Classic Citations: Erection of the Human Penis and Its Morphological and Vascular Basis by Guiseppe Conti

Abstract

I n 1952, Giuseppe Conti published a long paper (45 pages) [1] in which he detailed his anatomic findings on the human penis and proposed a theory to explain the erection phenomenon. In the introduction Conti explained that he conducted the research at the anatomical school of Padua, which had been interested since 1915 in “the structural characteristics of the vessels walls but extended to all the mechanisms that favored, retarded, or diverted the flow of the blood.” Conti justified that he had chosen the research on the blood vessels of the human penis because of the “enormous functional importance of the dynamics of circulation in this organ.” He examined 20 human penises from men ranging in age from newborn to 77 years. The specimens were obtained from autopsied cadavers 24 hours after their death; individuals with visible macroscopic changes of the external genitalia or whose histories might indicate possible lesions of the penis were excluded. Conti made various sections from the pendulous portion of the penis and the glans; the sections were in series, making possible to follow structures for as far as 3–4 mm. The author divided his manuscript into chapters. Chapter 1 was dedicated to introduction, chapter 2 to material and methods. In chapter 3, Conti started with a general consideration of the arteries of the penis and their divisions (artery of the penis, bulbourethral artery, urethral artery, cavernous artery, and dorsal artery). As a result of his observations, Conti stated that he had found, along the entire course of the dorsal artery and the cavernous artery, structures that regulate the blood flow. They were little endoarterial bands formed of muscle and connective tissue (cushions). In chapter 4, Conti summarized his observations on the deep dorsal vein and its collaterals. He had found that “the walls of the veins in the deep network of the penis very often include muscular cushions projecting into the lumen” and “they were more frequent where smaller veins entered into a larger vein; at those points the cushions often had a sphincter-like structure.” In chapter 5, the author gave an explanation of the mechanism of erection based on his findings: “in the flaccid penis, the muscles of the arterial cushions are contracted and the vascular lumen is greatly reduced. During erection, on the other hand, the muscles of the arterial cushions relax. At the same time, the muscles of the venous cushions contract, closing the lumen of the veins, thus preventing the outflow of blood.” Chapter 6 was devoted to the corpus cavernosum and corpus spongiosum. The first was described as a sponge, formed by cavities forming numerous intercommunicating sinuses. Its walls were formed by muscular and connective tissue and lined with endothelium. In the peripheral portion of the corpus cavernosum, located directly beneath the albuginea, Conti described “bloodcontaining spaces which should probably be considered veins.” He classified the sinuses of the corpus cavernosum as a venous segment of arteriovenous anastomoses. According to Conti, the corpus spongiosum was clearly differentiated from the corpus cavernosum; its morphology varied from the dorsal portion of the urethra to the ventral portion and with age. Its sinuses were surrounded by columns with sparse muscular tissue in the newborn. With age, those columns were populated with muscular tissue and a network of elastic fibers. Conti stated that the © 2008 International Society for Sexual Medicine