3.5 inches in length and 3.9
inches in circumference. The average erect penis was
5.1 inches long and 4.9 inches in circumference. Using
Chapter 3 Male Sexual Anatomy and Physiology
Jake was also concerned about the size of his pe-
nis and had written for information on penile en-
largement surgery, which he had seen advertised in a
men’s magazine. After investigating this option fur-
ther, he gave up the idea of pursuing expensive—
and risky—surgery. He decided his penis was within
normal size ranges. Nonetheless, he continued to be
reluctant in his relationships with women and was
troubled by his insecurities.
What do you think Jake ought to do? With whom
would you recommend he speak about his personal
concerns? Is Jake just being silly in worrying about
the size of his penis, or do you think size really mat-
ters to men’s sexual partners?
the statistical measures of a standard bell curve, the re-
searchers concluded that the range in length for average
erect penises would be between 2.8 and 7.2 inches. The
2 percent of men whose erect penises are smaller than
2.8 inches and the 2 percent whose penises are larger
than 7.2 inches would be considered smaller or larger
than average (Wessels, Lue, & McAninch, 1996).
It has been suggested that measurements of the
nonerect penis do not have great meaning because the
flaccid penis length of any particular man may vary a
great deal depending on emotional and environmental
conditions. It is assumed that the erect length would be
more consistent from situation to situation, although no
reliable data are available support this assumption.
Studies generally show that erect penises tend to be
somewhat shorter than often believed or as reported in
studies relying on self-measurements. A rough group-
ing of sizes would put about 40 percent of erections
between 4.5 and 5.75 inches in length, and about 50
percent of erections between 6 and 7.5 inches long.
Probably only about 15 percent of men have erect
penises longer than 6.75 inches.
Masters and Johnson found that erection seems to
have an equalizing effect: Smaller penises gain propor-
tionately more size than larger penises upon erection.
This equalizing effect was confirmed by later researchers
(Jamison & Gebhard, 1988) who divided flaccid penises
into two categories: short (averaging 3.1 inches) and
long (averaging 4.4 inches). They found that shorter
penises tended to gain about 85 percent in size during
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The Penis 69

erection, to an average of 5.8 inches, whereas longer

penises grew by only 47 percent, to an average of 6.5
inches. Likewise, narrower penises gain more in circum-
ference than wider penises during erection.
Capitalizing on men’s concerns about penile size, a
variety of “penis enlargement” techniques have been
marketed. Most involve using some sort of suction de-
vice, with the penis being inserted into a plastic chamber
and a plunger-type device then being used to remove A B
some air from the chamber. This stimulation typically
creates an erection for men, therefore providing FIGURE 3.6 Circumcision
“enlargement.” Such devices have been known to cause The circumcised penis (A) leaves the glans exposed, supposedly
injury to the penis, if too much suction is used. Some making it easier to keep the penis clean and prevent the possi-
cosmetic surgeons offer surgical techniques to enlarge bility of cancer. The uncircumcised penis (B) in a very few in-
the penis. One procedure, in which some of the internal stances may have a condition called phimosis, in which the
ligaments at the base of the penis are cut away so some foreskin cannot be retracted over the glans.
of the penile structure inside the body can be extended
outside, has been found to be too risky. In fact, scarring
may result in poor erections or in pulling the penis back, Foreskin
making it appear even shorter. Clinical evidence indi-
cates that many men who have had penis enlargement
procedures are unhappy with the results. Experts rec-
ommend that surgical interventions not be considered
Foreskin pulled
unless the man’s erect penis falls in the “below average” forward over guide
length category of less than 2.8 inches and he is experi- Plastic guide
encing significant functional problems with sex because inserted under
of his penis size (Wessels, Lue, & McAninch, 1996). Also, foreskin
men born with micropenis, an unusually small organ,
are known to be able to have happy and pleasurable sex
lives (Bankhead, 2005).

Breast size and penis size seem to preoccupy North

Americans. How have the media and other factors
Suture placed over Completed circumcision
influenced these concerns? What are your feelings foreskin and guide
about these issues?
FIGURE 3.7 Circumcision of an Infant
The surgical removal of the penile foreskin has a history that
See “Male Anatomy” on goes back as far as 4000 B.C.E. in Egypt. Its justification has
SexSource Online. been ritualistic, religious, and medical. The surgical procedure
illustrated here is usually performed on infant males, but it is
sometimes used for adult circumcision.

Male Circumcision: The Debate permit the buildup of a material called smegma that
can lead to infection.
When a male is born, his parents may decide to have
There has been continuing controversy over the
the foreskin of the baby’s penis removed in a surgical
widespread practice of circumcising male infants (see
procedure called circumcision, leaving the glans
Figure 3.7). Some have complained that no legitimate
fully exposed (see Figure 3.6). Until the mid-1970s,
reasons justify circumcision or the potential pain and
most males in the United States were circumcised.
discomfort it might cause to infants. Current standard
The procedure, however, has been much less com-
procedure is to use a form of anesthesia called the dor-
monly performed in Europe and Canada. Circumci-
sal penile nerve block, permitting pain-free surgery.
sion has sometimes been a part of religious custom,
Anticircumcision groups, however, believe that the
as for example in the Jewish faith. The other most
procedure may be traumatic as well as unnecessary.
frequently stated reason for circumcision involves
hygiene. It has been assumed that young males will
circumcision (SIR-cum-sizh-uhn) in the male, surgical
find it troublesome to learn how to pull back the
removal of the foreskin from the penis.
foreskin and wash the glans. Such inattention may
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70
One medical problem that has been cited as a
good reason for circumcision is phimosis, or an un-
usually long and tight foreskin that makes it difficult
to retract. Yet opponents of circumcision insist that
spontaneous erections begin even before birth and
gradually stretch the foreskin, so that by 6 years of age
it can be retracted without difficulty in almost 100 per-
cent of cases. If a real problem exists at some later
stage in life, circumcision can then be performed.
Opponents also believe that in infants the foreskin
should be tight and nonretractable to protect the ure-
thral opening from exposure to fecal material or other
possible irritants.
In the 1960s, 95 percent of boys in the United
States were circumcised. The 1980s saw a distinct de-
cline in the procedure. Later in that decade, mounting
evidence seemed to show that this trend was leading
to an increase in urinary tract infections in infant boys,
a condition that can cause kidney complications. How-
ever, even among infants who keep their foreskins, the
rate of such infection is only about 1 percent (Sprin-
gen, 2000). The American Academy of Pediatrics, the
FOH American Medical Association, and the American
Association of Family Physicians have taken positions
opposing routine circumcision, citing evidence that the
benefits of circumcising newborns are not significant
enough to recommend it as a routine procedure.
When circumcision is done, it is recommended that
anesthesia be used. A study of 130,475 newborn cir-
cumcisions, examining the trade-offs, concluded that
the procedure offers practically no medical benefit but
also causes virtually no harm. It is believed that today
about 60 percent of boys in the United States are cir-
cumcised, but the incidence of the procedure seems to
be decreasing (Christakis et al., 2000).
Growing evidence from studies in other parts of
the globe indicates that circumcision can reduce the
likelihood of HIV and HPV infection, and perhaps
some other sexually transmitted diseases. Partners of
circumcised men are therefore less likely to contract
the viruses from them. The HPV virus is associated
with the development of cervical cancer in women
(Baldwin et al., 2004; Castellsague et al., 2002; Cohen,
2005). The World Health Organization, the U.N. Pop-
ulation Fund, and UNICEF have pointed out that
these findings are dramatic enough to warrant recon-
sideration of circumcision guidelines, at least in the
developing world. They also are concerned that peo-
ple will grow overconfident about the preventative
value of circumcision, which clearly does not pro-
vide complete protection from disease (World Health
Organization, 2006).
Given the available information concerning male
circumcision, if you were a physician, would you
recommend to parents that they have their newborn
baby boy circumcised? Justify your recommendation.
Chapter 3 Male Sexual Anatomy and Physiology
Disorders of the Penis
Disorders of the penis are relatively uncommon, but a
few are worth mentioning here. Two disorders relate
to the erection of the penis. Priapism, a condition that
involves continual, painful, undesired erection of the
penis, can be caused by circulatory disorders or abuse
of certain drugs, including cocaine. If the erection is
not medically relieved within a few hours, there can
be eventual destruction of the corpora cavernosa,
making future erection impossible (Kuefer et al.,
2005). Peyronie’s disease occurs primarily in older
males and involves the development of tough, fibrous
tissue around the corpora cavernosa within the penis.
Eventual calcification of this tissue may result. The dis-
ease causes curvature of the penis and painful erec-
tion, both of which can make intercourse difficult or
impossible. Drug therapy or surgical procedures often
can help correct the curvature (Bokarica et al., 2005).
Particularly vigorous stimulation of the penis during
sexual activity can sometimes inflame lymphatic vessels,
creating a swollen band around the penile shaft just be-
hind the glans. Although this condition may be alarming
to men, it is not dangerous, and generally the swelling
gradually subsides over a few weeks. Use of ringlike
devices to maintain erection can damage penile tissues
and blood vessels, especially if they are left on too long.
If damage occurs, extensive surgical treatment may be
required. If the erect penis is suddenly bent or hit, FOH
the tough sheath that encloses the columns of spongy tis-
sue may tear, possibly causing permanent damage to the
penis that interferes with erection and sexual function.
Cancer of the penis is quite rare. It may be even less
common in circumcised males. Although the hypothesis
is open to debate, it has been suggested that the accu-
mulation of secretions and impurities under the foreskin
of uncircumcised males may predispose them to malig-
nant growth on their penises. Careful attention to clean-
liness and personal hygiene is therefore particularly
important for uncircumcised males.
There are a number of congenital conditions of the
penis. Occasionally, a male child is born with agenesis
(absence) of the penis, in which the phallus is very
phimosis (fye-MOE-sus) a condition in which the penile
foreskin is too long and tight to retract easily.
priapism (pry-AE-pizm) continual, undesired, and
painful erection of the penis that lasts longer than four
hours.
Peyronie’s disease (pay-ra-NEEZ) development of fibrous
tissue in the spongy erectile columns within the penis.
agenesis (absence) of the penis (ae-JEN-a-sis) a con-
genital condition in which the penis is undersized and
nonfunctional.
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Internal Male Organs
Urinary bladder
Vas deferens
Penis
Urethra
Head of penis
(glans)
Scrotum
Testes
FIGURE 3.8 Male Sexual and Reproductive Organs
The external and internal sexual and reproductive organs of the male are shown here in longitudinal section. Although men are familiar
with their more obvious external sex organs, they often are less well informed about their internal reproductive and sexual anatomy.
tiny and nonfunctional. Surgical intervention and even-
tual counseling may be necessary to offer help with
the sexual adjustments of adolescence and adulthood.
In Chapter 5, the gender implications of such condi-
tions are discussed in further detail. Two congenital
conditions result from difficulties in fetal development
of the penis: hypospadias and epispadias. Hypospa-
dias is an incompletely fused penis, with an open
“gutter” extending along the underside of the penis in-
stead of an internal urethra. In the United States and
some European nations, a sharp increase in the inci-
dence of hypospadias has been noted since 1970,
although the cause for the increase is not understood.
There has been some suspicion that the hormone
progestin, found in some birth control pills, might be
playing a role. Hypospadias occurs in about 79 of every
10,000 births of males. In epispadias, the urinary blad-
der empties through a large opening in the abdomen,
and the penis is split open along its upper length. Both
hypospadias and epispadias require surgical repair, and
the penis may not be fully functional for intercourse
following the surgery.
Internal Male Organs
The vas deferens of each testis carries sperm up into
the body cavity, around to the back of the bladder, and
back down to the prostate. Near the junction of the
71
Spine
Seminal vesicle
Ejaculatory duct
Prostate gland
Anus
Cowper’s gland
(bulbourethral gland)
two vasa deferentia into a single ejaculatory duct, each
vas deferens joins with a saclike structure called the
seminal vesicle. Both seminal vesicles are about
2 inches long. The seminal vesicles produce secretions
that help activate the sperm and make them motile.
Secretions from the vesicles, which constitute about 70
percent of the seminal fluid, join with the sperm and
empty into the ejaculatory duct, which then joins the
urethra inside the prostate gland.
Located at the underside of the urinary bladder,
and surrounding the urethra where it enters the blad-
der, is the prostate (see Figure 3.8). This gland, a lit-
tle larger than a walnut, has three lobes of muscular
and glandular tissue. Along with the seminal vesicles,
hypospadias (hye-pa-SPADE-ee-as) birth defect caused
by incomplete closure of the urethra during fetal devel-
opment.
epispadias (ep-a-SPADE-ee-as) birth defect in which the
urinary bladder empties through an abdominal opening
and the urethra is malformed.
seminal vesicle (SEM-un-al) gland at the end of each
vas deferens that secretes a chemical that helps sperm
become motile.
prostate gland located beneath the urinary bladder in
the male; it produces some of the secretions in semen.
keL82663_ch03_061-079.qxd 10/5/07 5:01 PM Page 72 109:MHCA040:mhkeL09%:ch03:
72
Clearing the way for blessed relief
Some 14 million American men suffer from benign swelling of the prostate.
A new procedure called TUNA could make treatment easier than ever before.
Bladder
Prostate
Urethra
Sphincter
Healthy prostate: Enlarged prostate:
The gland fits around The swelling that comes
the urethra like a with age often blocks
well-tailored collar. the free flow of urine.
FIGURE 3.9 Prostate Enlargement Using Transurethral Needle Ablation (TUNA)
Source: From Geoffrey Cowley, “Good News for Boomers,” Newsweek, 30 December 1996/6 January 1997, p. 74. Copyright © 1997 Newsweek, Inc. All rights reserved.
Reprinted by permission.
it produces secretions that help transport the sperm
through the penis. This fluid, called semen or seminal
fluid, is a milky, sticky alkaline substance composed of
proteins, citric acid, calcium, fats, and some enzymes.
Semen may be quite thick and gelatinous when it
leaves the penis, or it may be thin and watery. It usu-
ally becomes thicker soon after ejaculation but then
liquefies in 15 to 25 minutes.
Below the prostate gland, at the base of the pe-
nis and on each side of the urethra, are two pea-size
glands called Cowper’s glands or bulbourethral
FOH glands. When a male is sexually aroused, these two
glands secrete a clear, sticky alkaline substance, or
pre-ejaculatory fluid, that coats the inner lining of
the urethra. Some of it may appear as droplets at the
tip of the penis during arousal. The secretion has of-
ten been called a lubricant, and indeed, if present in
sufficient amounts, it can serve as a lubricant for sex-
ual activity. However, it is not always produced in
such copious amounts and is believed instead to pri-
marily help neutralize acids in the urethra and thus
permit safe passage of sperm. Although the primary
function of Cowper’s gland secretion is not to carry
sperm, it often does; therefore, it can be responsible
for pregnancy even if ejaculation does not occur
within the vagina.
FOH Prostate Problems
A large proportion of men at one time or another suf-
fer from prostatitis, or inflammation of the prostate
gland (see Figure 3.9). Prostatitis may be of the acute
form, caused by bacterial infection. Acute symptoms
Chapter 3 Male Sexual Anatomy and Physiology
New procedure: Result:
Urologists can now kill Within six weeks
excess tissue by heating it to three months, patients
with tiny needles. regain normal flow.
include sudden onset of fever, chills, and urinary dis-
comfort. It may also be chronic, typically caused by
changes in the prostate other than bacterial infection.
Chronic symptoms can include some thin discharge
from the penis, pain in the lower abdomen and scro-
tum, or painful ejaculation. Antibiotics are used for
acute prostatitis, but prostatitis in its more chronic
forms can be difficult to cure completely.
In older men, enlargement of the prostate gland is
common and sometimes is the result of malignant
tumors. More than 200,000 new cases of prostatic can-
cer are detected each year; if found early, the chances
of complete cure are good (see Figure 3.10). The num-
ber of deaths from prostatic cancer continues to decline
because of more refined techniques for detection and
treatment (Springen & Adler, 2003). Benign prostatic
hyperplasia (BPH) refers to nonmalignant prostatic
enlargement. Medications are now available to shrink
prostate tissues. If the prostate enlarges too much, uri-
semen (SEE-men) mixture of fluids and sperm cells that
is ejaculated through the penis.
Cowper’s glands two small glands in the male that
secrete an alkaline fluid into the urethra during sexual
arousal.
bulbourethral glands another term for Cowper’s glands.
prostatitis (pras-tuh-TITE-us) inflammation of the
prostate gland.
benign prostatic hyperplasia (BPH) enlargement of the
prostate gland that is not caused by malignancy.
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Internal Male Organs 73

Rising prostate cancer rates over time ble enlargement or tumors. The physician, using a rub-
Probability of developing invasive prostate cancer ber glove and lubricant, inserts a finger into the rectum,
between the following ages:
where the surface of the prostate can be felt through the
10 rectal wall. Although such an examination is not particu-
9.59 larly pleasant, it represents an important health care
8 measure. A blood test that can help detect prostatic can-
6.71
7.27 cer, the prostate-specific antigen (PSA) test, is recom-
6
Percent

mended on a regular basis for men over age 50. The test
has led to a dramatic increase in the number of prostate
4
surgeries, yet there is no evidence to prove that the mor-
2.13 tality rate from the disease has been lowered. Although
2
0.22
research has confirmed the accuracy of the PSA test and
0
most physicians support its use, more research is needed
40–49 50–59 60–69 70–79 80–89 to determine whether such testing significantly reduces
the number of deaths from prostate cancer. New tests
Survival rates, then and now
are being developed to measure other indicators of
Percentage of men who are still alive five years after being prostate cancer presence or the risk of developing the
diagnosed: malignancy. There is also evidence that a healthy
100 lifestyle, including a diet low in fat and high in vegeta-
bles and fruits, may slow the progress of prostate cancer
90 and perhaps prevent its development in the first place
(Noonan & Springen, 2002; Springen & Adler, 2003).
80
Percent

70
60
50
1980–82 1983–85 1986–88 1989–91 1992–99
FIGURE 3.10 Rates of Occurrence and Survival for
Prostate Cancer
Source: From Karen Springen and Jerry Adler, “Prostate Cancer’s Difficult
Choices,” Newsweek, 16 June 2003, p. 57. Copyright © 2003 Newsweek, Inc.
All rights reserved. Reprinted by permission.
nation may become difficult or eventually even impos-
sible, because the urethral passageway may be pinched
by the swollen prostate. This leads to increased sus-
ceptibility to bladder and prostate infections. Various
surgical treatments are available, ranging from removal
of the prostate (prostatectomy), or parts of it, to less in-
vasive treatments that can widen the urethral canal
through the prostate and require only a local anes-
thetic. If a malignancy is present, surgery is often fol-
lowed by radiation or chemical therapy. Newer surgical
techniques reduce the risks of interfering with erectile
function or ejaculation, but there are often side effects
that decrease sexual satisfaction at least for a time
(Arrington, 2003; Quek et al., 2003). One study has sug-
gested that African-American men have a higher risk
than white men of being distressed and upset when the
treatment for prostate cancer causes problems with
sexual functioning (Jenkins et al., 2004).
It is generally recommended that men over age 35
have regular prostate examinations to detect any possi-
Sperm Production and Ejaculation
From puberty to old age, the male testes produce large
amounts of sperm cells. The testes are partially con-
trolled by two pituitary hormones, which are also
found in females: luteinizing hormone (LH), called
interstitial-cell-stimulating hormone (ICSH) in
males; and follicle-stimulating hormone (FSH). The
ICSH begins to be produced at puberty and stimulates
the interstitial cells of the testes to produce the male
hormone testosterone. The FSH helps stimulate the
sperm-producing cells—called spermatocytes—in the
linings of the seminiferous tubules to produce sperm.
Each mature sperm consists of a head and a tail,
separated by a short thickened area (see Figure 3.11).
The head contains the male’s genetic material, and the
thickened middle area contains an energy-releasing
mechanism that helps move the tail. Sperm are usually
about 55 microns long (0.0021 inch or 0.055 millime-
ter) and can be seen only through a microscope. An
adult male is believed to produce about 15 to 30
billion sperm each month.
During sexual excitement and activity, the sperm
are moved from the epididymis in the testes up to the
interstitial-cell-stimulating hormone (ICSH) pituitary
hormone that stimulates the testes to secrete
testosterone; known as luteinizing hormone (LH) in
females.
spermatocytes (sper-MAT-o-sites) cells lining the semi-
niferous tubules from which sperm cells are produced.
keL82663_ch03_061-079.qxd 8/31/07 17:29 Page 74 PINNACLE 109:MHCA040:mhkeL09%:ch03:
74
Head
Middle piece
Tail
FIGURE 3.11 Sperm
A mature sperm consists of a head, middle piece, and tail. The
head contains the chromosomes and is the part involved in fertil-
ization. The tail moves the sperm from the ejaculatory duct into
the urethra prior to ejaculation. If all the ova needed to repopu-
late the world would fit into a 2-gallon container, the sperm
needed for the same purpose would fit into an aspirin tablet.
ejaculatory duct through each vas deferens. Their tails
are activated to make a lashing movement by the se-
cretions of the seminal vesicles. Stimulation of the
erect penis sends nerve impulses to the ejaculatory
center of the spinal cord. When these impulses have
built to a certain threshold, the ejaculatory response is
triggered. Sperm from the ejaculatory duct are moved
into the urethra, along with fluids from both the semi-
nal vesicles and the prostate that form the semen. Con-
tractions in the muscles surrounding the ejaculatory
duct and urethra follow, forcing the semen to be ejac-
ulated through the end of the penis. This usually is ac-
companied by the pleasurable sensations of orgasm,
or sexual climax, although the two phenomena—
ejaculation and orgasm—can occur separately (see
Chapter 4, “Human Sexual Arousal and Response”).
Studies seem to indicate that average sperm counts
in the male population dropped by one-third from
the mid-1970s to the mid-1990s. To what has this
drop been attributed? What concerns might this
trend raise for the future?
The amount of semen ejaculated depends on
many factors, including age, amount of sexual stimula-
tion, general health, and interval of time since the last
ejaculation, but typically there are 3 to 5 cubic cen-
timeters of semen—about a teaspoonful or less. As
much as 11 cubic centimeters of semen can be ejacu-
lated. The typical ejaculate contains 150 million to 600
million sperm. Many men subjectively report that the
more intense the sensation of orgasm, the more semen
ejaculated and the more force with which it is pro-
Chapter 3 Male Sexual Anatomy and Physiology
pelled out of the penis. Most often the semen oozes
out of the penis under some pressure, but it sometimes
can spurt several inches.
Although ejaculation is a reflexive phenomenon, it
is possible for men to learn to control the length of
time it takes to reach orgasm and ejaculation. This usu-
ally involves learning how to modulate sexual excite-
ment or to control inner musculature so that when
ejaculation is near, stimulation to the penis is reduced
until the sensation subsides. More about controlling
ejaculation can be found in Chapter 18, “Sexual Dys-
functions and Their Treatment.”
As a result of certain illnesses, some prostate sur-
geries, or the effects of certain tranquilizing drugs, the
semen may be ejaculated into the urinary bladder. The
muscles at the base of the bladder that normally close
off the bladder during ejaculation apparently do not
contract, so semen is permitted to enter the bladder.
Despite the full sensation of orgasm, no semen leaves
the penis. This phenomenon is called retrograde
ejaculation. Some organic problems simply lead to
the absence of semen and a resultant dry orgasm
called anejaculation.
Under ideal laboratory conditions, sperm may be
kept alive for up to two weeks after ejaculation. How-
ever, after ejaculation into the vagina during sexual in-
tercourse, it is unlikely that many sperm remain motile
for more than two or three days. Older sperm are more
likely to have deformities, so it is not considered a
good idea to abstain from sexual activity before trying
to get pregnant because the newest sperm are the
healthiest. Once semen has been deposited in the
vagina, some of it begins to seep into the uterus, and
the sperm swim against mucous currents and gravita-
tional pull. Healthy sperm can swim about 3 to 7
inches in an hour, and following ejaculation some
sperm can be expected to reach the female’s fallopian
tubes in one to two hours. Despite the many millions
of sperm deposited in the vagina, only a few thousand
actually reach the fallopian tubes, where fertilization of
the ovum can take place.
Concern has been growing that sperm counts in
otherwise healthy human males have been dropping
in recent years and that the quality of human sperm is
orgasm pleasurable sensations and series of contractions
that release sexual tension, usually accompanied by ejac-
ulation in men.
ejaculation muscular expulsion of semen from the penis.
retrograde ejaculation abnormal passage of semen into
the urinary bladder at the time of ejaculation.
anejaculation lack of ejaculation at the time of orgasm.
keL82663_ch03_061-079.qxd 10/5/07 5:01 PM Page 75 109:MHCA040:mhkeL09%:ch03:
Male Hormones and the Male Climacteric
gradually deteriorating as well. Although men con-
tinue to produce sperm throughout their lives, studies
show that the DNA in sperm tends to undergo more
mutational changes as men age. This is of concern, be-
cause men are tending to postpone fatherhood until
later in life. Aging leads to an increase in DNA dam-
age, which can decrease the chances of conception or
produce certain birth defects in offspring. One study
has also shown that men who consume substantial
amounts of caffeine every day have increased levels of
sperm DNA damage that might cause chromosomal
aberrations after fertilization (Schmid et al., 2007;
Wyrobek et al., 2006).
FOH Men who have fewer than 20 million sperm per
milliliter are considered infertile, because the chances of
their conceiving a child are slim with that low a sperm
count. It has been proposed that chemical pollutants in
the environment resembling the female hormone estro-
gen, fetal exposure to estrogen in the uterus, or possi-
ble changes in diet and lifestyle might be responsible
for low sperm counts, but no clear link has been estab-
lished. Several research studies give evidence that ciga-
rette smoking can reduce sperm production signifi-
cantly, but probably not enough to impair fertility
unless a man already had a low sperm count caused by
other factors. There is no evidence at this point that fluc-
tuations in sperm count have had any profound effect
on male fertility (Schmid et al., 2007).
FOH
Male Hormones and the
Male Climacteric
Men do not seem to undergo predictable cyclical
changes in hormonal levels, such as the female men-
strual cycle, that affect their fertility. Some medical con-
ditions, such as epileptic seizures, seem to worsen on
roughly monthly cycles, which might be traced to sub-
tle shifts in hormonal concentrations. Studies have
shown that testosterone levels tend to be lower in the
spring, when literary tradition would have it that men’s
sex drive is strong. About the only thing psychological
tests have correlated with lower hormonal levels is an
increase in men’s spatial aptitude. There have also been
suggestions that men experience periodic emotional
ups and downs that seem to follow cyclical patterns, but
this has been difficult to substantiate in research.
Although men do not seem to have a well-defined
hormonal cycle, they experience changes in their bod-
ies as they age. The concentrations of male hormones
found in the body gradually decline through the mid-
40s, and by age 75 testosterone levels often drop by up
to 90 percent compared with levels before age 30.
More significantly, biochemical changes in the body
cause more testosterone to become chemically bound
75
to blood proteins, or plasma, as a man ages, resulting
in a lower free testosterone index (FTI). It is the free,
unbound testosterone that seems to have the most im-
portant influence on the body. For some men over the
age of 60 who have lower-than-normal levels of testos-
terone, there seems to be some correlation with the
presence of depression (Seidman, 2006).
Because there usually is no loss of reproductive
capacity, nothing in males is completely equivalent to
female menopause. Nevertheless, popular media have
promoted the idea of a “male menopause.” Although
it is less predictable and its symptoms are more
variable, men often do experience a period of stress
as they age. Often called mid-life crisis, the male
climacteric, aging male syndrome, or “andropause,”
this period is characterized by increased anxiety, de-
pression, insomnia, hypochondria, loss of appetite,
and/or chronic fatigue. These may also be the symp-
toms of untreated depression. However, there also is
usually a reduction in testosterone levels and a de-
crease in sexual desire and capability as men age.
Because of this, the male climacteric has more re-
cently been called ADAM, which stands for androgen
decline in the aging male (Barqawi & Crawford, 2006;
Seidman & Roose, 2006).
This time in a man’s life is often characterized by
major changes and realizations. Most professionals
believe that these psychological stresses play a role in
the male climacteric. In a youth-oriented culture, men
must face the fact that they are aging. Men with wives
and families are sharing the menopausal changes of
their spouses and watching their children leave
home. In more traditional family structures, in which
the man has been a primary breadwinner, he may be-
gin to feel weary from the years of responsibility for
his family. Middle age may be a time when a career
plateau has been reached and further vocational
opportunities become more limited. Physical changes
and stress-generated tension may produce alterations
in sexual interest and behavior, resulting in even
more worry and discouragement. The male climac-
teric seems largely to be a vicious cycle of middle-age
stresses and gradual physiological changes that feed
on one another.
Testosterone Replacement Therapy FOH
Optimal sexual functioning in males may be dependent
on the presence of a minimum amount of free testos-
terone in the body, as stated earlier. For some men in
whom the FTI is low, administration of extra testosterone
male climacteric one of the terms applied to a vaguely
defined period in male mid-life characterized by hormonal,
psychological, and sexual changes.
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76 Chapter 3 Male Sexual Anatomy and Physiology

How Age Can Change a Man’s Body

The term “male menopause” drives medical experts crazy. In women, “menopause is a clearly defined biological event,” says Dr.
Abraham Morgenthaler of Boston’s Beth Israel Hospital. “There is no equivalent for men.” True enough, but middle age does
bring changes, and few of them would qualify as improvements. Here’s a rundown of the main ones:

Hair loss. The number of hair follicles on the scalp Brain function. Concentration and language skills don’t
decreases as men age, and the hair that is left change much with age. The ability to store and retrieve
grows at a slower rate. information declines slightly but steadily from the 20s on.

Vision. By age 50, lifelong thickening of the lens Hearing. Eardrums thicken and the ear canal atrophies,
causes a noticeable loss of night vision and making pure tones and high frequencies harder to hear,
close-in focus. especially in the late 50s.

Heart response. After 20, the heart becomes less

adept at accelerating in response to exertion.
Lung power. Chest wall stiffens, increasing Bars show maximum rate in beats per minute:
the workload of respiratory muscles. More
residual air is left in lungs after each breath. 200
190
180 170
160 150

Aerobic endurance. As the body’s ability to

deliver oxygen declines, the capacity for
physical work falls. The work capacity of a
70-year-old is only half that of a 20-year-old.

Body fat. Between the ages of 25 and 75 Age 20 30 40 50 60 70

the amount of fat in proportion to the
body’s composition doubles. Much of that
growth occurs in muscles and organs. Angle of
erection. Frequency of sex. Decline in sex
Many men drive varies from man to man, but some
Muscle and bone. Eventually muscles get reduction is inevitable due to lower levels
smaller and weaker, but those changes can experience a
slight loss of of sex hormones and loss of vitality.
be offset by exercise. Bone loss, a universal Orgasms per year:
aging trait, occurs at individual rates. upward mobility
from 30 to 50, and 121
a major loss from 50 104
to 70. Preventable
vascular disease 84
is largely to
blame. 0°
0 :2 52
e2
Ag 35
22
: 10°
Age 30
Age 40: 1°
Age 50: ⫺1° Age 20 30 40 50 60 70
ERECTION
DEGREES
ABOVE
Age
70:
HORIZONTAL ⫺2
5°

Source: From Geoffrey Cowley, “How Age Can Change a Man’s Body,” Newsweek, 16 September 1996, p. 73.
Copyright © 1996 Newsweek, Inc. All rights reserved. Reprinted by permission.
keL82663_ch03_061-079.qxd 8/31/07 17:29 Page 77 PINNACLE 109:MHCA040:mhkeL09%:ch03:
Self-Evaluation
seems to improve sexual interest and potency and may
decrease the risks of depression (Seidman & Roose,
2006). Testosterone replacement therapy (TRT)
carries some increased risks of prostate difficulties and
cardiovascular disease, so it must be prescribed with
caution. TRT has been touted as a miracle treatment by
some patients and clinicians, and branded as risky and
dangerous by others. It is generally agreed that adminis-
tration of testosterone should be done cautiously, and
generally only for men who have lower-than-normal
levels of testosterone for their age as shown by appro-
priate medical tests. The Institute of Medicine has rec-
ommended further research on the effects of TRT on
several hundred older men, and everyone remains
mindful of the controversial history of HRT for women.
Surviving the Male Climacteric
Because menopause has been more clearly identified,
women may tend to receive more support and under-
standing for their difficult physical and psychological
symptoms. Men may need the same supportive help
through their mid-life crises as well. Counseling can
help a man express his concerns and deal with his
confusing emotions, but men may be reluctant to seek
this sort of help. They may need guidance to help
Self-Evaluation
Learning about Sexuality: Past,
Present, and Future
Sexuality education is far more than learning about
the body’s reproductive system. It is also an exercise in
self-awareness—becoming acquainted with one’s own
sexual feelings, needs, and values. Learning about sex-
uality is a lifelong process that must constantly integrate
new information and changing personal situations. The
exercises that follow ask you to examine the process of
sexuality education as it relates to your life.
1. Looking back. Spend some time thinking about your
answers to the following questions. They will help
clarify some of the background of your learning
about sexuality. You may want to discuss your
answers with another trusted person.
a. Can you recall your first discussions about sexuality
when you were a child with another child, a parent, or
another adult? If so, can you remember any feelings
77
them realize that finding appropriate support during
life’s various crises is a strength, not a weakness. It is
important that men be cautioned about making major
life changes during the throes of such a crisis. They
might be better advised to try sticking with their pres-
ent careers and relationships as they work to resolve
any conflicts or tensions within those important areas
of life. Then, as things are brought into a more rational
perspective, sensible changes in lifestyle and goals can
be considered.
Both medical and psychological sciences are mak-
ing great progress in understanding the changes within
men’s bodies and psyches as they age. Just as Viagra
and other erection-enhancing medications have offered
hope to men with erection problems, treatments likely
will become available to help men cope with the vari-
ous other symptoms associated with sex and aging.
Ultimately, the best help will come from within, as men
draw on their own resources to accept the natural
processes of aging and also the positive outcomes that
these processes can yield along with the less positive.
testosterone replacement therapy (TRT) administering
testosterone injections to increase sexual interest or po-
tency in older men; not considered safe for routine use.
or attitudes that you developed in relationship to
that time and the topic of sex?
b. How and when did you first learn what you consider
to be the important information about the sex organs,
reproduction, and other aspects of human sexuality?
Was the information conveyed to you in a relatively
positive, negative, or neutral atmosphere emotionally?
c. Do you remember the first book or magazine you read,
or the first television program or movie you saw, that
had factual information about sex or graphically
depicted sexual behaviors? How did you react?
d. In what ways have you increased your level of infor-
mation and awareness about human sexuality more
recently in your life?
2. Following these exercises is a list of topics related to
human sexuality. You may be better informed on
some of them than on others. Using the rating
standards shown, rate each topic as to your level of
competence, using appropriate check marks.
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78 Chapter 3 Male Sexual Anatomy and Physiology

3. As you reexamine the check marks you made in
exercise 2, pay attention to those topics you need to
know more about. For each of these, indicate what
your course of action, if any, will be.
a. Will you seek further information on the topic? Why or
why not?
b. Where will you begin your search for the information?
c. Are any personal implications involved in your want-
ing to understand the topic better?
4. Do you expect to have children (or do you have chil-
dren) for whom you will bear some responsibility to
provide effective education about sexuality? If so,
consider the following questions.
a. Have you already made some attempts at educating
children about sexuality? If so, how successful do you
think you were, and on what criteria do you base that
evaluation?
b. Make a list of goals that you believe are important to
the sexuality education of children at different age lev-
els; choose those goals in whose achievement you may
play an active part. What areas would you not want to
be a part of your children’s sexuality education?
c. What resources can you have available to assist with
the sexuality education process? Consider books,
films, television programs, computer software or ac-
cessible networks, other people (including profession-
als), and your own skills and competencies.
d. Now, either alone or with another adult, try explain-
ing aloud some of the things you would want your
child to know about human sexuality, considering the
child’s age and level of maturity. You might want to
tape-record your talk so you can evaluate its effec-
tiveness later, or you might have the other adult make
comments and suggestions. This is an exercise to see
how clearly and accurately you can express concepts
about sexuality. Are you aware of institutional sexual-
ity education programs that might be available in
your local schools, churches, or other agencies? If
none exist, you might consider becoming instrumental
in working for effective sexuality education. If pro-
grams already exist, you might want to help evaluate
their effectiveness. First of all, you should clarify how
you feel about sexuality education and get as much
information about various programs as you can.

I know very little I understand this I feel comfortable

about this and reasonably well but with this and do
could use further could use more in- not need further
information. formation. information.

Male genital anatomy and physiology

Female genital anatomy and physiology
Sexual intercourse
The physiology of reproduction and birth
Advances in reproductive technology
Same-gender orientation and bisexuality
Masturbation
Psychosexual development of children and adolescents
Sex therapy and counseling
Gender identity, masculinity, and femininity
Sexually transmitted diseases
Transmission of HIV
Sexual dysfunctions
Human sexual response
Improving communication in sexual relationships
Sexual variations

Chapter Summary
1. The male testes, located in the scrotum, produce body temperature, mature in tubes called the epi-
male hormones and sperm. Sperm cells develop didymis, and will travel upward through the vas
best at a temperature slightly lower than inner deferens.
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Focus on Health Questions
2. Regular self-examination of the penis and testes
is an effective way to detect infections or growths
that indicate the presence of testicular cancer.
3. Both testes may not descend into the scrotum
before birth.
4. Epididymitis is an inflammation of the epididymis
in the testes.
5. The penis has a sensitive, rounded head called
the glans and a longer shaft. Three columns of
spongy tissue compose the interior of the penile
shaft and become filled with blood during erec-
tion. Sperm and urine move through the penis
via the urethra.
6. Penis size is quite variable among males and
includes a wide range of “normal” sizes.
7. Circumcision is a surgical procedure in which
the penile foreskin, or prepuce, is removed. Its
advisability has been the subject of controversy,
although it has been shown to reduce the
likelihood of HIV and HPV infection.
8. Some diseases that can affect the penis are pri-
apism (painful, continuous erection), Peyronie’s
disease (calcification of erectile tissue), phimosis
(too-tight foreskin), and cancer.
9. The prostate gland and seminal vesicles of the
male produce secretions that mix with sperm to
produce the semen that is ejaculated through the
penis. Cowper’s glands produce a clear secretion
that lines the urethra during sexual arousal.
10. Prostatitis, or prostate infection, can be either
acute or chronic. A common problem in older
Focus on Health Questions
In this section you will find the kinds of questions that
you may have concerning your own health and sexu-
ality. The page references indicate where in the text
the answer is located; the exact place is marked with
this logo: FOH
1. Is it normal for one of my testicles to hang lower
than the other? 63
2. How much risk do I have for testicular cancer? 64
3. How do I perform the self-examination to detect
testicular cancer? 64
4. Can men still have children if they have only one
testicle? 64
5. What are “blue balls”? 65
6. How big is a normal-size penis? 68
7. Are there any ways to make my penis larger? 68
79
men is prostate enlargement, which may be
caused by benign prostatic hyperplasia or by
malignant tumors. It must be corrected, usually
by surgery. The PSA test has proved useful in
detection of prostatic cancer.
11. Sperm production is controlled by the secretion
of FSH. Interstitial-cell-stimulating hormone
(ICSH) stimulates the testes to produce testos-
terone. Up to 30 billion sperm are produced by
the testes each month.
12. Sexual stimulation of the penis can lead to ejacu-
lation of semen. The ejaculate can contain be-
tween 150 million and 600 million sperm.
13. The sperm counts of human males may have
been decreasing over the past few decades, al-
though fertility has not yet been affected. As men
age, the chance for DNA changes in their sperm
increases.
14. Men do not seem to have predictable hormonal
cycles, although their emotions may follow cycli-
cal patterns.
15. Men experience a less well-defined climacteric
than women, involving mood changes that may
be associated with reduced production of testos-
terone.
16. Testosterone replacement therapy may improve
sexual desire and other symptoms of male mid-life,
but it also carries health risks and needs further
research.
8. Does the fact that I was circumcised when I was
a boy change my sexual functioning? 70
9. Can the penis actually get “bent” or “broken”? 70
10. What is the fluid that comes out of my penis
when I’m sexually aroused, before ejaculation? 72
11. What can be done about prostatitis or prostate
cancer? 72–73
12. How many sperm do I need in order to be fer-
tile? 75
13. Do men have anything like the menstrual cycle,
controlled by hormones? 75
14. Do men go through anything like menopause? 75
15. Is there anything men can take to prevent sexual
aging? 75–77