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Ganong's Review of Medical Physiology, 23rd Edition

Ganong's Review of Medical Physiology, 23rd Edition

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Effect <strong>of</strong> Temperature<br />

Spermatogenesis requires a temperature considerably lower<br />

than that <strong>of</strong> the interior <strong>of</strong> the body. The testes are normally<br />

maintained at a temperature <strong>of</strong> about 32 °C. They are kept cool<br />

by air circulating around the scrotum and probably by heat exchange<br />

in a countercurrent fashion between the spermatic arteries<br />

and veins. When the testes are retained in the abdomen<br />

or when, in experimental animals, they are held close to the<br />

body by tight cloth binders, degeneration <strong>of</strong> the tubular walls<br />

and sterility result. Hot baths (43–45 °C for 30 min/d) and insulated<br />

athletic supporters reduce the sperm count in humans,<br />

in some cases by 90%. However, the reductions produced in<br />

this manner are not consistent enough to make the procedures<br />

reliable forms <strong>of</strong> male contraception. In addition, evidence<br />

suggests a seasonal effect in men, with sperm counts being<br />

greater in the winter regardless <strong>of</strong> the temperature to which<br />

the scrotum is exposed.<br />

Semen<br />

The fluid that is ejaculated at the time <strong>of</strong> orgasm, the semen,<br />

contains sperms and the secretions <strong>of</strong> the seminal vesicles,<br />

prostate, Cowper’s glands, and, probably, the urethral glands<br />

(Table 25–4). An average volume per ejaculate is 2.5 to 3.5 mL<br />

after several days <strong>of</strong> abstinence. The volume <strong>of</strong> semen and the<br />

sperm count decrease rapidly with repeated ejaculation. Even<br />

though it takes only one sperm to fertilize the ovum, each milliliter<br />

<strong>of</strong> semen normally contains about 100 million sperms.<br />

Fifty percent <strong>of</strong> men with counts <strong>of</strong> 20 to 40 million/mL and<br />

essentially all <strong>of</strong> those with counts under 20 million/mL are<br />

sterile. The presence <strong>of</strong> many morphologically abnormal or<br />

immotile spermatozoa also correlates with infertility. The<br />

prostaglandins in semen, which actually come from the seminal<br />

vesicles, are in high concentration, but the function <strong>of</strong><br />

these fatty acid derivatives in semen is unknown.<br />

Human sperms move at a speed <strong>of</strong> about 3 mm/min<br />

through the female genital tract. Sperms reach the uterine<br />

tubes 30 to 60 min after copulation. In some species, contractions<br />

<strong>of</strong> the female organs facilitate the transport <strong>of</strong> the<br />

sperms to the uterine tubes, but it is unknown if such contractions<br />

are important in humans.<br />

Erection<br />

Erection is initiated by dilation <strong>of</strong> the arterioles <strong>of</strong> the penis.<br />

As the erectile tissue <strong>of</strong> the penis fills with blood, the veins are<br />

compressed, blocking outflow and adding to the turgor <strong>of</strong> the<br />

organ. The integrating centers in the lumbar segments <strong>of</strong> the<br />

spinal cord are activated by impulses in afferents from the<br />

genitalia and descending tracts that mediate erection in response<br />

to erotic psychologic stimuli. The efferent parasympathetic<br />

fibers are in the pelvic splanchnic nerves (nervi<br />

erigentes). The fibers presumably release acetylcholine and<br />

the vasodilator vasoactive intestinal polypeptide (VIP) as<br />

cotransmitters (see Chapter 7).<br />

CHAPTER 25 The Gonads: Development & Function <strong>of</strong> the Reproductive System 405<br />

TABLE 25–4 Composition <strong>of</strong> human semen.<br />

Color: White, opalescent<br />

Specific gravity: 1.028<br />

pH: 7.35–7.50<br />

Sperm count: Average about 100 million/mL, with fewer than 20%<br />

abnormal forms<br />

Other components:<br />

Fructose (1.5-6.5 mg/mL)<br />

Phosphorylcholine<br />

Ergothioneine<br />

Ascorbic acid<br />

Flavins<br />

Prostaglandins<br />

Spermine<br />

Citric acid<br />

Cholesterol, phospholipids<br />

Fibrinolysin, fibrinogenase<br />

Zinc<br />

Acid phosphatase<br />

Phosphate<br />

Bicarbonate<br />

Hyaluronidase<br />

From seminal vesicles<br />

(contributes 60% <strong>of</strong><br />

total volume)<br />

From prostate (contributes<br />

20% <strong>of</strong> total volume)<br />

Buffers<br />

Nonadrenergic noncholinergic fibers are also present in the<br />

nervi erigentes, and these contain large amounts <strong>of</strong> NO synthase,<br />

the enzyme that catalyzes the formation <strong>of</strong> nitric oxide<br />

(NO; see Chapter 33). NO activates guanylyl cyclase, resulting<br />

in increased production <strong>of</strong> cyclic GMP (cGMP), and cGMP is<br />

a potent vasodilator. Injection <strong>of</strong> inhibitors <strong>of</strong> NO synthase<br />

prevents the erection normally produced by stimulation <strong>of</strong> the<br />

pelvic nerve in experimental animals. Thus, it seems clear that<br />

NO plays a prominent role in the production <strong>of</strong> erection. The<br />

drugs sildenafil, tadalafil, and vardenafil all inhibit the breakdown<br />

<strong>of</strong> cGMP by phosphodiesterases and have gained worldwide<br />

fame for the treatment <strong>of</strong> impotence. The multiple<br />

phosphodiesterases (PDEs) in the body have been divided into<br />

seven isoenzyme families, and these drugs are all most active<br />

against PDE V, the type <strong>of</strong> phosphodiesterase found in the corpora<br />

cavernosa. It is worth noting, however, that these drugs<br />

can also produces significant inhibition <strong>of</strong> PDE VI (and others,<br />

if taken at high doses). Phosphodiesterase VI is found in the<br />

retina, and one <strong>of</strong> the side effects <strong>of</strong> these drugs is a transient<br />

loss <strong>of</strong> the ability to discriminate between blue and green (see<br />

Chapter 12).<br />

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