Anatomy of Penis &

Physiology of Erection

By:
Dr. Kenny Robert.J
PG, II year M.S ( G.S)
Govt.Royapettah Hospital

Introduction:
Male copulatory organ
Radix and Corpus
SKIN:
Thin , dark, loose
corona- prepuce/ foreskin
confluence
frenulum
prepucial sac

Root:
2

crura and 1 bulb

crura corpus cavernosum
bulb corpus spongiosum glans
penis
Body:
3 erectile tissues
Corpus cavernosa:
common fibrous envelope , median
fibrous septum
median groove

 dorsal

groove deep dorsal vein

distally ending hollow of glans
tunica albuginea covering

two

layers inner circular and outer

longitudinal fibres
deep fibres median septumcomplete proximally and distally
pectiniform septum

Corpus spongiosum:
bulb
traversed by urethra
cylindrical , tapering distally
concal enlargement glans penis
corona glandis
preputial glands corona and
neck

Superficial Penile fascia:

dartos fascia
Deepest layer condensed to form
tough fascia Bucks Fascia
Blends at neck with all others

Suspensory ligaments:

Vascular and Lymphatic

drainage:
Perineal Artery:
internal pudendal artery
between bulbospongiosus and
ischiocavernosis
Anastamosis with contralateral
branch, posterior scrotal and
inferior rectal arteries
Artery of the Bulb of Penis:

Cavernosal artery:
deep artery of penis
internal pudendal
corpus cavernosa
trabeculae / cavernous spaces/
convuluted and dilated ( helicine
arteries)
Dorsal Artery of penis:
Deep to Bucks fascia
artery/ vein / nerve

Penile

skin
circumflex branches tunica
albuginea of corpus cavernosum
anastamosing with them
Dorsal Veins of Penis:
Small veins circumflex veins
circumferential tributaries
Deep dorsal Vein

Dorsal veins: superficial and

deep

superficial veins external

pudendal vein

Deep

dorsal vein blood from

glans penis and corpora
cavernosa penis course
anterior margin of perineal

LYMPHATIC DRAINAGE:
penile skin external pudendal
vessels superficial inguinal
nodes
glans penis deep inguinal and
external iliac nodes
erectile tissue and penile urethra
internal iliac nodes.

Innervation:
corpora cavernosa- lesser and
greater cavernous nerves ( pelvic
plexus)
lesser cavernous nerves penile
fibrous sheath erectile tissue
and penile urethra
Greater cavernous nerves
dorsum of penis spongiosum
and erectile tissue
T 11 to L 2 sympatheic

Physiology of Erection:
Emission ?
Ejaculation?
Modern investigations of penile
hemodynamics ?
current physiology is based on F
MRI and PET- CT

Anatomical orientation:
Tunica albuginea outer layer
absent in corpus spongiosum
low pressure stucture
Emissary veins
cavernous artery- soft tissue
sheath
contains fibrillar collagen and
elastin

Corpora cavernosa, spongiosum

and Glans penis:
within tunica smooth muscle
trabeculae separating
sinuisoids elastic fibres,
collagen, loose areolar tissue
normal state? , erection?
Spongiosum- tunical thinner
glans penis- absent tunica

Arteries:
Internal

pudendal atery penile

artery Dorsal, bulbourethral
and cavernous vascular ring
near glans.

cavernous artery- cavernosa

helicine arteries erectile
tissue dilated during erection
Veins:
Subtunical plexus of veins

Hemodynamics

Stimulation

Neurotransmitters
Smooth muscle relaxation
Dilation of arterioles and arteries
Expanding sinuisoids

Compression

of subtunical
venous plexus

Expanding
Emissary

tunica

venous compression

P o2 , intercavernous pressure
100mm Hg

erection rigid erection

Corpus spongiosum- difference
Glanular tumescence- dorsal and
circumflex veins
Rigid erection phase
ischiocavernosis and bulbo
spongiosis compress penile
veins
Full

Neuro Anatomy and Neuro

Physiology of erection:
Sympathetic and
Parasympathetic supply

erection and detumuscence

Visually

evoked stimulus
1) Perceptual- cognitive:
recognises stimuli inferior
temporal cortex
2) Emotional / Motivational:
processes information right
insula, inferior frontal and left
cingulate cortex
3) Physiologic process

Psychogenic erection:
REM sleep : activation of pontine
area, amygdala and anterior
cingulate gyrus
cholinergic activation

Adrenergic , serotonergic
silent

Neurotransmitters:
non adrenergic/ non cholinergic
endings& endothelium penile erection
NO c GMP relaxes cavernous
smooth muscles
Acetylcholine presynaptic inhibition
of adrenergic neurons and stimulate NO
release
Flaccid state- myogenics, adrenergics
and endothelin
Detumescence cessation of NO
NO

Factors affecting NO?

Dopamine: D1, D2 Erection
5HT inhibit it
GABA
Opoids
Cannabinoids
Oxytocin: via dopaminergic
stimulation
Prolactin

Smooth Muscle
Physiology:

Endothelin, Prostaglandin,
Thromboxane mediated IP 3/
DAG pathway
RELAXATION:
MLC phosphatase mediated
Decreasing intracellular calcium
c GMP and c AMP mediated
protein kinase ion channels /
proteins opening of pottasium
channels hyperpolarization

Sequestration

of intracellular
calcium by Endoplasmic
reticulum
Inhibit voltage dependant
calcium channels drop in
cystolic free calcium
C amp Adenosine, calcitocin
gene related peptides, PG, VIP
G amp NO, CO, natriuretic
peptides, Protein kinase G

Ion channels :
smooth

muscle difference
Calcium channels voltage dependent
L type
Pottasium Channels: 1) calcium
sensitive
2) metabolically
regulated
3) Delayed rectifier
4) Fast transient
current

Molecular Oxygen:
Flaccid state 35 mm hg
Erection- 90 mm hg
NO synthase activity
Synchronous relaxation:
intercellular communication
gap junctions exchange of ions
and messengers

Intracavernous
architecture:
intra cavernous architecture
sonic hedgehog (SHH)
expression of VEGF and NOS