Male Sexuality from health perspective - Part 3

Let's see how the reproductive organs play a role physiologically and psychologically in a man's sex life.

Erection: The shaft of the penis consists of three cylinders of erectile tissue. When the penis is limp, there is very little blood flow and the erectile tissue is like a compressed dry sponge. The blood that flows into the penile artery is diverted/shunted directly into the outflow vein bypassing the erectile tissue. When erection occurs, tiny trapdoors called polsters close off the shunt and the erectile tissue is filled with blood. This causes the penis to straighten out like a garden hose when the faucet is turned on and the nozzle is closed off.

The polsters are not physical structures. Doctors have tried to look for this in autopsy bodies and couldn't find. Chemical receptors are the physiological equivalent of polsters as it is possible to create an erection by injecting chemical receptors directly into the erectile tissue. The polsters can be stimulated in two ways. Firstly, sexy thoughts send a message to polsters through sympathetic nerves. Secondly, touching, rubbing or direct stimulation activates the polsters through the spinal column like a knee jerk. It is normal for a man to have morning erection and this means that his physiological systems are functioning properly. This morning erection is mainly a reflex erection due to the stimulation of full bladder. If erection occurs when the bladder is not full, then other factors are the reason. The chemical ingredient that induces erection is nitric oxide NO, not to be confused with nitrous oxide NO₂, also known as laughing gas.

In adult men, the erect penis assumes an angle of 140 to 160 degrees with few degrees off. This angle corresponds to the angle of the vagina. When the erection is normal but the angle is leass than 90 degrees, it is surgically possible to shorten the upper surface of the penis by removing the wedges from the erectile cylinders so that intercourse can be comfortable. When  there is no erection, the penis is flaccid. In some men, upon erection, the penis curves upwards, instead of downward, left or right, 10 to 30 degrees and sometimes 90 degrees or more. A normal healthy penis can curve 10 degrees or slightly more. But when the curvature is severe, it can cause pain and intercourse becomes impossible. This condition is known as Peyronie's disease but this never turns into a cancer. The only problem with this condition is it causes a scar of the tissue and calcification can occur. 

Erectile Dysfunction(ED) can be due to circulation, harmonal, neuronal or psychological based. 90% of ED is mainly of psychological origin. People, who have Type II Diabetes, who smoke and drink quite regularly or heavily, suffer ED. For most people with ED, the magic pill Viagra(Sildenafil) works and other drugs Cialis and Levitra are also prescribed. Fat, overeating, lack of exercise and stress also interfere with libido and can affect fertility in both men & women. For some men, the ED can be solved by quitting smoking, doing more exercise, cutting back on alcohol and losing weight. If the ED is due to circulation based then the blood vessels in the penis are blocked. If its harmonal based, then its due to low levels of testosterone. If its neuronal based then there is some damage to the nerves in the penis. If its psychological, then a man may have erection and experience orgasm with one female and doesn't with another.

Intercourse: It is one of the sex plays but an ultimate act. There are roughly 6000 nerves in the head of the penis. The thrusting motions massage the penile nerve endings in a rhytmic manner to create an intense preorgasmic sensation which gives immense pleasure. Frenulum is a tag of skin that runs from foreskin to the undersurface of the head of the penis. It is common for this skin to tear and heal with a scar. But erection and intercourse can pull on it and cause pain. Circumcision, also known as Frenuloplasty, solves this problem.

Orgasm: This is something that requires lot of coordination and knowledge of sex between the partners. When stimulation increases and reaches a certain intensity it triggers waves of contractions which we call orgasm. Bladder neck contracts, muscle around prostate gland, seminal vesicles, vas deferens contract squeezing the semen into the urethral passage. The ejaculate forms the glob stretching the wall of the urethra and the pelvic muscles contract. This leads to a culmination of orgasm and ejaculation.

Ejaculation: The normal ejaculate is alkaline which means a pH of 7 or more. Its volume varies anywhere from 0.1 to 1.6 tsp (0.5 mL to 8 mL) and most of the fluid is from the prostate. Sperm makes only 1% of the total semen(seminal fluid). This is one of the reason men, who have had vasectomy, don't see a change in their semen/ejaculate. A normal ejaculate contains more than 20 million sperm per milliliter. The prostate gland secretes a protein which helps protect the sperm from the acidic environment of urethra and vagina. It also contains Vitamin C, Zinc, Cholestrol and a few other compounds. A normal healthy semen doesn't contain any harmful substances although non-healthy ones may carry bacteria and viruses of sexually transmitted diseases. A healthy sperm swims at a rate 48 to 96 mm per second.

Sometimes the ejaculation may hurt due to acidity. Urologists prescribe baking soda(sodium bi carbonate, NaHCO₃) which is alkaline, to reduce the acidity and patients report that they feel better after taking baking soda in a glass of water for couple of days. One of my friend's 9 year old son was having problem urinating. He was complaining that its burning. I told the mother to put 1/4 tsp baking soda in a glass of water and make him drink for 2 to 3 days. My friend told me that the symptoms were completely gone. Ejaculate fluid is sticky, milky and has an odour not due to the sperm. The ejaculate is liquefied by a protein(PSA-Prostatic Specific Antigen) secreted by the glandular cells of the prostate gland. The Physician tests for this protein incase he suspects there is a tumor in the prostate.

It is quite common for normal men to ejaculate prematurely before or late after penetration. This can be trained with mental training and some physical reconditioning until a satisfactory ejaculation is performed. Some of the physiological causes of premature ejaculation are injury to the nervous system, pelvic structures, diabetes, heart disease. The treatment for premature ejaculation is a prescription of antidepressant drugs like Prozac and Paxil. The same drugs are also used to treat depression! 

Normally one should not see sperms in the urine. If it happens, its called retrograde ejaculation. The semen backs up in the ejaculatory duct and ends up in the bladder. Also when one sees white cells(immune cells) in the semen, then one has to make sure if its to do with infection or some other serious problem.

Delayed ejaculation is exactly the opposite of premature ejaculation. This can also lead to more serious ejaculatory incompetence in which case the man will not be able to ejaculate inside his partner's vagina. This poses difficulty for couple who wants to have a baby. As similar to the premature ejaculation, physiological causes like diabetes, blood pressure medication, psychiatric drugs etc contribute to this condition. One of the common reason associated with delayed ejaculation is masturbation. Some of the other factors at play are marital conflict, substance(drug & alcohol) abuse, anger toward women and oppressive upbringing. It can be treated with positive reinforcement. Sexual satisfaction requires lot of understanding and committment from the partners.