Male Reproductive & Sexual Health - Healthy Male

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Malereproductive &sexual healthA User’s Guide

Good health is vital for a happyand full life. But as life gets busy,sometimes it’s easy to overlookwhat’s happening in your body.Reproductive and sexual health plays akey role in your wellbeing. Knowing moreabout your body, how it works, and theconditions that can affect you is the firststep to a healthier life.3

ContentsTHE MALE REPRODUCTIVE SYSTEM 46THE SPERM’S JOURNEY 10MALE HORMONES 11COMMON CONDITIONSTHAT MEN MAY FACE 14- Infertility 14- Prostate enlargement 14- Prostate cancer 15- Erectile dysfunction 16- Androgen (testosterone) deficiency 16- Testicular cancer 175

The malereproductive systemThe male reproductive system is made up ofmany individual organs acting together. Someare visible, such as the penis and the scrotum.Some are hidden inside your body. The brainalso has an important role in controlling yourreproductive function.PenisThe penis is made up of two erectile cylinders(corpora cavernosa) that swell with blood duringerection. A tough, fibrous, partially elastic outercasing surrounds the two cylinders. Your urethrasits below the two cylinders and is surrounded bya spongy tissue (called the corpus spongiosum). Ifyou’re uncircumcised, the head of the penis (glanspenis) is covered by foreskin.UrethraThe urethra (you-ree-thrah) is a tube that runsfrom your bladder to the end of the penis. Itcarries urine and semen from your bladder to theoutside of your body.Scrotum126871211394105Testicles1Bladder2Vas deferens3Urethra4Penis5Scrotum6Seminal vesicle1Bladder7Rectum2Vas deferens8Prostate Cowper’s gland6Seminal vesicle12Ejaculatory duct7Rectum8Prostate gland9Epididymis10Testicle11Cowper’s gland6The scrotum is a loose pouch of skin that hangsoutside your body from your lower abdominalregion behind the penis. Your scrotum holds yourtesticles in place, and helps to keep them coolerthan your core body temperature.The testes, or testicles, are a pair of egg shapedglands that sit in your scrotum, next to the baseof the penis on the outside of the body. You needtesticles for your reproductive system to worknormally.The testicles have two related, but separate roles: To make sperm To make testosterone.The testicles develop inside the abdomen whenyou’re an unborn baby. They then move down(descend) into your scrotum before or just afterbirth. The descent of your testicles is importantfor your fertility, because your testicles need tobe in a cooler temperature to make sperm and towork normally. In the scrotum, testicles are about2 C cooler than normal core body temperature.7

This is why, in cold weather, the scrotum contractsand brings the testicles closer to the body, andrelaxes in hotter weather.EpididymisYour epididymis (ep-ee-did-ee-miss) is a thin,coiled tube that lies at the back of each testicleand connects the testicle to another single tube,called the vas deferens.Vas deferensThe vas deferens (vaas def-er-ens) is a musculartube, about 30 cm long, that connects theepididymis to the urinary tract (urethra) at theback of the bladder. The main job of the vasdeferens is to transport mature sperm and semento the urethra.Ejaculatory ductThe ejaculatory duct is a tube that joins the vasdeferens and the seminal vesicle. The ejaculatoryduct empties mature sperm and semen into theurethra.Seminal vesiclesThe seminal vesicles (sem-in-al vess-ick-ells)are two small glands that sit directly above yourprostate gland, near the base of your bladder.These glands are very active, and create a fluidthat makes up more than half of your semen.ProstateThe prostate is a small but important gland.The main role of your prostate is to make fluidthat protects and gives nutrients to sperm. Yourprostate makes about one third of the fluid that isejaculated from the penis when you orgasm.Cowper’s glandsCowper’s glands are a pair of pea-sized glandsthat sit near your prostate. These glands produceclear mucus that’s released before ejaculationto neutralise any urine that might be left in yoururethra. This fluid also acts as a lubricant.BladderThe bladder is a muscular sac that stores urine. Thebladder receives urine from the kidneys. When thebladder is full, urine is released into the urethra, thetube that carries the urine out of the body.RectumThe rectum is the final 20 cm strip of the largeintestine. Bowel motions (faeces) are stored inthe rectum before being passed out during abowel movement.SpermSperm are male reproductive cells that containthe father’s genetic information (DNA) that will bepassed on to his children. Each sperm takes aboutthree months to mature. Mature sperm have atail, allowing them to move inside the femalereproductive tract to meet the egg (femalereproductive cell).SemenSemen is the fluid that transports the spermduring ejaculation. During an orgasm, sperm arereleased from the epididymis, and are mixedwith fluid released by the prostate gland and theseminal vesicles. This creates semen. The semenfluid protects and provides nutrients to the sperm.D I D YO U K N O W ?Every day your body makesaround 70 million sperm!89

The sperm’s journeyMale hormonesWhen released from the testicles, the spermspend two to 10 days passing through theepididymis that lies at the back of each testicle.At orgasm (sexual climax), waves of musclecontractions transport the sperm, with a smallamount of fluid, from the epididymis through thevas deferens (the tube that connects the vasdeferens to the urethra) to the seminal vesicles,and then to the ejaculatory ducts in the prostate.The brain also plays an important part in thefunctioning of your reproductive system.During this journey, fluid is added to the sperm tomake semen. The semen, containing the sperm,is released from the ejaculatory ducts into theurethra, which carries the sperm out of the tip ofthe penis.The pituitary gland and the hypothalamus,located at the base of your brain, control theproduction of your male hormones and sperm.The hypothalamus makes gonadotropin-releasinghormone (GnRH), which controls the release ofother hormones from your pituitary gland.The pituitary gland makes two important‘messenger’ hormones, the luteinising hormone(LH) and the follicle stimulating hormone (FSH).These hormones travel in the blood to thetesticles and signal them to make testosteroneand sperm.12FSHLH3101Hypothalamus2Pituitary gland3Testis11

What are hormones?Hormones are chemical messengers made by glandsin your body, which are carried in your blood to acton other organs in the body. You need hormones forgrowth, reproduction and well-being.What are androgens?Androgens are male sex hormones that increaseat puberty. You need them to develop into asexually mature adult who can reproduce.What is testosterone?Testosterone is the most important androgen(male sex hormone). You need it to have normalreproductive and sexual function. Testosteroneis important for the physical changes thathappen during puberty, such as the developmentof the penis, testicles, facial and body hair, andmuscle growth. Testosterone acts on cells inyour testicles to make sperm. Testosterone isalso important for overall good health. It helpsthe growth of bones, and affects your mood andsex drive. Some testosterone is changed intooestrogen, the female sex hormone, and this isimportant for your bone health.What happens to testosterone in theblood?As testosterone moves through your body in yourblood, it’s changed or metabolised into other sexhormones, oestradiol and dihydrotestosterone(DHT). Oestradiol, known as the female sexhormone, is also important for your bone healthand for preventing osteoporosis. DHT is apowerful androgen that’s made from testosteronein some parts of your body, such as your skinand prostate.How do testosterone levels change overthe day?The levels of testosterone in your blood changeacross the day. Your testosterone is at its highestearly in the morning, and at its lowest late in theevening. This pattern across the day is called a‘circadian rhythm’ and happens normally in manyof your body’s hormonal systems.Where is testosterone made?Testosterone is mainly made in your testicles.A small amount of testosterone is also made byyour adrenal glands, which are small glands thatsit on top of your kidneys.1213

Common conditionsthat men may faceInfertilityProstate cancerOften, men can be shocked to be told that they’rethe reason why they and their partner are havingproblems conceiving. But, in fact, about one in 20men in Australia are infertile.Each year, about 20,000 Australian men aretold they have prostate cancer. Prostate canceroften causes no symptoms, so as men get older,it’s a good idea to talk to a doctor about tests.Common tests for prostate cancer include theprostate specific antigen (PSA) blood test, orspecialist referral for a digital rectal examination,ultrasound or MRI scans, and prostate biopsy.Male infertility can have many causes, but problemswith the number, or quality, of sperm are the mostcommon. Sometimes treatment can restore naturalfertility. But often doctors can’t find a reason forsperm not being made properly, which can makecoping with male infertility difficult. Fertilityspecialists can treat some male infertility problemsusing assisted reproductive treatment. For menwithout sperm, couples may consider donor sperm,adoption or foster parenting.There’s much debate about the PSA test, so talkit over with a doctor to see if it is appropriatefor you and to make sure you understand all thebenefits and risks of testing.Early prostate cancer can be treated with surgery,radiation therapy or active surveillance.Prostate enlargementMost common in older men, about one in sevenAustralian men over 40 years of age haveproblems with their prostate.The most common prostate disease is a noncancerous enlargement of the prostate calledbenign prostatic hyperplasia (BPH). While notusually life-threatening, for some men BPH canhave a major effect on quality of life because ofproblems with urination.Medicines, and sometimes surgery, can help thesymptoms of prostate disease. However, not allurination problems are caused by the prostate, soit’s important to see your doctor to find the cause.1415

Erectile dysfunctionTesticular cancerSexual problems in men are more common thanyou might think. About one in five Australianmen over the age of 40 have problems gettingor keeping an erection (erectile dysfunction orimpotence). In some cases, erectile dysfunctionis a sign of a serious health problem such asdiabetes or heart disease.Testicular cancer is the second most commoncancer in men aged from 18 to 39, with about700 Australian men diagnosed each year. But it’seasy to treat and more than 95 per cent of menare cured.There are many treatments for erectiledysfunction, including medicines, but talkingto your partner and your doctor is the mostimportant first step. Even if the cause of erectiledysfunction is a physical one, getting somecounselling or emotional support is an importantpart of treatment.A hard, painless lump in the testicle is the mostcommon symptom, but the testicle may alsofeel painful and tender. In a few men, constantbackache, coughing or breathlessness, andenlarged or tender nipples can mean the cancerhas spread to other parts of the body. Surgicalremoval of the cancerous testicle is the firsttreatment for all testicular cancer. This surgeryalmost never affects sexual performance.It is important to consider sperm banking beforestarting treatment for testicular cancer.Androgen (testosterone) deficiencyLower energy levels, mood swings, bad temper(irritability), poor concentration, reduced musclestrength or a lack of interest in sex can be a signof androgen deficiency (low testosterone levels).About one in 200 men in Australia have androgendeficiency, but not all are diagnosed.Androgen (testosterone) deficiency affects menof all ages and can be caused by a genetic ormedical problem, or by damage to the testicles. Insome men, testosterone levels fall with older agemostly often due to illness or weight gain.Androgen deficiency is diagnosed by a doctorsuch as your GP, or by a specialist (usually anendocrinologist). Testosterone treatment canbe given by a doctor in the form of injections,capsules, creams or gels.1617

How to find out moreThe most important stepis to see your doctor.If you would like more information abouta range of male reproductive and sexual healthissues, visit the Healthy Male website athealthymale.org.au.You can also download or order resources onmale reproductive and sexual health issuesfrom the Healthy Male website.1819

Healthy Male is supported by funding from theAustralian Government Department of Health.Date Reviewed: November 2018 (2nd edition) Healthy Male (Andrology Australia) 2008For more information, go to healthymale.org.au

of the penis, testicles, facial and body hair, and muscle growth. Testosterone acts on cells in your testicles to make sperm. Testosterone is also important for overall good health. It helps the growth of bones, and affects your mood and sex drive. Some testosterone is changed into oestrogen, the female sex hormone, and this is