In the seminal cord there is a tangle of arteries ( plexus pampiniformis), from where blood flows back to the heart. On a level with the internal ring of the inguinal canal this complex becomes the drainage vein ( vena spermatica interna). On the right-hand side this flows directly into the inferior vena cava, and on the left into the renal vein. This division is the reason why varicose veins in the scrotum, varicocele, are much more common on the left than on the right.
Lymphatic drainage from the testicles is in the first instance into lymph glands behind the abdomen and not, as many people think, into glands in the groin. That fact is particularly important in the treatment of testicular cancer. The lymph glands in the groin do, however, form part of the drainage system of lymph from the skin of the scrotum. In the past cancer of the skin of the scrotum was very common among chimney sweeps and coalmen, who had soot and coal dust more or less continually in their crotch. Today cancer of the skin of the scrotum is extremely rare.
Nerve supply
A dentist about to start root canal work on a woman suddenly feels her hand firmly grasping his testicles. As he stares at the women open-mouthed, she says with a smile: ‘Let’s promise not to hurt each other!’
Pain in the testicles is excruciating, but hard to understand even for doctors. The fact is that nerve provision in the testes is complicated.
The autonomous, sympathetic nerve supply derives from the spinal segments of the tenth and twelfth vertebrae. These nerves run parallel with the blood vessels. They penetrate the fibrous sheath surrounding the testicles ( tunica albuginea) and continue their course among the lobules 29
m a n h o o d
The plexus
pampiniformis
and the vena
spermatica
inferma.
Arteria testicularis
Vena spermatica
interna
Plexus
pampiniformis
where the sperm cells are produced. Their most important function seems to be to affect the contraction or otherwise of the smooth muscular tissue in the tunica albuginea. The nerve endings governing sensation in the testicles are located in the same compartment as the Leydig cells. If the skin of the scrotum and the tunica vaginalis are anaesthetized and the testicle is then injected with a physiological salt solution, pain is felt not in the scrotum, but instead deep down in the abdomen. This is probably referred pain, deriving from the auto -
nomous nerve supply.
The somatic, or non-autonomous nerve supply is through the nervus genito-femoralis and derives from the spinal segments of the first and second lumbar vertebrae. The nerve branch to the interior of the scrotum runs first to the testicular muscles, and passes right through them before continuing to the tunica vaginalis and tunica albuginea of the testicles. If in the course of an operation this nerve is severed, whether or not deliberately, henceforth when the testicles are squeezed hard pain will be felt only deep in the groin. With spinal anaesthesia up to the level of the first lumbar vertebrae ‘testicle sensation’ also disappears. The above findings indicate that only with intense stimulation, for example hard squeezing, does autonomous nerve pain occur: dull, nauseating pain that is difficult to localize. If pain is clearly felt in the scrotum, it is conducted via somatic nerves.
Referred pain in the scrotum may be the result of, for example, a kidney stone that has descended into the urethra, a weak spot in the inguinal artery, a minute hernia in the groin that is not yet visible or wear and tear on the spinal column.
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t h e t e s t i c l e s a n d t h e s c ro t u m The epididymis
The sperm-forming tubes in a testicle discharge into a kind of transit depot. Between six and eight ducts lead to the epididymis. In the epididymis those ducts merge into a single tube. While the sperm-forming tubes in a testicle have a combined length of 250 metres, an epididymis is a duct of approximately 6 metres in length. The epididymis curls in a comma-shape behind the testicle. One can distinguish a head ( caput), a body ( corpus) and a tail ( cauda). On a level with the head of the epididymis the network of drainage tubes in the testicle connects to the narrow epididymal duct, and the tail then connects to the seminal duct, the ductus deferens.
The blood supply comes both from the testicular artery and from its own epididymal artery. Drainage of blood takes place through the previously mentioned plexus pampiniformis. During a passage of several days through the epididymis the still infertile sperm cells mature into fertile cells. One of the most striking changes is an increase in the percentage of moving spermatozoa and their swimming speed.
Biochemical changes in their surface increase the ability of sperm cells to attach themselves to the ovum.
The epididymis is highly dependent on testosterone, and the head is exposed to high concentrations through the influx from the testicles.
Further down stream in the epididymis, the concentration of testosterone is much lower. Besides the testosterone supply via the rete testis (testicular network of tubes), the epididymis is also supplied with testosterone via the bloodstream. The exposure of different sections of Caput
Ductus
deferens
Cauda
The epididymis.
m a n h o o d
the epididymis to different concentrations of testosterone make it a unique organ.
At orgasm the sperm cell stored in the tail of the epididymis are forced into the seminal duct. The impetus is provided by the contraction of the smooth muscles in the wall of this long, tubular organ. If a man does not ejaculate for two weeks, sperm cells will appear spontaneously in his urine.
The seminal duct
The ductus deferens, between 30 and 40 cm long, links the epididymis with the urethra. Immediately before the actual ejaculation rhythmic contractions take place in the smooth muscle tissue of the wall, pro-pelling the sperm cells towards the ampoule and the urethra. This muscle-lined tube with a diameter of between 3 and 4 mm can be felt between the tail of the epididymis and the external groin opening. It feels like a liquorice shoelace. In this area the duct forms part of the seminal cord, which also consists of arteries and a network of veins, nerves and lymph vessels.
The seminal cord is encased in structures originating from the abdominal wall, the fascia spermatica interna and the fascia spematica externa. Contained in this casing are the cremaster or transverse testi cular muscles. From the inner inguinal ring the seminal duct runs along the inside of the abdominal wall, passing behind the bladder to the centre of the prostate. Close to the prostate, between the bladder Fascia spermatica interna
Musculus cremaster
Fascia spermatica externa
The covering of
the seminal cord.
t h e t e s t i c l e s a n d t h e s c ro t u m The appendices
of the testicle and
the epididymis.
Paradidymis
Appendix epididymis
Vas aberrans
Appendix testis
superior
Vas aberrans
inferior
and the rectum, the duct widens into the ampoule ( ampulla ductus deferentis). Within the prostate the duct narrows to the ejaculatory duct, or ductus ejaculatorius. The two ejaculatory ducts discharge at a point near the verumontanum, a thickening in the rear wall of the urethra that runs right through the prostate.
Appendices
Attached to the testicle and the epididymis are a number of appendices that are polyp-shaped, up to 1 cm long and up to 2 cm in diameter.
These are: the appendix testis (Morgagni’s hydatid), the appendix epididymis, the paradidymis (organ of Giraldis), the superior vas aberrans superior (Haller’s organ) and the vas aberrans inferior.
An appendix testis is found in 90 per cent of men. It originates from remnants of Müller’s duct, a structure in the embryo from which female sex organs are made. The other appendices (remnants of mesonephric tubules) are much less common. An appendix to the epididymis is found
in 30 per cent of men, the last three mentioned in a maximum of between 1 and 5 per cent. Torsion can result in acute pain in these organs – nearly always in the appendix testis – and in the atrophy of the appendix. There is, though, absolutely no need for an operation in such cases.
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chapter two
The Penis
Impotence means literally the inability to perform sexual intercourse, though the word is often used in a disparaging sense, implying helplessness. Impotence is probably one of the best kept bedroom secrets and, at least for those affected, one of the most shameful. Fortunately a euphemism has been devised: erection problems or, even more useful, erectile dysfunction or ed.
Modern medicine sees the erection of the penis as based on a neuro-vascular reflex, dependent on a correct hormonal balance, a healthy anatomy, an adequate blood supply and an undamaged and efficiently functioning nervous system. If one takes all this on board, one realizes that it’s easy for things to go wrong occasionally. Put more strongly, it’s a miracle that things go smoothly so often! So this chapter will highlight not only the technical, but also the miraculous aspects.
Displaying an erection or having sex in public is not usually pos -
sible – in fact, it’s illegal. So to show that one is functioning properly as a man, there is only one option, which is to father a child. If that fails, for example because of poor sperm quality, the man involved feels seriously inadequate. These days things are a little less pressured, since quite a few married couples opt – by their own testimony, at least – for voluntary childlessness. (This topic will be discussed in greater depth later.)
There has never been such a thing as an impotent woman. Leaving aside anatomical or mental abnormalities, every woman is capable of passively accepting a man’s sexual advances. This is sadly not true of the man, and for that reason a man’s relationship with his penis is not comparable with a woman’s with her clitoris and/or vagina. A woman says ‘I’m not in the mood’; for her the vagina is an integral part of her body. Of course a man’s penis is too, but an erect penis, the phallus, is more.
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t h e p e n i s
In the novel Io e lui (1971, English title The Two of Us) by the Italian writer Alberto Moravia, the hero Federico is constantly getting into difficult and embarrassing situations because of his huge and demanding penis, which he calls Federico Rex. It is a confrontational book: the protagonist is constantly debating with his unruly member and plunging into every conceivable erotic folly. The final scene is humiliating for Federico: his member, ‘he’, carries him back triumphantly to the woman from whom he had tried to escape:
To satisfy him, I pressed the bell once more. Standing stiffly in the air, ‘he’ seemed now to be rising up, in short, successive jerks, as if to bring himself to the level of the keyhole and look into the flat. At last I heard a slight bustling sound. Then Fausta’s voice asking: ‘Who is it?’
‘It’s me, Rico.’
Fausta’s hand undid the chain, the door opened, and she appeared on the threshold in her dressing-gown. She looked at me, looked down, saw ‘him’ and then, without saying a word, put out her hand to take hold of ‘him’, as one might take hold of a donkey’s halter to make it move. Then she turned her back to me, pulling ‘him’ in behind her, and, with ‘him’, me. She went into the flat; ‘he’ went behind her: I followed them both.
The title of the novel is very apt, in both Italian and English. Many men suspect or think that their penis has a will of its own and does what it likes. Quite a few men refer to their penis as ‘he’. It is the symbol of the ability to procreate with the accompanying feelings of male self-worth. Muscularity, determination, effectiveness, penetration, directness, strength – the phallus underlies them all.
And so it happens that every man discovers one fine day that his penis is not like an arm, finger or leg: it doesn’t react automatically.
The penis can be compared to a well-trained dog, which usually follows the instructions it is given – but the owner must always allow for the possibility that one day it will refuse, despite the fact that it is trained, or in more human terms, socialized. Men can gain some control over their penis: on a nudist beach, for example, you scarcely ever see men with erections, although there are naked women (or men) to admire everywhere. A half-naked woman lying in stirrups for a bladder examination is unlikely to provoke an erection in any urologist. He is focused on the sick woman in front of him.
35
m a n h o o d
The phallus
Phallus is the name given to the erect penis as a symbol; most people associate the term penis with something or someone else, for example their bearded biology teacher from school or sex education manuals.
This is not to say that the sex education manuals of, say, the 1960s were bad books – on the contrary, they preserved some of the mystery surrounding the adolescent penis. Their modern counterparts are so intrusive that little is left to the imagination. One of the nicest things about puberty is surely discovering things for yourself and making your own mind up. Fortunately for most young children the discovery of the differences between the male and female external sex organs is still a very exciting business. Who has never played ‘doctors and nurses’? In such situations the differences are discussed at length, something that most adults no longer do or dare to do. In his fascinating novel The Year of Cancer (1972) the Flemish writer Hugo Claus shows that it can sometimes still happen.
‘You’ve got the nicest pussy I’ve ever seen,’ he whispered.
‘No,’ she said. ‘It used to be nice. But when I had the baby they stitched me up wrong. And afterwards I got piles. It often hurts really badly.’
‘I love you,’ said Pierre.
‘I love you,’ she said. ‘And you’ve got the nicest one I’ve ever seen too. I don’t usually look at them with men.’
‘But if you’ve never looked, how do you know mine’s nicer?’
‘Well, I have sneaked a look. Most of them are red or bluish. Ugh!’
The girl in this story emphasizes a common female view of the penis.
With the phallus it is a different story, for men too. In many ancient cultures the phallus was the symbol of immortality, of vitality eternally renewing itself. It was no accident that at the end of his life the celebrated English writer D. H. Lawrence was fascinated by the Etruscans, who placed a phallus on every grave. As an outwardly visible bio logical feature the phallus came in the course of history to bear a heavy religious and moral burden. Consequently the study of the phallus led to the study of theology, of the phallus that rises and when the party is over dies again, and that as an ‘immortal’ can repeat this feat again and again: the eternal resurrection of the flesh.
The phallus cult was a striking feature of Ancient Greek religion, and the impotent man was more mocked than pitied. For the Greeks a 36
t h e p e n i s
small phallus was preferable, since a large one was associated with barbarians and satyrs. That may have been connected with Aristotle’s view that a shorter penis enhanced fertility. He thought that ‘sperm cools down less the shorter the distance to be travelled’.
Both in front of temples and at the doors of Athenian homes there stood a herm, a square column with a man’s head and an erect penis at the front, but without limbs. Herms stood not only in front of homes, but also at city gates, outside citadels, in markets and in gymnasiums.
In short, they were everywhere in Ancient Greece. The herm was wreathed in green and had olive oil poured over it. During worship people put their hand on its head, or took hold of it by the beard or the phallus. The latter action particularly would not be possible nowadays.
But wait a minute! In Piazza Signoria in Florence there is a Neptune in the middle of a pool, around which are a number of seated bronze fauns all naked and with erect penises. Although for the most part the bronze of the fauns has the familiar oxidized colour, the phalluses are like brass, due to the countl
ess hands that have taken them by that part of the body and stroked them. Florentine women believe that this increases their chances of becoming pregnant. But what a difference: while the touching in Florence takes place in secret, in Ancient Greek it happened freely and publicly. Sexuality and religious observance were inseparable. Of course, the symbolic significance of the phallus embraced much more than sex alone. At Dionysian celebrations its religious importance was stressed, and huge phalluses were borne in pro -
cession. Dionysus was the god of intoxication, of the ecstatic rapture brought about by wine, the blood of the earth, the god of passion and of the rowdy exuberance that characterized these autumnal festivities.
In the drama Acharnes the Greek comic playwright Aristophanes ( c. 446– c.386 bc) tells the story of the procession marking the private Dionysian celebration held by the good Dikaiopolis together with his daughter and his slave Xanthius on the occasion of the armistice between Athens and Sparta. In advance of the procession he instructs Xanthius to hold the phallus pole straight in front of him, and then sings the following phallic hymn:
Oh, Phales, companion of Bacchus,
life of the party, old goat,
lover of women and boys,
with peace in my hands I greet you
and rejoicing return to my village.
The great city festivals of Dionysus were important civic events. They were accompanied by much pomp and ceremony and drew spectators 37
m a n h o o d
from miles around. Not only were countless phallic images carried in procession, but the participants also tied on large artificial penises.
However, it was precisely the Greeks who drew a sharp line between the phallus in its symbolic meaning and the same organ as an anatomical component. The phallus was used only symbolically and ritually.
Manhood Page 4
