Male reproductive organs

Dr Yasrul Izad Abu Bakar

Faculty of Medicine UniSZA
 Male reproductive system: overview
Consists of series of ducts, tubules &
glands

Functions:
1. Production of male gametes
(sperm)

2. Synthesis of androgens (male sex

hormones) such as testosterone

3. Delivery of sperm into the female

reproductive tract
 Learning outcome
• Describe the gross anatomy of:
1. testes
2. ductus deferens
3. accessory sex glands
4. penis
5. scrotum

• Describe the important relations of ductus deferens and seminal

vesicles

• Describe the blood supply, nerve supply and lymphatic drainage of

the male reproductive system

• Discuss the clinical anatomy of the male reproductive system

• Describe the spermatic cord (will be covered during tutorial)

 1. Testis
testis
Is the male sex glands (gonads) –
homologous to ovary in female

Primary functions of testes are:

i. Production of sperm (spermatogenesis)
ii. Synthesis of androgens (steroidogenesis)

Androgens (mainly testosterone) are essential

for spermatogenesis
 4 months fetus

Testis
• The testes originally developed
on the posterior wall of abdomen
& later descend through the
inguinal canal into the scrotum
testis
• During descent, it carry their
vessels, lymphatic, nerves & vas
deferens

• Testes located outside the

abdominal/pelvic cavity as it
cannot withstand the
temperature of abdominal cavity
(lower temperature is required for
spermatogenesis)

Adult
 Testis
• Is suspended in scrotum
by spermatic cord

• Left testis hanging slightly

lower than right testis

testis
 Testis: external features
Oval in shape
It lies obliquely (upper pole tilted anteromedially)

Has:
• 2 poles (upper & lower)

• 2 borders (anterior & posterior)

• 2 surfaces (medial & lateral)

 Testis: external features
Upper pole Lateral
• provide attachment to the spermatic cord surface
• Attached to appendix of testis (remnant of
paramesonephric duct)

Anterior border: Upper pole

• convex & smooth
• fully covered by tunica vaginalis
Posterior border :
• straight Posterior
• partially covered by tunica vaginalis
• Epididymis lies along its lateral part
Anterior
2 surfaces (medial & lateral)
• Convex & smooth
Lower pole
 Testis: coverings Tunica
albuginea Tunica vaginalis
(visceral layer)
Testis is covered by 3
coats:

1. Tunica vaginalis
Testis
2. Tunica albuginea
3. Tunica vasculosa

Tunica vaginalis
(parietal layer)
 Testis: coverings
Tunica vaginalis
Tunica vaginalis: (parietal layer)

• Represents the persistent lower

portion of processus vaginalis

• It is invaginated by testis from

behind (thus, has visceral, parietal layer &
cavity)

• Covers whole testis (except posterior

border)

Tunica vaginalis
(visceral layer)
- covering the testis
During development
 Testis: coverings
Tunica albuginea: Tunica
albuginea Lobules
• A dense fibrous coat (capsule)
• Cover whole testis
• Thickened posteriorly to form
mediastinum testis
• Numerous septa extend from
mediastinum to inner surface of
tunica albuginea
• Septa incompletely divide testis into Septa
200-300 lobules

Tunica vasculosa
• Innermost
• Coat lining the lobules of testis
Mediastinum
 Internal structure of testis
• Each lobule consists of 2-3
seminiferous tubules

Seminiferous tubules:
• Highly coiled (about 60cm if stretched out)

• Join together to form 20-30 straight

tubules (tubuli recti)

• In mediastinum, straight tubules

anastomose to form rete testis
(network of tubules)

• Rete testis give rise to 12-30

efferent ductules
Efferent
ductule
Structure of testis
 Seminiferous tubules
Seminiferous tubules:

• Sperm are produced

here (spermatogenesis)

• The wall is line by cells

which represent
stages in spermatozoa
formation
Seminiferous tubules: cross section

Function of Leydig cells???

 Structure of testis
Epididymal
Efferent ductules: duct
Efferents
Ductus ductules
• enter epididymis & deferens

become highly coiled

• end in a single duct

(epidydimal duct) to
form the body & tail of
epididymis

• continuous with
ductus deferens
 2. Epididymis
• Is an elongated
structure that lies along
the posterior surface of
testis

• Contains:
1. Efferent ductules

2. Duct of epididymis
(epididymal duct)
Epididymis
 Epididymis
• The epididymis can be
divided into:
Head

1. Head
2. Body Body
3. Tail (continues as ductus
deferens)

Tail
 Epididymis
Efferent
ductules
Efferent ductules Duct of epididymis

Occupy the head Occupy the body & tail

Efferent ductules:

transport newly developed

sperms to epididymis from
rete testis Duct of
epididymis
 3. Ductus (vas) deferens
Function: Conveys spermatozoa from
epididymis to the ejaculatory duct by
muscular contraction

• Emerges from tail of epididymis

• Fibromuscular tube with relatively

thick muscular wall Vas
deferens
• On examination, it can be palpated
as the cord-like structure along the
upper pole & posterior border of
testis
 Superficial
inguinal
Vas deferens: courses ring

Course & relations:

• Begins as continuation of tail of

epididymis (at inferior pole of testis) Vas
deferens

• Ascend posterior to testis

• Enters the spermatic cord

In spermatic cord:
• runs upward & enters the superficial
inguinal ring & then traverses the Spermatic
cord
inguinal canal (penetrates anterior abdominal wall)
 Vas deferens: courses Inferior
epigastric
External vessels
iliac
vessels
• It leaves the spermatic
cord at the deep inguinal
canal & hooks around
lateral side of inferior
epigastric artery

• Crosses over the external

iliac vessels & enters the
pelvis
 Vas deferens: courses
In lesser pelvis: Superior
• Passes along lateral wall of vesical
artery
pelvis

• Direct contact with

peritoneum (lies external to
parietal peritoneum)

• Crossed by umbilical artery,

vesical vessels, obturator Ureter
vessels & nerve

• Crosses superior to ureters

 Vas deferens: courses
At the base of bladder:
• Lies superior & medial
to seminal vesicle
• Enlarges to form
ampulla of ductus Vas
deferens deferens
• Approaches the
opposite ductus
deferens

At the base of prostate:

Seminal
• terminates by joining vesicle
duct of seminal vesicle
to form ejaculatory
duct
Ampulla
 Clinical application –
male contraception
Vasectomy
• Common method of
male sterilisation
• A.k.a deferectomy
• Incision is made at the
superior part of
scrotum
• Part of vas deferens is
ligated and/or excised
 4. Seminal vesicles
• Two lobulated sac glands
Function: secretes thick alkaline fluid (fructose
& coagulating agent) to be added to the sperms in
the urethra

Seminal vesicles lie:

• obliquely at the base of urinary bladder
• between bladder & rectum

• Lower narrow end forms the duct of

seminal vesicle

• Duct of seminal vesicle joins ductus

deferens to form the ejaculatory duct
Seminal
vesicle
 Seminal vesicles
Relations:
Superior: Inferior:
Covered by
peritoneum

Ampulla of vas Rectum

deferens – separated by
rectovesical fascia
(Denonvillier’s)

Ureters Prostate
Seminal
Rectovesical pouch vesicle
 Ejaculatory ducts
• formed by union of vas
deferens & seminal vesicles at Ejaculatory
the base of prostate duct

• Pierce the prostate

gland to reach the
prostatic urethra
• Open on the
seminal colliculus
• Along the sides of
prostatic utricle
 5. Bulbourethral glands (of Cowper)
Lateral view
• Are 2 small pea-size glands lie
posterolateral to membranous
urethra

• Function: Secrete mucus-like fluid

that lubricates penile urethra
before ejaculation (during sexual arousal)

• Embedded within the external

urethral sphincter Bulbourethral
gland

• The ducts pass through the

perineal membrane & open into
the penile (spongy) urethra in the
bulb of penis Anterior view
 6. Penis
Function: Transfer sperm to female
genital tract

Consists of 3 fibrous columns of

erectile cavernous tissues (bodies):
• 2 corpora cavernosa (dorsal) & 1
corpus spongiosum (ventral)
• The columns have cavernous sinus
filled with blood

Can be divided into root (attached

portion), body (free portion) & glans

*During sexual arousal, great increase of blood volume flowing

into cavernous space
 Penis Corpora
cavernosa

• Corpus spongiosum traversed Corpus

by spongy urethra spongiosum

• Corpora cavernosa are fused

side by side (except at root where
they are separated to form crura)

Deep
• Each cavernous body covered (Buck’s)
by capsule known as tunica fascia
albuginea

• External to tunica albuginea is

the deep fascia of penis (Buck
fascia) that cover all 3
cavernous tissues together
 Tunica
albuginea

Deep
(Buck’s)
fascia
 Penis: root
Root of penis: Ischiocavernosus

• The attached part of penis

• Situated in superficial perineal
pouch
• Composed of 3 masses erectile
tissue – 2 crura & 1 bulb

Each crus:
• is firmly attached to the margins of
ischiopubic rami
• Covered by ischiocavernosus muscle

Bulb:
• Attached to the perineal membrane
• Covered by bulbospongiosus muscle
• Pierced by urethra in its centre Bulb
(urethra is dilated = intrabulbar fossa)
Bulbospongiosus
Crus
 Penis: body
Glans of
Corpora
Body of penis: penis
cavernosa
• The free portion of penis
• Completely enveloped by skin (no
muscle)
• Composed of – a median corpus Corpus
spongiosum, right & left corpora spongiosum
carvenosa

Corpora cavernosa:
• Forward continuation of crura
• In close apposition with each other
• Terminate under the glans of penis

Corpus spongiosum:
• Forward continuation of bulb of penis
• Terminal part expanded to form a
conical enlargement known as glans
penis
 Penis: glans
External Neck of Corona of
Glans (head) of penis: urethral glans glans
meatus

• Its margin projects beyond the

ends of corpora cavernosa to
form corona glandis

• Neck of glans (groove) separate

glans from body of penis

• The urethra shows dilatation

called navicular fossa

• External urethral orifice (meatus) is

near the tip of glans
 Penis Frenulum

Skin:
• Connected to fascia by loose CT
• At the neck, the skin & fascia folded as
double layer called prepuce (foreskin)

Prepuce:
covering glans to a varying extent & can be
retracted posteriorly to expose glans Prepuce
• Preputial sac: potential space between
glans - prepuce
• Frenulum: median fold of skin
undersurface of glans to prepuce

Smegma (sebaceous material):

• Secreted by numerous small sebaceous
glands on corona glandis & neck of
penis
• Collected in preputial sac
 Penis
Fascias:
Superficial fascia Deep fascia of penis
(Dartos fascia) (Buck’s fascia)

• Loose areolar tissue (no Membranous

fat)
• Contains few muscle
fibres
Continuous with Surround the body of
membranous layer of penis but does not
superficial fascia of extend into the glans Superficial
abdomen & perineum (dartos)
fascia of
penis &
Contains: Beneath it: scrotum
Superficial vein of penis 1. Deep dorsal vein
Deep
2. Dorsal arteries (Buck’s)
3. Dorsal nerves of penis fascia
 Deep
(Buck’s)
fascia

Superficial
(dartos)
fascia of
penis &
scrotum
 Supports of the Fundiform
ligament

body of penis
Fundiform ligament Suspensary ligament

Extends inferiorly from Extends from pubic symphysis

linea alba & splits to (Lies deep to fundiform ligament)
surround the penis

Blends inferiorly with Attached to Buck’s fascia

dartos fascia (at the junction of root & body of
penis)

Long & loose Short & taut

Anchoring erectile bodies to

pubic symphysis
Suspensary
ligament
Anterior abdominal wall Anterior abdominal wall
(superficial dissection) (intermediate dissection)

Suspensary
ligament
Fundiform
ligament

Dartos
fascia (cut) Buck’s
fascia
 Clinical application
Hypospadias:
• Common congenital anomaly of
penis
• 1 in 300 newborns

Developmental anomaly where

external urethral orifice located
inferior to its normal position:
• Glanular hypospadias –on
ventral aspect of glans
• Penile hypospadias – body of
penis
• Scrotal hypospadias - perineum
 Clinical application
Phimosis:
• Prepuce is fits closely over glans (cannot be
retracted)
• Can cause irritation due to accumulation of
smegma in preputial sac

Paraphimosis:
• a condition characterized by an inability to
replace the phimotic prepuce to its normal
position after it has been retracted behind
the glans penis.
• May constrict neck of glans & interferes the
blood supply of penis
• Circumcision may be required

Circumcision:
• Surgical excision of prepuce
• In adult, usually performed when phimosis
or paraphimosis is present
 Scrotal raphe:
7. Scrotum line of cutaneous marking of fusion of
embryonic labioscrotal swellings

Is a cutaneous bag contains testes

and parts of the spermatic cords

• Scrotum is divided internally by

septum (continuation of dartos fascia)
– demarcated externally by
scrotal raphe
• The left scrotum hangs lower than
the right, to correspond with the longer Dartos
left spermatic cord fascia

Dartos fascia:
• fat-free fascial layer Septum
• includes dartos muscle Skin
responsible for rugose (wrinkled)
appearance of the scrotum
Raphe
 Scrotum
Dartos fascia continues:
Anteriorly Posteriorly
membranous superficial
layer of perineal fascia Scarpa
superficial (Colle’s fascia) fascia
fascia of
abdomen
(Scarpa fascia)

Colle’s
fascia
Dartos fascia of
scrotum & penis
 Dartos fascia
Dartos fascia
continues:

• Anteriorly –
Scarpa fascia

• Posteriorly –
Colle’s fascia
 Scrotum Dartos
muscle

Layers (including spermatic cord): External

spermatic f.
1. Skin
2. Dartos muscle & fascia Cremasteric
muscle
3. External spermatic
fascia Internal
spermatic f.
4. Cremasteric muscle &
fascia
5. Internal spermatic * 3 to 5 are the
fascia coverings of
spermatic cord
Skin
 Clinical case scenario
26 y.o male came with complaint of
left scrotal swelling.

On examination:
The swelling is
• non tender on palpation
• not reducible

Possible diagnosis???
• What should you look for during
further physical examination
 Clinical application
Hydrocele

• Presence of excess fluid in

the persistent processus
vaginalis

• The fluid accumulation

results from abnormal
secretion from visceral layer
of tunica vaginalis

• On examination, hydrocele
appears transilluminated
(procedure which bright light applied to
the side of scrotal swelling & red glow
transmission of light indicate excess
serous fluid in scrotum)
Clinical application
Undescended testis
(cryptorchidism)

• Testis may lie in lumbar,

iliac, inguinal or upper
scrotal
• Spermatogenesis may fail to
occur
• Higher risk of carcinoma
• Can be surgically corrected
Blood supply of Male
Reproductive System
 Blood supply of male reproductive
system
Artery Vein
Testis Testicular artery Pampiniform venous plexus
Epididymis - testicular vein
Ductus Vesical arteries (superior / inferior) - artery to 1. Pampiniform venous plexus -
deferens the ductus deferens testicular vein
2. Vesical /prostatic venous
plexus – internal iliac vein
Seminal 1. Inferior vesicle artery Accompany the arteries
vesicle 2. Middle rectal artery
Penis • Internal Pudendal (IP) Superficial dorsal vein – EP
1. Deep artery of penis Lateral superficial veins – EP
2. Dorsal arteries of penis Deep dorsal vein – IP
3. Artery of bulb of penis

• Branches of external pudendal (EP)

Scrotum Posterior scrotal artery (IP)
Anterior scrotal branch (EP)
Cremasteric artery (inferior epigastric)
 Testis Testicular
vessels

Arterial supply Venous drainage

• Testicular • Pampiniform venous

artery plexus
> Drains into testicular
vein

*branches of *Right testicular vein

abdominal drains into IVC
aorta (at level of *Left testicular vein Spermatic
L2) cord
drains into left renal vein
*enters the
spermatic cord Pampiniform
plexus
 Vas deferens
Internal
Arterial supply Venous drainage iliac
Vesical arteries Pampiniform venous plexus vessels
(superior or inferior) & testicular vein
give rises to
tiny artery to
Superior
the ductus vesical
deferens artery

Vesical /prostatic venous

plexus – opens into internal
iliac vein

Inferior
vesical
Vesicle artery
venous
plexus
Lymphatic : drains into external iliac LN
Artery to
ductus
deferens
 Seminal vesicles
Inferior
vesical
Arterial supply Venous drainage
artery

Inferior vesicle artery

Middle rectal artery Accompanies arteries

Lymphatic drainage:
• External iliac LN (superior part)
Middle
• Internal iliac LN (inferior part) rectal
artery
 Arterial supply of penis
Arteries: Area supplied
Mainly by Internal pudendal
Dorsal
artery (through its branches) artery

Deep artery of penis Erectile tissue of corpora

• runs in corpus cavernosum cavernosa
• involved in erection of penis
• give off to numerous helicine
arteries, when penis is
flaccid, these arteries coiled

Dorsal arteries of penis corpus spongiosum, penile

• beneath the deep fascia & skin & fibrous tissue of
run on each side of deep corpora cavernosa
dorsal vein
Artery of bulb of penis bulb & bulbourethral gland
Deep
artery
In addition, branches of external pudendal
artery also supply penile skin & anastomose with
branches of internal pudendal artery
 Venous drainage of penis
Lateral
Superficial superficial
Veins Drain from v
dorsal v
Superficial dorsal vein penile skin
Lateral superficial prepuce
veins (paired)
Deep dorsal vein blood from glans &
– lies in dorsal groove corpora cavernosa
beneath the deep fascia

• Superficial veins drain blood from superficial

covering of penis into external pudendal
veins
Deep Dorsal
dorsal v nerve of
• Deep dorsal veins drains into prostatic plexus penis
& internal pudendal veins
 Internal
pudendal
artery
Superficial
dorsal v

Dorsal Prostatic
artery & venous
deep plexus
dorsal vein
 Innervation of male reproductive system (T10-S4)
Nerve supply
Testis T10
Epididymis T11-L1
1. Ductus deferens T12-L2/L3
2. Prostate
3. Ejaculatory ducts
4. Seminal vesicles
(*DPRES)

Penis • S2 – S4
Sensory: pudendal nerve - dorsal nerve of penis
Parasympathetic: Prostatic nerve plexus
• T10 – L2
Sympathetic:
T10 – L2: inferior hypogastric plexus – prostatic plexus
Scrotum (L1–S4) 1. Ilioinguinal nerve (L1)
2. Genital branch of genitofemoral nerve (L1 – L2)
3. Pudendal nerve (S2 – S4)
4. Perineal branch of posterior cutaneous nerve of thigh (S2 –
S3)
 Testis: T10 T10

Nerve supply:
• Sympathetic from T10
• Afferent for testicular
sensation
• Efferent to blood
vessels (vasomotor)
Lymphatic:
• Drain into preaortic &
paraaortic LN (L2)
 Epididymis:
T11-L1 T11
T12
L1
• Nerve supply:
sympathetic nerves
through testicular
artery derived from
T11-L1

• Blood supply, venous &

lymphatic drainage
similar with testis
 Other
male internal genital organs: T12-L3
• Ductus deferens, prostate,
ejaculatory ducts, seminal
vesicles
T12
L1
Sympathetic nerve fibres originate
from T12 – L2/L3 L2 /L3

• Hypogastric & pelvic plexuses

During orgasm, sympathetic system

stimulates:
• rapid peristaltic movement of vas
deferens
• combined contraction & secretion
from seminal & prostate glands to
provide vehicle for sperms
discharge during ejaculation
 Sensory of Penis: S2 –S4
Sensory nerve: supplies both
skin & glans of penis

Derived from S2 – S4 spinal

segments
• Passing through pudendal Prostatic
plexus
nerve
• Sensory: dorsal nerve of penis
(terminal branch of pudendal nerve)

*Skin at root of penis – supplied by ilioinguinal Pudendal

nerve nerve
Dorsal nerve of
penis
 Autonomic innervation
of Penis
Penis
Erection:
• Parasympathetic derived from S2–S4
• S2-S4 - prostatic nerve plexus –
cavernous nerve of penis
• Vasodilators of helicine artery
• Engorgement of erectile tissues
Inferior
Ejaculation hypogastric
plexus
• Sympathetic
• Preganglionic from T10 – L2 synapse on Prostatic
postganglionic nerve cell bodies in plexus
inferior mesenteric ganglion Cavernous
• The postganglionic sympathetic fibres nerve
are responsible for release of
secretions from prostate gland &
seminal vesicle
‘P’ for ‘Point’
• Vasoconstrictors of helicine artery
‘S’ for ‘Shoot’
 Penis: lymphatic drainage

Lymphatic drainage:
• Glans & distal spongy
urethra drain into deep Internal
iliac LN
inguinal LN

• Skin of penis drains into

superficial inguinal LN

• Proximal spongy urethra & Deep

cavernous bodies drain into Superficial
inguinal LN

internal iliac LN ingiunal LN

 Scrotum
Posterior
Posterior scrotal artery:
scrotal a.
branch of internal pudendal artery
Arterial Anterior scrotal branch:
supply branch of external pudendal artery
Cremasteric artery:
branch of inferior epigastric artery
Anterior • Anterior scrotal nerve – branch of
(1/3) ilioinguinal nerve (L1)
• Genital branch of genitofemoral
nerve (L1 – L2)
Nerve Posterior • Posterior scrotal nerves – branches
supply (2/3) of pudendal nerve (S2 – S4)
• Perineal branch of posterior
cutaneous nerve of thigh (S2 – S3)

Dartos • Genital branch of genitofemoral

muscle nerve (L1 – L2)

Veins: accompany the arteries Internal

Lymphatic drainage: superficial inguinal LN pudendal a.
 Clinical application
Cremasteric reflex

• Contraction of cremaster muscle

is elicited by lightly stroking the
skin on medial aspect of superior
part of thigh (area supplied by
ilioinguinal nerve: L1)

• Rapid elevation of testis on same

side is the cremasteric reflex

• L1 spinal injury, ilioinguinal nerve

injury, upper & lower motor
neuron disorders can lead to
absence cremasteric reflex
 Self study (tutorial)
• Spermatic cord

• Processus vaginalis

• Scrotal swelling (reducible vs non reducible)

• Inguinal canal (revision)

 Spermatic cord
• Contains structures running to &
from the testis & suspend testis in
the scrotum
Spermatic
cord
• Begins at the deep inguinal ring

• Then passes through the inguinal

canal

• Exits at the superficial inguinal ring

• Ends in the scrotum at the posterior

border & upper pole of testis
 Spermatic cord
Coverings include (internal to External
external): spermatic f.

1. Internal spermatic fascia

(derived from transversalis Cremasteric
fascia) muscle

2. Cremasteric fascia (derived Internal

spermatic f.
from fascia of internal
oblique muscle)

3. External spermatic fascia

(derived from external
oblique aponeurosis)
 Spermatic cord: cremaster fascia
Cremasteric fascia: Dartos
• Contains loop of cremaster muscle
muscle (formed by lowermost fascicles of Cremasteric
internal oblique muscle)
muscle &
fascia
Cremaster muscle:
• reflexively draws superiorly the
testis (particularly in response to cold) – to
regulate the temperature of
testis for spermatogenesis
• Acts coincidentally with dartos
muscle (elevates testis by contraction due to
same stimuli)
• Innervated by genital branch of
genitofemoral nerve (L1, L2)
 Transversalis Internal
Spermatic cord: coverings fascia oblique
muscle

External
oblique
aponeurosis

Origin of
internal
spermatic
fascia

Cremasteric
muscle &
fascia
External
spermatic
fascia
 Spermatic cord Pampiniform
venous plexus

Contains:
1. Ductus deferens
2. Arteries: Testicular, cremasteric Ductus
arteries & artery of the ductus deferens
(artery of its)
deferens
3. Pampiniform venous plexus
4. Lymph vessels from testis
5. Nerves: Genital branch of
genitofemoral & sympathetic
nerve plexus (on arteries & ductus deferens)
6. Remains of processus vaginalis
 Testicular vessels &
Spermatic cord: genital branch of
genitofemoral nerve
contents
Ductus
deferens

Cremasteric Ilioinguinal
vessels nerve
Remains of processus vaginalis (may not be detectable or seen
as fibrous thread extending between abdominal peritoneum &
tunica vaginalis)
 Clinical
application
Varicocele

• Dilatation of the
pampiniform venous plexus

Usually left side because -

Left testicular vein:
• is longer than right
• enters the left renal vein
vertically
Left renal vein:
• Anteriorly crossed by SMA
Thank you….