How is the penis made and how it works

Not all men are aware of their bodies and genitals.
Below are hints of anatomy and physiology, in order to understand and distinguish a normal or pathological condition.
The penis (or phallus, or rod or rod) is the male genital organ which has the dual function, copulatory and urinary.
Its size and conformations can vary from individual to individual and between different ethnic groups.
It is made up of three elongated cylindrical formations, the two cavernous bodies of the penis and the spongy body that penetrates the urethra inside it, covered by a series of connective bands and the skin.
Summary

• 1.1 Anatomical parts of the penis
  • 1.1.1- The root of the penis or fixed part
  • 1.1.2 The body of the penis or moving part
  • 1.1.3 The glans
  • 1.1.4 The foreskin
  • 1.1.5 Structure of the penis
• 2.1 Enclosures and means of fixity
• 3 The suspensory apparatus of the penis
• 4 Microscopic anatomy
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• 5 Vascularization of the penis
  • 5.1 The arterial system
  • 5.2 The venous system
  • 5.3 The microcirculation
  • 5.4 Lymphatic circulation
• 6. The innervation of the penis
• 7 Physiology of erection
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1.1 Anatomical parts of the penis
4 portions can be distinguished: 1.1.1- The root of the penis or fixed part The root and the fixed and hidden part are located in the anterior perineum. It consists of the initial parts of the corpora cavernosa, or crura, which are fixed at the level of the periosteum of the ischiopubic branches. The corpus spongiosum surrounds the bulbar urethra and is covered by the bulbocavernosus muscle. 1.1.2 The body of the penis or movable part The body or movable part of the penis and the continuation of the root , starting under the pubic symphysis from the meeting of the two corpora cavernosa and the urethral corpus spongiosum.
Its size varies depending on whether it is in a state of rest (flaccidita) or in erection. A thin layer of skin wraps and covers the shaft of the penis along its entirety; here the skin is thin and slightly pigmented, therefore darker than the color of the skin of the remaining areas of the body. The upper face of the shaft (dorsal face) consists of two corpora cavernosa, while the lower face (ventral) consists of the corpus spongiosum (or corpus cavernosum of the urethra).
In the flaccid state, the shaft of the penis hangs vertically downward between the two thighs, leaning against the scrotum. In the state of erection, however, the shaft of the penis changes size and consistency, lengthening and swelling; in addition, it rises from the scrotum and approaches the abdomen. 1.1.3 The glans The glans represents the terminal part of the penis. It has a pink color and a conical shape with the base enlarged at the level of the penile body and the rounded apex useful to facilitate penetration into the vagina. It is crossed by the navicular urethra, which ends at the apex of the glans forming the external urethral meatus from where urine and sperm come out. The base on the dorsal part has a protruding circular outline, called the crown of the glans.Between the base of the glans and the shaft of the penis there is a groove, called the balanopreputial sulcus. Here, small pinkish white growths can be found, called penile pearly papules. Their eventual presence is a constitutional characteristic of the individual devoid of pathological significance. 1.1.4 The foreskin The foreskin is a skin fold, shaped like a sleeve, which originates from the balanopreputial sulcus and continues with the skin of the penis shaft. In the state of flaccidity two sheets can be distinguished.
The outer layer follows directly on the skin lining of the penis and after a certain stretch it folds back on itself, continuing in the inner skin layer, of a lighter color (pink), it merges with the crown of the glans and is fixed behind it through a skin fold median called frenulum (“fillet”). The frenulum, therefore, represents the thin flap of skin that joins the glans penis to the foreskin . The frenulum guarantees the covering of the glans by the foreskin, ensuring its correct positioning. However, the frenulum also has a precise role in sexual dynamics. It is indeed very rich in sensory receptors, which have the task of transmitting (usually) pleasant sensations.
The reflection area of ​​the two sheets takes thename of preputial orifice which, if narrowed, can prevent the glans passage (phimosis). The functions of the foreskin are therefore protective and erogenous sensitivity. 1.1.5 Structure of the penis
From a structural point of view, the penis consists of two corpora cavernosa and a corpus spongiosum surrounded by penile envelopes. The corpora cavernosa of the penis are two cylindrical structures , equal and symmetrical (right and left), with pointed ends. They originate separate at the level of the penis root and run medially. At the level of the pubic symphysis they join and then run together until they end below the glans, which covers their distal extremity.
At the level of the penile body they run in close contact with each other, separated by a connective septum (septum of the penis or pectiniform septum). The septum is fenestrated, therefore the two corpora cavernosa are communicating with each other. Thus united they form a groove, a groove, both on the dorsal part (upper surface) and on the ventral part (lower surface). The vascular-nervous bundle of the penis runs along the dorsal sulcus and the penile urethra covered by the corpus spongiosum fits on the ventral sulcus. The spongy body of the urethraand unequal and median, also cylindrical in shape and spongy structure. It is thinner than the corpora cavernosa. It originates at the level of the anterior perineum, below the urogenital diaphragm. It then moves towards the pubic symphysis and below the pubic arch it fits into the ventral sulcus of the corpora cavernosa, joining them to form the body of the penis. It ends by forming a conical expansion known as the glans.
The corpus spongiosum envelops the urethra. Originally, the corpus spongiosum has a spherical shape and is very thick, constituting the bulb of the urethra. The membranous urethra penetrates obliquely at the level of the upper part of the bulb, a few mm from the bottom of the bulb itself, thus continuing as a bulbar urethra. The bulb is covered by the bulbocavernosus muscle, which contracts during erection and ejaculation.2.1 Casings and means of fixity
Going from the outside to the inside we find:

• Cute
• Superficial fascia of the penis
• Underfascial tunic
• Buck band or deep penis band
• Tunica albuginea

The skin is thin, very mobile on the underlying planes and very elastic . It covers the shaft of the penis, the foreskin and the glans. At the level of the ventral aspect of the penis it forms a thin median pigmented line, the penile raphe. Characterized by the absence of subcutaneous adipose tissue.
The superficial fascia of the penis or Colles’s fascia (dartos penieno) and a part of the membranous layer of the superficial fascia of the groin and perineum, includes the superficial penile arteries and the superficial dorsal vein.
The subfascial tunic is located below the dartos, consisting of a thin connective layer, more prominent at the base of the penis.
The Buck band is a very thin elastic band that covers the corpora cavernosa and the corpus spongiosum from the crown of the glans to the hilum of the penis. It continues at the level of the pubic symphysis with the suspensory apparatus of the penis. On the dorsal side of the penis it contains the vascular-nerve bundle of the penis, consisting of the dorsal vein of the penis centrally, the dorsal arteries of the penis and the dorsal nerves of the penis laterally. Buck’s fascia then envelops and unites the two corpora cavernosa and the corpus spius.
The tunica albuginea is a structure consisting of bundles of collagen fibers arranged to form both an internal, circular and thin layer, which surrounds and penetrates the cavernous tissue, and an external, longitudinal, incomplete layer, which tapers considerably at the ventral level. close to the urethral spongiosa. The thickness of the albuginea varies from individual to individual and in different locations (greater at the ventrolateral level); on average, however, we have values ​​between 2-3 mm in the flaccid penis and 0.5 mm during erection. 3 The suspensory apparatus of the penis
The body of the penis is fixed at the level of the penile root by the skin and by two ligament structures:
A more superficial,the fundiform ligament which is a loose fibroelastic structure which originates from the linea alba and, after having split to pass around the base of the penis, reaches the Colles fascia. The suspensory ligament of the penis is a very strong, triangular fibrous structure located deeper than the fundiform ligament. It originates from the anterior face of the pubic symphysis and continues with Buck’s fascia . It is a true ligament and plays a role in maintaining the penile angle during an erection. 4 Microscopic anatomy Cavernous (or erectile) tissue can be compared to a sponge, being formed by irregularly shaped blood lacunae(cavernulae) incompletely separated by trabeculae of varying thickness. The cavernulae reach, in the central part, a considerable volume ; they communicate widely with each other and are covered by a fenestrated endothelium.
They receive blood mainly from particular sinuous arterioles, the helicine arteries, located in the trabeculae and supplied, in the subendothelial position, with epithelioid cell pads which, with a flaccid penis, almost completely occlude the vascular lumen. During an erection the helicine arteries dilate and therefore pour a considerable amount of blood into the cavernulae.
The latter are drained by venules which, when the penis is erect, are compressed, causing a stagnation of blood in the cavernulae themselves and therefore increasing the erection. The trabeculae that delimit the cavernulae detach from the internal surface of the albuginea and take on a reticulated appearance, branching and anastomosing in a very complicated way; they are made up of bundles of collagen and elastic fibers and contain bundles of smooth muscle fiber cells that increase in number in the thinnest trabeculae.
In the trabeculae, in addition to the helicine arteries, some arterioles run, giving rise to a network of capillarieswhose emulgent veins subsequently flow into the cavernulae; the latter system has the meaning of a nutritional circle, while the helicine arteries system represents a circle that acts exclusively for the purpose of erectile function. [/ vc_column_text] [/ vc_column] [/ vc_row]

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The penis receives its blood supply from the internal pudendal artery, which originates from the hypogastric (internal iliac) artery. The internal pudendal artery gives rise to the perineal branch that crosses the urogenital diaphragm taking the name of penile artery.
The latter gives rise to three vessels, the dorsal artery of the penis, the bulbourethral artery and the cavernous artery (one on each side), which penetrate the corpora cavernosa at the level of the crura. It is the main source of blood supply to the cavernous tissue, therefore the main source of the blood that arrives during an erection.Along the course in the cavernous bodies emit the elicine arteries, thin twigs that go to supply the trabeculae of the cavernous bodies. The skin of the penis, on the other hand, is supplied for the most part by an arterial system other than that of the hypogastric artery, i.e. the external pudendal artery, a branch of the femoral artery. The external pudendal arteries at the base of the penis give rise to a subcutaneous arterial system via the axial penile arteries that run towards the foreskin. At the base of the penis the axial arteries give rise to a more superficial thin arterial plexus, which is located just below the dermis. This plexus reaches the level of the foreskin.5.2 The Venous System
The deep dorsal vein is generally single and discharges into the periprostatic plexus of Santorini.
Schematically we can describe three main venous systems draining the blood of the penis: the superficial, intermediate and deep systems. Superficial venous system represented by the superficial dorsal vein of the penis which runs along the dorsal part of the dartos of the penis. It usually flows into a great saphenous vein but may empty into the femoral or inferior epigastric vein. Drains the foreskin, skin and subcutaneous tissue. The intermediate venous systemand between the Buck belt and the albuginea tunic. Consisting of the retocoronal plexus, emissary veins, circumflex veins and lateral veins that open into the deep dorsal vein. It flows towards the pubis in the dorsal sulcus between the corpora cavernosa. Drains the glans and distal two thirds of the corpora cavernosa and corpus spongiosum. The deep system drains the proximal third of the corpus spongiosum and the corpora cavernosa. Consisting of the cavernous veins, bulbar veins and crural veins that open into the internal pudendal vein or into the prostate plexus. 5.3 The microcirculation
The arterial and venous system of the erectile tissue at the microcirculation level is represented by:

• the elicine arteries at the level of the trabeculae
• the subalbuginous venous plexus
• the cavernulae lined with endothelium

In close contact with these structures are smooth muscle cells and a dense network of nerve fibers. These regulate the inflow and outflow of blood in the erectile tissue, thus regulating the erection which is nothing more than a vascular phenomenon. 5.4 Lymphatic circulation
The lymphatic drainage of the penis is divided into two separate networks. The superficial and satellite network of the superficial dorsal vein of the penis and reiverse into the superficial inguinal lymph nodes . The deep one, on the other hand, is a satellite of the deep dordal vein in which the lymphatics that drain the glans, corpora cavernosa and urethra flow . The two systems, superficial and deep, are connected to each other at the level of the foreskin of the glans penis.6. The innervation of the penis The penis is a richly innervated organ. We can distinguish the superficial nerves which are represented by the external spermatic nerve of the genitofemoral, the genital branch of the ilioinguinal nerve and, mainly, the superficial perineal nerve and the dorsal nerve of the penis (branches of the pudendal nerve). The sensitive nerve endings, particularly abundant at the glans penis and the frenulum of the foreskin, are mostly corpuscular. The deep nerves, on the other hand , destined for the erectile organs, come from the pudendal nerve via the dorsal nerves of the penis,which run together with the dorsal arteries and the deep dorsal vein, and the deep perineal nerves, which are also intended for the innervation of the ischium and bulbocavernosus muscles. The erectile organs are also provided with a rich sympathetic innervation, which derives from the hypogastric plexus, and a parasympathetic innervation belonging to the sacral parasympathetic. The sympathetic has a vasoconstrictive action and the parasympathetic has a vasodilating action. 7 Physiology of erection Erection is a haemodynamic event that affects both the nervous system and local factors and is regulated by the relaxation of the arteries of the pudendal artery district.that of smooth muscle cells of the corpora cavernosa. Adequate blood flow plays a key role in the process.
During rest, the penis is in a flaccid state. Smooth muscles are contracted and blood flow is minimal.
During an erection the smooth muscles of the vessels and caverns relax, arterial blood flow increases and venous drainage is blocked so blood remains trapped. The muscles of the perineum (ischiocavernosa) contract, increasing penile rigidity. The erection is therefore due to the massive arrival and blockage of blood inside the penis.
The different stages of erection include:

• the flaccid phase
• the filling phase
• the tumescent phase
• the phase of complete erection
• the rigid erection phase

detumescence phase Bibliography

1. Gray’s anatomy; Zanichelli, 4th Italian edition, ISBN 88-08-17710-6
2. Treatise on human anatomy, Edi. Hermes, 4th Edition, ISBN 88-7051-285-1
3. Frank H. Netter, Atlas of Human Anatomy, third edition, Elsevier Masson, 2007. ISBN 978-88-214-2976-7