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Male genital problems may be the cause of significant morbidity. One of the most anxiety-provoking problems presenting to an ED is the male with acute genital discomfort. Furthermore, the extensive sensory innervations of the genital area with common final sensory afferent pathways in the male account for the common association of abdominal pain with some acute genital disorders. Approximately 10% of all traumatic conditions presenting to the ED involve the genital system—of that, only 2% involve the genital system exclusively.1 Life-threatening GU conditions, such as Fournier gangrene, remain relatively rare.

This chapter reviews some of the common acute infectious and structural or anatomic genital disorders.


The penis is composed of three cylindrical bodies: the corpus spongiosum, which surrounds the urethra, and the two corpora cavernosa, which form the main bulk of the penis (Figure 96-1). The corpora cavernosa are the major erectile bodies, extending distally from the pubic rami and capped by the glans penis. These cylindrical structures are encased in a thick tunic of dense connective tissue, the tunica albuginea. All three cylinders are collectively covered by a thinner fascia, Buck fascia, which fuses with Colles fascia at the level of the urogenital diaphragm. The internal pudendal artery provides the blood supply, which branches to form the deep and superficial penile arteries. Lymphatics drain from the penis into the deep and superficial inguinal nodes.

Figure 96-1.

Cross-section of the penis.


The prepubertal scrotal skin is thin and thickens with subsequent hormonal stimulation. Immediately beneath the skin are the smooth muscle and elastic tissue layers of Dartos fascia, similar to the superficial fatty layer (Camper fascia) of the abdominal wall. The deep membranous layer (Scarpa fascia) of the abdominal wall extends into the perineum, where it is referred to as Colles fascia, and forms part of the scrotal wall (Figure 96-2). The blood supply is derived primarily from branches of the femoral and internal pudendal arteries. Lymphatics from the scrotum drain into the inguinal and femoral nodes.

Figure 96-2.

Anatomy of the scrotum and the testis. a. = artery; v. = vein.


The testes average in size between 4 and 5 cm in length and 3 cm in width and depth, and usually lie in an upright position, with the superior portion tipped slightly forward and outward. Each testis is encased in a thick fibrous tunica albuginea except posterolaterally, where it is in tight apposition with the epididymis. The enveloping tunica vaginalis covers the anterior and lateral aspects of the testes and attaches to the posterior scrotal wall. Superiorly, the testes are suspended from the spermatic cord; inferiorly, the testis is anchored to the scrotum ...

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