mechanism of penile erection ken-ichi kano at the
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IRYO Vol.46 No.5 (305ïœ311) 1992. 5 ç· èª¬
å èµ· ã® çº çŸ ã« é¢ ã ã ã¡ ã« ã 㺠ã
ç© é å¥ äž
èŠ æš åèµ·ã®çºçŸ ã«ã¯, 海綿äœæŽ ã«è¡æ¶²ãæ¥éã«æµå ¥ã ãå¿ èŠã ãã. ãã®åŒ ãé ã«ãªã ã® ãVIPãš
ããããŠã ã. VIPã« ã ã£ãŠæµ·ç¶¿ äœå°æ±ã®å¹³æ»ç,ã ã«ã¹ã¿ãŒãå« ãè¡ç®¡å£ã®å¹³æ»çãåŒç·©ã ã ãšæµ· 綿
äœæŽãžæµå ¥ã ãè¡æ¶²ãå¢å ã ã. ãã®çµæ, 海綿äœæŽå§ãäžæ ã, åæã«å骚海綿äœçãåçž® ã ããšå§ã¯
ãã㪠ãè¡ ç®¡ã®å§ ã ããé« ã㪠ã, 硬çŽç¶æ ãšãªã. ãã®æ, æµ·ç¶¿äœ æŽã«è¡æ¶²ãé ããã ãã ãã®ã¯äœåŸª
ç° ã ãéé¢ ãããééç³»ãç ããããã§ãã. (ããŒã¯ãŒ ã:å èµ·, è¡ç®¡æ§ç¯, è¡æµ, 海綿äœæŽå§, ç¥
çµ)
MECHANISM OF PENILE ERECTION
Ken-ichi KANO
At the beginning of penile erection, blood flows rapidly into the cavernous sinuses.
In order to increase the blood flow, relaxation of the smooth muscles in the trabeculae
and arterioles is required. This is induced by secretion of vasoactive intestinal peptide
(VIP). When the sinuses are expanded by the blood, the ischiocavernous muscles con-
tract. As a result, the intracavernous pressure rises markedly, and a closed system is
created, separate from the body's main blood circulation. This condition, known as the
rigid stage, is maintained by prevention of arterial backflow into the helicine arteries and
venous outflow into the post cavernous venules. (Key Words:penile erection, vascular
construction, blood flow, intracavernous pressure, nerves)
人é¡ã ãã®äž ã«ç ãŸããŠä»¥æ¥, çæ® ã«ä¿ã ãã®ã ã
åèµ· ãšã ãçŸ è±¡ã¯åžž ã«å¥œå¥ ãšæ¬² æ ãšé¡ æãšã䌎 ã£ãŠçŸ
代 ã«è³ ã£ãŠã ã. ã«ã ããµ ã³ã¹ã®å€© æ 㬠㪠ãã« ã.
ã ã»ãŽã£ã³ãã¯å€§é ã®è¡æ¶²ãé°è å ã«æµå ¥ã ãããšã«
ã ãå èµ·ãèµ· ããããšãç¥ ã£ãã, æ ã®ãŸãŸã«ãª ããª
ã ããšã«é¢ ããŠã¯å ãæãã ããã1). æ ã®ãŸãŸã« ãª
ããªã ããšã¯ããŠã ã, ã ãã¯éåžžå£ç¯ ã«é¢ä¿ãª ãå
èµ·ã ã. äžæ¹åç©ã¯çºæ æãå£ç¯ç ã«èšªã ãã, ä»® ã«
〠ã³ããã³ã¹ã«ãª ã£ã ãšã㊠ãæ© ãããšããªã㧠ãã
ã. ããã«ã ããšåç© ãšã®é ã«ã¯å€§ ããªå·®ã ãã.ãŸ
ã, åç© ã®é°èã¯åèµ· ããŠããªãæã«ã¯äœ è¡šã«åºãŠã
ãªãã ã ãã§ã¯åžžã«åºãŠã ã.
é°èã®æ§é ã¯åç© ã®çš®é¡ ã«ãã£ãŠç° 㪠ã£ãŠ 㯠ã ã
ã, åèµ· ã®åº æ¬ç㪠ã¡ã«ããºã ã¯å ããšèã ãããŠã
ã. ãããã£ãŠæ¬æ¥ã¯ ã ãã§ç 究 ãã ãã¹ ã㧠ã ã
ã, ããã¯éåžžãªå°é£ ã䌎 ãã®ã§åºç€çå®éš ã®å€ ãã¯
åç© ã§ä»£çš ãã㊠ãã. ããã§ã¯, ã€ã, ãµã«, ãã
ã®é°è ã®è¡ç®¡æ§ç¯, è¡ æµé, æµ·ç¶¿äœ æŽå§, ç¥çµæ¯é ãª
ã©ãåè ã«ã, é°èæµ·ç¶¿äœ ãäž» ãšããåèµ· ã®ã¡ã«ããº
ã ã«ã€ããŠè¿°ã¹ ãããšã«ã ã.
å èµ· ãš ã¯
æ£åžžãªåèµ· ã¯é°èæµ·ç¶¿äœ ãšå°¿éæµ·ç¶¿äœ ãšã®å 調ã§ç
ãã. ã€ãŸ ã, é°èæµ·ç¶¿äœ ã¯ç¡¬çŽ ãå°¿ éæµ·ç¶¿äœ ã¯èšåŒµ
ã ãå¿ èŠã ãã. ãã®åèª¿æ§ ãæ¬ ãã ãã®ã«æç¶åèµ·
ç ãã ã. ããã§ã¯é°è海綿äœã®åœ¹å² ã¯äœ ã ãšã ã
åœ ç« ç é€ æ æ æŸ ç é¢Muramatsu National Sanatoriumé¢ é·
Address for reprints:Ken-ichi Kano, Director, Muramatsu National Sanatorium, 2925-2
Muramatsu-machi, Nakakanbara-gun, Niigata 959-17 JAPAN
Received November 1, 1991
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May 1992
ããšã å é¡ ã«ãª ã£ãŠ ã ã. ã ã㧠㯠ã ã®åœ¹ å² ã¯äž» ãš ã
㊠尿 é æµ· 綿 äœ ãæ¯ ã, ã€ã 㧠ã¯äž» ãš ããŠé° è ãäœ è¡š ãž
çµ æŒ ãåº ã ã ãšã« ã ã ãšæ ãã ã.
å èµ· ãšã ãèšè ã¯åº ãçš ã ãã ãŠã ã ã« ãã ã ã ã
ã æ æ§ ãª ãš ãã ã ã ã. äž è¬ ã« ã¯é° è ã æ¥ é ã« èµ· ã ã
ç« ã¡æ§ 亀 å¯ èœ ãªç¶ æ 㫠㪠ã ã ãš ãã ãã, å® éš ç ã« ã¯
é° è æµ· 綿 äœ ã® å§ æµé 枬 å® çµ æ ã«åº 㥠ã ㊠å èµ· ã® éå§ å
ã ãæ¶ é ãŸã§ 㯠次 ã® ã ãã«å é¡ ãã ã2).
1. é å èµ· æ, å¹³ åžž(flaccid stage, quiscence)
2. èš åŒµ æ, èš åŒµ(tumescent stage, tumes-
cence)
3. å èµ· æ(erect stage)
4. 硬 çŽ æ, 硬 çŽ(rigid stage, rigidity)
5. æ¶ é æ, æ¶ é æ(detumescent stage, de-
tumescence)
äž èš ã® çš èª ã®äœ¿ çš ã¯é° è æµ· 綿 äœ å å§ ã枬 å® ã㪠ã ã§
䜿 çš ãã ã ãšäž»èŠ³ ã å ¥ ãå¯ èœ æ§ ã ã ãã, å§ ã枬 å® ã
㪠ã ã§tumescence, erection, full erection, ri-
gidity㪠ã©ã åºå¥ ãã 㪠ã ã§çš ã ãã ã ã ãš ã ã ã
ã® ã§, ã ã㧠ã¯æ ã㮠㪠ã é ãå³ å¯ ã« ã¯åº å¥ ã㪠ã ã§
çš ã ã ã ãšã« ã ã.
åèµ·ã® ã¡ã«ããºã
åèµ· ã®ã¡ã«ããºã ãç解ã ãããã«ã¯é°è ã®è¡æµå
æ ãç¥ ãå¿ èŠã ãã. ã ãé°è ã®åèµ· ã®ã¡ã«ããºã ã«
é¢ ããŠã¯Conti3)ã« ãã£ãŠé£èºçãªé²æ©ã ãã ããã
ã.
åèµ·ã® ã¡ã«ããºã ã®ç 究ã¯è¡ç®¡æ§ç¯, è¡æµåæ , ç¥
çµæ¯é ãã®ä»ã ãã€ãã®åéã ãç 究 ãé² ããå¿ èŠã
ãã. ä»¥äž ãã ãã«ã€ã ãŠé ãã ã£ãŠè¿°ã¹ ãããšã«ã
ãã, ããã§ã¯ã€ãã®å®éšçµæã«åºã¥ããã㌠ã¿ãå€
ãçšã ãã®ã§, Fig. 1ã« ã€ãé°è æµ· 綿 äœ ã®äžãæµ ã
ãè¡æ¶²ã®çµè·¯ ã®æŠç¥ ã瀺 ãã.
1. è¡ç®¡æ§ç¯
é°è海綿äœæŽã«ã¯é°èåè ã®æã§ã ãé°èæ·±åè ã
çµç± ããŠè¡æ¶²ãæµå ¥ã ã. é°è ã®è¡ç®¡ æ§ç¯ã¯è¡ç®¡é³å
ãäœæ ããŠèµ°æ»é»é¡ã§èŠ³ å¯ã ãã®ãäžè¬ çã§ãã. é°
èè¡ç®¡ ã® ããã¿ã¯ ã ããšåç©ã§ã¯ç° 㪠ã£ãŠã ã, åç©
ãçš®é¡ ã«ãã£ãŠç°ãª ã£ãŠã ããšãã ã ã ã. 以 äž ã€
ã, ãµã«, ããã®é°èæµ·ç¶¿äœ ã®è¡ç®¡æ§ç¯ ã«ã€ã ãŠèšè¿°
ã ã.
ã€ã:é° èæ·±åè ã¯é°èæµ·ç¶¿äœ ã®èãžå ¥ ãæåã§å€
Fig. 1 Schematic representation of the vascular system in the corpus cavernosum
penis of the dog. Arrows indicate the route of the blood flow.Insert:Helicine artery is equipped with polsters.
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IRYO Vol.46(5)
ãã¯3㪠ã ã4æ¬ ã«å ãã(Fig. 2), è, èã® è¿ ã
ã®è¿äœéšã ãã³é äœéšãž ãšåã ã. ãã ãã®æ ã¯äœå
ãåæ ããåŸèºè¡å ãšãª ã海綿äœæŽãžé£ 㪠ã. èºè¡å
è ã海綿äœæŽã«é£ãª ãæå ã«ã¯ãã«ã¹ ã¿ãŒãã ã,é³
åæšæ¬ ã§ã¯è窩ç¶ã«å¹ãã§ã ã(Fig. 3)ã, ã ã« ã
ãªã³ã§åºå® ããè³æ ã§èŠ³å¯ã ããš, ãã«ã¹ ã¿ãŒã¯é·è»ž
æ¹å ã«è¡ç®¡ å è ãžçª åº ããŠã ã. ãã®ãã« ã¹ã¿ãŒã¯æµ·
ç¶¿äœ æŽãžå ¥ ãè¡æ¶²ã®èª¿ç¯ ãããŠã ããšè ã ãã ㊠ã
ã3). 海綿äœæŽ 㯠ãã³ããã ãã«ãªã£ãŠäºã ã«é£ 㪠ã£
ãŠã ãã, å·Šå³ã®æµ·ç¶¿äœã®é ã«äº€éã¯ãªã.
海綿äœæŽ ãå» ãéè ã¯, é°èæ·±åèã海綿äœãžå ¥ ã
è¿åã®æµ·ç¶¿äœæŽã®è¡šé¢ ããã ã¯è¡šé¢ã«æ¥µ ãè¿ ã ãšãã
ã®æµ·ç¶¿äœæŽ ã ãåºãŠæµ·ç¶¿äœåŸå°éè ãšãª ã, 海綿äœæŽ
ã®è¡šé¢ ãé ãããã«èµ° ã£ãåŸéå ã, å çŽã«å ããå€
ãçœè ã貫 ã貫ééè ãšãªã£ãŠæµ·ç¶¿äœ ãå» ã£ ãŠ ã ã
(Fig. 1). åè-æµ· 綿äœæŽ-é è ãšã ãçµè·¯ ã®ä» ã«
åè-æ¯ çŽ°è¡ç®¡-é è ãšã ãçµè·¯ ãèŠ³å¯ ãã ãã, æµ·
綿äœæŽ è¡šé¢ã®æ¯çŽ°è¡ç®¡ã®çºéã¯ã㟠ãè¯å¥œ ãšã¯ã ããª
ã4). ã¡ãªã¿ã«, 海綿äœæŽ ãšæŽ ã®é ã«ã¯æ¯çŽ°è¡ç®¡ 網 ãš
Fig. 2 SEM view of corrosion cast ofthe corpus cavernosum penisof a dog. Two penile deep ar-teries (Da) enter the corpuscavernosum penis (Ccp). Post-cavernous venules arise fromthe cavernous sinuses (arrowheads) and join each otherin penetrating veins (asterisks).
ã ããã» ã©ã® ãã® ã¯ãªã. ãã ãã®ä»ã«çœèã貫 ã现
ãéè ãå€æ°èŠ ãã ã.
ãµã«(ã ãã³ã¶ã«):é° èæ·±åèã¯3æ¬ ã«åæããŠé°
Fig. 3 The terminals of helicine ar-teries (asterisks), showingtortuous course, continueto the cavernous sinuses (Ca).Arrow heads indicate scaph-oid cavities.
Fig. 4 The helicine artery of a mon-key is also equipped with ascaphoid cavity (arrow).
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May 1992
5a
a:Blood flow curve of the penile deep artery.
â¢Âª Onset of electrical stimulation of the
cavernous nerve. â¢Â« End of stimulatino.
5b
b:Blood flow curve of the penile
artery.
5c
c:Blood flow curve of the bulbo-
urethral artery.
Fig. 5 Measurement of blood flow
in the three arteries.
è海綿äœãžå ¥ ã. èºè¡åèã海綿äœ
æŽãžé£ãª ãæåã«ã¯ã€ããšå ãã ã
ã«ãã«ã¹ã¿ãŒ ã æ ã㊠ã ã(Fig.
4). æµ·ç¶¿äœ ãå» ãéè ã¯æµ· 綿 äœ æŽ
ã ãåºãŠ, ã€ããšåæ§ ãªèµ°è¡çµè·¯ã
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IRYO Vol.46(5)
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ãã€ãã¹ ãšè ãã. ããã¯éåèµ·æ ã«è¡æ¶² ã¯ã ã€ãã¹
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ã ãã®é°èã«ååž ããŠããç¥çµ ã¯äž» ãšããŠS2-S4ã
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ããŠã ãææžã¯ã» ãšã ã©ãªããšã ã£ãŠ ããã. 骚ç€ç¥
çµ ãåºæ¿ã ããšåèµ·ãèµ· ãã. åèµ· ã«å ç« ã£ãŠã¯æµ·ç¶¿
äœæŽãžåãã£ãŠè¡æ¶²ãæ¥éã«æµå ¥ ã ã. ãã ã«ã¯ãã«
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ç·©ã ãå¿ èŠã ã ã. ãã®åŒ ãéã«ãª ã£ãŠ ã ãç© è³ª ã
VIp(vaso-active intestinal polypeptideè¡ ç®¡ äœ
åæ§è žç®¡ããã ã)ã§ããã ãšã å ã 㣠㊠ãã. ã
ã®åŸã®ç 究 㧠ãVIPå« æç¥çµã¯ é° è ã® å è ã å¹³æ»
ç20)21), ã€ã㧠ã¯èºè¡åè ã®ãã«ã¹ã¿ãŒã®ããéšäœ,
ã ã㧠ã¯èºè¡åèã®å£ãè¥å ããŠããéš äœ ã«VIPå«
æ ç¥çµãå¯ ã«ååš ããŠã ã22). ãã ã«å ã㊠ã€ã³ãã
ã³ã¹æ£è ã§ã¯VIPå« æç¥çµãæžå° ã, ãã®æžå° ã®çš
床 ã¯çµéã«ã ã, ãŸãæžå°ã®çšåºŠã«ã ãçç¶ã®çšåºŠã
å€ ãããš ãããããŠã ã. ãã®VIPå« æç¥çµã® æž å°
ã¯ç¥çµ ãã® ãã®ãæžå° ããŠã ãã®ã§ 㯠㪠ã, VIPã
æ¯æž ããŠã ãã®ã§ã ã22).
6. 人çºæäœã«ããåèµ·
èªç¶ãªåèµ· ãšã¯ç° 㪠ã, é°è海綿äœãž ã®è¬å€ã®æ³šå ¥
ãçé£ ãæ³šå ¥ ããŠåèµ· ãæ¹èµ· ãã ã ã ãšã 㧠ã ã.
1982幎Virag23)ã ããã ãªã³ã§åèµ·ãç ãã ã ãšã
çºè¡šã ããš, é°èæµ·ç¶¿äœ ãžã®ããã ãªã³ã®æ³šå ¥ã«ã ã
ã€ã³ããã³ã¹ã®èšºæãæ²»ç ã«åº ãçšã ãã ã ã ã ã«
㪠ã£ãŠ ãã24)25). ãã®ä» ã«VIP26)ã ãã¹ã¿ã°ã© ã³ ã
ã³E127)28), ãã§ã³ ãã© ãã³, ã¢ã»ãã« ã³ãªã³, ã ã§
ãã ã·ãã³ã¶ ãã³ãª ã©ãçšã ãã ã ã ãš ãã ãã,
ãã§ã³ ãã© ãã³ã¯åç¬ã§ ã¯äœçšã匱 ãããã ãªã³ãšå ±
ã«æäž ãã ãããšãå€ ã29), ã¢ã»ãã« ã³ ãªã³ ã¯VIP
ãšåæã«æ³šå ¥ã ããšåç¬ ã§æ³šå ¥ã ãã ãã㯠ãã ã«åŒ·
ãæç¶æé ããªãã5). ãã§ãã ã·ã ã³ã¶ ãã³ã¯ å¯ äœ
çšã« ã泚æã ãå¿ èŠãã ã30). ãŸã, ã ããã°ãªã» ãª
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ã³3), ãš ãã³ ãã³32)ãªã©ãçšã ãã ãããšãã ã.
çé£ã®æ³šå ¥ã¯åèµ· æ©èœã®æ£ 垞㪠ãã®33), ã€ã³ããã³
ã¹ã蚎 ããŠã ããã®34), æ»äœ35), 㪠ã©ã«å¿çš ãããŠã
ãã, åèµ·ã®çºçŸã«èŠã ãæ³šå ¥é ã¯åèµ·ã®ç¶æé ã ã
ãå€ã. åèµ·é害 ã®ãªã ãã®ã¯é害㮠ãã ãã® ã ãã
æ³šå ¥éãå°ãª ã, éè ã ãã®æµ åºé ãå°ãªã.
以äžè¿° ã¹ãä»ã«åèµ· ãšç¡ç ãšã®é¢ä¿, åèµ·ã®æ¶éã
ã®ä»èšè¿° ããã ããšããã£ãã. çŽé¢ã®é¢ä¿ã§çç¥ã
ãããåŸãªã ã£ã.
㟠㚠ã
åèµ·ã®çºçŸã«é ããŠã¯æµ·ç¶¿äœæŽãžæµå ¥ã ãè¡æ¶²ãæ¥
é ã«å¢å ã ã. ãã®åŒ ãéã«ãª ãã®ã¯VIPã§, ãã
ã«ãã£ãŠæµ·ç¶¿äœå°æ± ã«ããå¹³æ» çããã³ãã«ã¹ã¿ãŒã
å« ãè¡ç®¡ã®å¹³æ» çãåŒç·© ããŠè¡æµãæ¥éã«å¢å ã ã.
ãã®çµæ, 海綿äœæŽå§ãäžæ ã, å骚海綿äœçãåçž®
ã ããšããã«å§ãäž æãã. åæã«æµ·ç¶¿äœåŸå°éèã
çœè ãšæµ· ç¶¿äœ ã®éã§å§å¹³ ãã, 貫 ééèã çœè ã«ãã£
ãŠçµæŒ ãã ããšæµ·ç¶¿äœæŽ ã ãã®è¡æ¶² ã® æµ åº ã 㪠ããª
ã. ãŸã, åèãžåã ã£ãŠã®éæµã¯èºè¡åèã§é²æ¢ ã
ããŠäœåŸª ç°ã ãéé¢ ãããééç³»ãæç« ã, 硬çŽç¶æ
ãšãª ã.
æ ç®
1) å±±ç°å°ç¥(ç£ ä¿®):㬠ãªãã« ãã»ã ã»ãŽã£ã³ã, 解
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(å¹³æ3幎11æ1æ¥ åä»)
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