Manhood: The Rise and Fall of the Penis (5 page)

I once adored a conductor who never bathed, had stringy hair, and was a complete failure at wiping his ass. He always left shit stripes on my sheets. Normally I don’t go in for that sort of thing – but in him it was OK – I’m still not sure why. I fell in love with Bennett partly because he had the cleanest balls I’d ever tasted. Hairless and he practically never sweats. You could (if you wanted) eat off his asshole (like my grandmother’s kitchen floor).

And later:

We lay on his bed and held each other. We examined each other’s nakedness with tenderness and amusement. The best thing about making love with a new man after all those years of marriage was rediscovering a man’s body. One’s husband’s body was practically like one’s own. Everything about it was known. All the smells and tastes of it, the lines, the hairs, the 27

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birthmarks. But Adrian was like a new country. My tongue made an unguided tour of it. I started at his mouth and went downward. His broad neck, which was sun-burned. His chest, covered with curly reddish hair. His belly, a bit paunchy –

unlike Bennett’s brown leanness. His curled pink penis which tasted vaguely of urine and refused to stand up in my mouth.

His very pink and hairy balls which I took in my mouth one at a time.

The technique Erica Jong is referring to here is called ‘teabagging’. The partner takes the testicles in his or her mouth – the testicles are first pushed downwards with the index finger and thumb around the top of the scrotum, and then the balls are taken into the mouth and gently stimulated with the tongue. The teeth are covered with the lips throughout, to avoid accidentally inflicting pain. The testicles are kept together; if they are pulled apart, it can be dreadfully painful.

Dartos

Back to temperature regulation by the scrotum: the skin of the scrotum is characterized, like that of the eyelids, by the absence of sub cutaneous fat, the presence of many tiny blood vessels, and a layer of muscle directly under the skin. Fat insulates too well, which does not help the ability to react rapidly to cold or heat. The muscular layer beneath the skin is called the
tunica dartos
. As we grow older the
tunica dartos
slackens, so that in elderly men the scrotum becomes larger and smoother. Everything starts to hang: it comes to resemble a set of bells. In cold temperatures the scrotum shrinks and when it is hot the muscle layer relaxes and the scrotum expands.

‘Croat traps testicles in sun lounger’, read a recent newspaper headline. Trying to stand up and finding to your annoyance that your tes ticles are trapped between the slats of your lounger is no joke. But it happened to Mario Visnjic after he had swum naked around the harbour of Valalta (Western Croatia). Mario had no inkling of danger when he sat down in his chair to get his breath back after his cold dip.

The cold sea had caused his testicles to shrink, so that they dropped between the wooden slats of the lounger. When a little later the sun did its work and the testicles expanded to their true size again, the damage was done. His rescuer had no alternative but to cut the lounger in half and release the unfortunate victim!

The blood supply to the scrotum is through the large inguinal artery, the deep pelvic artery and the abdominal wall artery. Lymphatic drainage takes place through the superficial lymph glands in the groin.

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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 It is important for the reader with hypochondriac tendencies to know exactly how lymphatic drainage works: this will help doctors to know exactly where to look for metastases.

The skin of the scrotum is fairly sensitive. Delicate nerve-endings are designed to maximize pleasure. Swellings on the skin of the scrotum are almost always sebaceous cysts. Treatment is necessary only if there is an infection. Swellings of the content of the scrotum, the testicles and epididymis are much more common. Various sections will be devoted to these in later chapters.

The blood supply to the testicles is closely related to that to the kidneys because of their common embryological origin. The main artery in the testicle (
arteria testicularis
) branches off the aorta just below the renal artery. The artery runs behind the abdominal cavity through the inguinal canal to the testicle. There are connections to the seminal duct artery. The latter is a branch of the main inguinal artery.

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

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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.

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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