Male Reproductive Health

Nice easy read on men's reproductive system, covering: Prostatitis, Prostate cancer, Blood flow,Erection, The Flaccid stage, The Tumescent Stage, The erect stage, Morning erections,Erectile dysfunction (ED), How ED Correlates to CVD.

The male reproductive system consists of the penis, scrotum, and testicles that are outside the body. The internal organs include the vas deferens, prostate, ejaculatory ducts, seminal vesicles, bulbourethral glands, and urethra. The male reproductive system is responsible for maintaining and transporting semen, discharging sperm, producing, and secreting male sex hormones. The system is dependent on hormones to regulate the activity of cells or organs. The main hormones involved in the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. Both FSH and LH are produced by the pituitary gland. Follicle-stimulating hormone is responsible for sperm production, luteinizing hormone stimulates the production of testosterone. A big conversation around male reproduction is sperm/semen count and quality. A normal sperm count ranges from 15 million sperm to more than 200 million sperm per milliliter of semen. Sperm less than 15 million or 39 million per ejaculate is considered low sperm count and should be checked out. There is an abundance of literature that that connects how diet is a key player in semen quality. There are some issues that can arise in the male reproductive system.

Prostatitis: Prostatitis is a disease that causes pain in the groin or pain upon urination. The pain can be caused by a bacterial infection, inflammation, and other undiagnosed conditions. In bacteria prostatitis, Bacteria gets into the prostate and causes the urine to flow backwards from the urethra. In inflammation-based prostatitis this can be caused due to a nerve injury or inflammation or prior urinary tract infections, non-bacterial prostatitis can also be linked to stress. There are four different categories of prostatitis listed below

· Category I: Acute bacterial prostatitis (ABP) which is associated with severe prostatitis symptoms, systemic infection and acute bacterial UTI.

· Category II: Chronic bacterial prostatitis (CBP) which is caused by chronic bacterial infection of the prostate with or without prostatitis symptoms and usually with recurrent UTIs caused by the same bacterial strain.

· Category III: Chronic prostatitis/chronic pelvic pain syndrome which is characterized by chronic pelvic pain symptoms and possibly voiding symptoms in the absence of UTI.

· Category IV: Asymptomatic inflammatory prostatitis (AIP) which is characterized by prostate inflammation in the absence of genitourinary tract symptoms.

Prostate cancer: Prostate cancer is the second most common cancer diagnosed in men globally. It is a cancer that does have high survival rates because of its slow progression. In 2018, cases amounted to 1,280,000 newly diagnosed cases and 359,000 deaths around the world. The majority of prostate cancers tend to grow slowly and are low-grade. There aren’t many initial symptoms that occur in the early stages, but late-stage symptoms may include fatigue due to anemia, bone pain, and paralysis from spinal metastases, and renal failure from bilateral ureteral obstruction. Diagnosis remains controversial but it is primarily based on prostate-specific antigen (PSA) testing, and transrectal ultrasound-guided (TRUS) prostate tissue biopsies, although PSA testing for screening for prostate cancer can differ based on the physician. The etiology of prostate cancer is very complex, but a couple of known factors can contribute to prostate cancer shown below.

· Men with a first degree relative (father or brother) with prostate cancer have twice the risk of the general population.

· Risk increases with an affected brother more than an affected father.

· Men with two, first-degree relatives affected have a five-fold greater risk.

· Patients with a strong family history of prostate cancer tend to present with cancer at a younger age (2.9 years) and with more locally advanced disease.

· They also have a higher risk of biochemical recurrence after radical prostatectomy surgery.

· In the United States, black men are more commonly affected than white or Hispanic men, and it is more deadly in blacks.

· The incidence and mortality for Hispanic men are one third lower than for non-Hispanic whites.

· No single gene is responsible for prostate cancer, although many genes have now been implicated.

· Mutations in BRCA1 and BRCA2 have been associated with prostate cancer as well as breast cancer.

· P53 mutations in primary prostate cancer are relatively rare and are more frequently seen in metastatic disease. Therefore, p53 mutations are generally considered a late and ominous finding in prostate cancer.

· Over 100 Single Nucleotide Polymorphisms (SNPs) and other genes have been linked to an increased risk of prostate cancer. These include: hereditary prostate cancer gene 1, various androgen and Vitamin D receptors, HPC1, HPC2, HPCX, CAPB, mutL homolog 1 (MLH1), mutS homologs 2 and 6 (MSH2 and MSH6, respectively), postmeiotic segregation increased 2 (PMS2), homeobox B13 (HOXB13), checkpoint kinase 2 (CHEK2), nibrin (NBN), BRCA1-interacting protein C-terminal helicase 1 (BRIP1), ataxia telangiectasia mutated (ATM), the TMPRSS2-ETS gene family; TMPRSS2-ERG and TMPRSS2-ETV1/4 which all tend to promote cancer cell growth. (Note: This is only a partial listing. This is the etiology of prostate cancer that makes it complex, the genetic causes.

Diet has been found to play a role in prostate cancer, but it has not been studied extensively. Particularly the western diet has been implicated in the research in regard to prostate cancer linkage.

Blood flow: The Penis becomes engorged with blood, usually in response too sexual arousal but sometimes spontaneously. The internal pudendal artery is the main vessel that supplies oxygenated blood to the penis. Problems with the internal pudendal artery would cause a man not to achieve an erection. Other arteries of the male pelvis are the inferior vesical, Internal iliac artery, testicular arteries.

Erection: A normal erection is a stiffening of the penis when the soft tissue inside fill with blood. It occurs most often during sexual arousal, but it can also happen first thing in the morning and randomly. How long an erection last varies among individuals. The duration of an erection can vary based on psychological factors that include age, stress, medications, health, etc. Priapism is a condition in which an erection lasts more than four hours. That can result in permanent dysfunction of the penis, usually the penis should become erect and then subside mins later if no arousal is in sight. There are three stages to an erection.

The Flaccid stage is when the penis is soft at its normal state. This stage occurs when there is no sexual arousal via touch, sight, or fantasizing. The blood flow to and from the penis is the equal during this stage.

The Tumescent Stage: This stage is when the male becomes aroused through either sight, touch or thoughts. During arousal, messages brought by nerves causes the blood vessels and spongy chambers to open up, more blood flows in than out and the penis starts to swell

The erect stage: In this stage the penis becomes rigid if arousal continues. The nerves carrying the messages of arousal between the brain and the penis, keep carrying the messages. The penis becomes fully erect. There is no set time for how long a penis should remain erect. A typical erection without manual stimulation can last from a few minutes to roughly half an hour. In the case of erectile dysfunction, men have difficulty getting an erection, or maintaining one long enough for satisfactory sex.

Morning erections: The parasympathetic nervous system plays a role in how erections occur, especially in the morning. During Rapid Eye Movement (REM) Sleep, the penis becomes engorged with blood, this engorgement is caused by the activity if the parasympathetic nervous system affecting the sacral nerve. Morning erections are a part of the body’s way of testing organ functioning. A lack of morning erections could suggest a problem with the blood vessels or nerves. Diminished neurological function can cause erectile dysfunction for this reason.

Erectile dysfunction (ED): ED is defined as the failure to achieve or maintain a rigid penile erection for satisfactory sexual intercourse. It was thought that this was only common in men over 40 years old, but it has become very common in men in their 20s and 30s. Erectile dysfunction is a condition that can exist with other co-morbidities. Erectile dysfunction can be a symptom of a wide range of underlying pathologies and is an important but underutilized cardiovascular risk factor. Any disease process which affects penile arteries, nerves, hormone levels, smooth muscle tissue, corporal endothelium, or tunica albuginea can cause erectile dysfunction. Erectile dysfunction (ED) can manifest 2 to 5 years before any coronary events. This condition affects up to 12 million U.S. men and 30 million men globally. ED can cause substantial emotional distress by negatively impacting intimate relationships, self-esteem, and overall quality of life. There are many pharmacological treatments on the market for erectile dysfunction available but most of them only provide temporary benefits and may cause minor to severe side effects. In previous studies researchers have found many causes ED such as age-related decline of hormone levels, diabetes, decline of penile elastic fibers, medication induced ED, biological causes & mainly cardiovascular disease (CVD) which accounts up for 80% of erectile dysfunction cases. Atherosclerosis, the most common vascular disease, impedes blood flow to the penis. CVD and high blood pressure contribute to endothelial dysfunction, which is most common contributing mechanism to erectile dysfunction overall. How ED Correlates to CVD: Researchers believe that ED proceeding heart problems is more often due to the dysfunction of the inner lining of the blood vessels (endothelium) in smooth muscle. Endothelial dysfunction causes inadequate blood supply to the heart and thereby impairs blood flow to the penis and aids in the development of atherosclerosis. A growing body of evidence links CVD and ED, with both conditions having similar risk factors including hypertension, hyperlipidemia, diabetes, obesity, and smoking. Since the penile arteries have a smaller diameter than coronary arteries, the earliest manifestation of cardiovascular disease may be erectile dysfunction. In surveys, men who were screened for CVD if they were experiencing ED not only cut medical cost but was also able to use preventive methods to prevent a further manifestation of ED. ED and CVD are considered a common endpoint of the same vascular pathology, and ED is an important predictor of vascular disease. In a meta-analysis study that demonstrated the risk of CVD in Men presenting with ED, it showed a clear cardiac risk in these men. In a meta-analysis study that demonstrated the risk of cardiovascular disease in men presenting with erectile dysfunction showed a clear cardiac risk in these men. Erectile dysfunction shares the underlying pathophysiology with CVD, specifically endothelial cell dysfunction in impaired nitrous oxide production.

Citations:

Brandon Peters, M. (n.d.). The REM Sleep Stage May Play a Role in Causing Erections. Retrieved December 29, 2020, from https://www.verywellhealth.com/what-causes-morning-wood-or-morning-erections-3015089

Chertoff, J. (2018, August 29). Normal Sperm Count: Understanding Your Semen Analysis. Retrieved December 29, 2020, from https://www.healthline.com/health/mens-health/normal-sperm-count

Home. (n.d.). Retrieved December 29, 2020, from https://www.wisurology.com/health-library/erectile-dysfunction/384787/erection-stages-of-an

Jackson, Graham. “Erectile dysfunction and cardiovascular disease.” Arab journal of urology vol. 11,3 (2013): 212-6. doi:10.1016/j.aju.2013.03.003

Male Reproductive System: Structure & Function. (n.d.). Retrieved December 29, 2020, from https://my.clevelandclinic.org/health/articles/9117-male-reproductive-system

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Prostatitis (Infection of the Prostate). (n.d.). Retrieved December 29, 2020, from https://www.urologyhealth.org/urology-a-z/p/prostatitis-(infection-of-the-prostate)

Leslie SW, Soon-Sutton TL, Sajjad H, et al. Prostate Cancer. [Updated 2020 Oct 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470550/

Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2020 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/