Download Chapter 19 Male Genitalia Examination of the male genitalia is

Chapter 19
Male Genitalia
Examination of the male genitalia is typically performed:
When patient has a specific complaint
As part of the newborn examination
As part of an overall well child or well person examination
In adults, examination of the anus, rectum, and prostate (see Chapter 20) is often performed at
the same time.
Physical Examination Preview
Male Genitalia
Inspect the pubic hair characteristics and distribution.
Retract the foreskin if the patient is uncircumcised.
Inspect the glans of the penis with foreskin retracted, noting the following:
Color
Smegma
External meatus of urethra
Urethral discharge
Male Genitalia (Cont.)
Palpate the penis, noting the following:
Tenderness
Induration
Strip the urethra for discharge.
Male Genitalia (Cont.)
Inspect the scrotum and ventral surface of the penis for the following:
Color
Texture
Asymmetry
Lesions
Unusual thickening
Presence of hernia
Transilluminate any masses in the scrotum.
Male Genitalia (Cont.)
Palpate the inguinal canal for a direct or indirect hernia.
Palpate the testes, epididymides, and vas deferens for the following:
Consistency
Size
Tenderness
Bleeding, masses, lumpiness, or nodules
Palpate for inguinal lymph nodes.
Elicit the cremasteric reflex bilaterally.
Anatomy and Physiology
Male Genitalia
Penis
Testicles
Epididymis
Scrotum
Prostate gland
Seminal vesicles
Male Genitalia (Cont.)
Penis
Corpora cavernosa
Corpus spongiosum
Urethra/orifice
Prepuce
Penis function
Excretes urine
Introduces sperm into vagina
Male Genitalia (Cont.)
Scrotum
Septum
Testis
Epididymis
Spermatic cord
Muscle layer
Cremasteric muscle
Male Genitalia (Cont.)
Testicular functions
Spermatogenesis
Testosterone production
Epididymal functions
Storage/maturation/transit of sperm
Vas deferens begins at the tail of the epididymis, ascends the spermatic cord, travels
through the inguinal canal, and unites with the seminal vesicle to form the
ejaculatory duct
Male Genitalia (Cont.)
Prostate gland
Approximately the size of a testis
Surrounds the urethra at the bladder neck
Produces the major volume of ejaculatory fluid
Contains fibrinolysin, which liquefies the coagulated semen―important in sperm motility
Male Genitalia (Cont.)
Sexual physiology
Erection of the penis occurs when the two corpora cavernosa become engorged with
blood.
Increased blood supply is produced by increased arterial dilation and decreased venous
outflow.
Autonomic nervous system
Local synthesis of nitric oxide
Male Genitalia (Cont.)
Sexual physiology
Ejaculation during orgasm consists of the emission of secretions from:
Testes
Vas deferens
Epididymides
Prostate
Seminal vesicles
Orgasm is followed by constriction of the vessels supplying blood to the corpora
cavernosa and gradual detumescence.
Infants and Children
Sexual differentiation by 12 weeks’gestation
During the third trimester, the testes descend from the retroperitoneal space through the inguinal
canal to the scrotum
Descent of testes may occur after birth.
Complete separation of prepuce from the glans at about 3 to 4 years in uncircumcised males
Adolescents
Puberty: functional maturation of reproductive organs
Increased size
Penis
Enlarges in length and breadth
Testes
Scrotal skin reddens, thins, and becomes increasingly pendulous.
Development of pubic hair
Older Adults
Pubic hair becomes finer and less abundant.
Pendulous scrotum
Decreased sexual activity
Slower erection
Orgasm less intense
Review of Related History
History of Present Illness
Difficulty achieving and maintaining erection
Pain
Constant or intermittent, with one or more sexual partners
Associated with alcohol ingestion or medication
Medications: diuretics, sedatives, antihypertensive agents, anxiolytics, estrogens,
inhibitors of androgen synthesis, antidepressants, carbamazepine, erectile
dysfunction agents
History of Present Illness (Cont.)
Persistent erections unrelated to sexual stimulation
Curvature of penis in any direction with erection
Difficulty with ejaculation
Painful or premature, efforts to treat the problem
Ejaculate color, consistency, odor, and amount
Medications: alpha-blockers, antidepressants, antipsychotics, clonidine, methyldopa
History of Present Illness (Cont.)
Infertility
Lifestyle factors
Time attempting pregnancy
Sexual activity pattern
History undescended testes
Diagnostic evaluation to date
Medications: testosterone, glucocorticoid steroids, hypothalamic releasing hormone
History of Present Illness (Cont.)
Enlargement in inguinal area
Intermittent or constant, association with straining or lifting, duration, presence of pain
Change in size or character of mass; ability to reduce the mass
Pain in groin
Efforts to treat
Medications: analgesics
History of Present Illness (Cont.)
Testicular pain or mass
Change in testicular size
Onset
Lumps
Soreness
Heaviness
Medications: analgesics, antibiotics
Past Medical History
Surgery of genitourinary tract
Undescended testes, hypospadias, epispadias, hydrocele, varicocele, hernia, prostate;
vasectomy
STDs
Single or multiple infections, specific organism (gonorrhea, syphilis, herpes, warts,
Chlamydia), treatment, effectiveness, residual problems
Chronic illness
Testicular or prostatic cancer, neurologic or vascular impairment, diabetes mellitus,
arthritis, cardiac or respiratory disease
Family History
Infertility in siblings
History of prostate, testicular, or penile cancer
Hernias
Peyronie disease (contracture of penis)
Personal and Social History
Occupational risk of trauma to suprapubic region or genitalia, exposure to radiation or toxins
Exercise risks
Concerns about genitalia
Testicular self-examination practices
Concerns about sexual practices
Reproductive function
Use of alcohol and drugs
Infants and Children
Maternal use of sex hormones
Circumcised: complications
Uncircumcised: hygiene measures
Scrotal swelling with crying or bowel movement
Congenital anomalies
Masturbation and sexual exploration
Swelling or sores on penis or scrotum
Concern of sexual abuse
Adolescents
Knowledge of reproduction and sexual function
Presence of nocturnal emissions, pubic hair, enlargement of genitalia, age at time of each
occurrence
Concern of sexual abuse
Sexual activity, protection used for contraception and STI prevention
Older Adults
Change in sexual desire or activity
Change in sexual response
Longer time required to achieve full erection
Less forceful ejaculation
More rapid detumescence
Longer interval between erections
Prostate surgery
Examination and Findings
Equipment
Gloves
Penlight
Drapes
Inspection and Palpation
Genital hair distribution
Coarseness
Abundance
Penis
Dorsal vein
Foreskin retraction
Texture
Tenderness or induration
Discharge
Inspection and Palpation (Cont.)
Urethral meatus
Orifice size and location
Color and moisture
Scrotum
Color
Texture
Cysts
Edema
Inspection and Palpation (Cont.)
Hernias
Inguinal
Indirect
Direct
Femoral
Testes
Tenderness
Texture
Nodules
Inspection and Palpation (Cont.)
Epididymis and vas deferens
Texture
Tenderness
Cremasteric reflex
Stroke the inner thigh with a blunt instrument.
Testicle and scrotum should rise on the stroked side.
Prostate
Detailed in Chapter 20
Infants
Inspect and palpate
Congenital anomalies
Incomplete development
Sexual ambiguity
Urethral placement
Retractability of foreskin
Descent of testicles
Masses
Transilluminate scrotum if mass found
Children
Inspect and palpate
Penis
Size, lesions, swelling, inflammation, and malformation
Foreskin retraction
Scrotum
Descent of testes
Testes
Masses
Adolescents
Examination of older children and adolescents is the same as for adults.
Allay anxiety.
Protect privacy.
Inspect and palpate.
Expected maturational changes
Older Adults
Examination procedure for older adults same as that for younger men
Age-related changes
Graying and less abundant pubic hair
Pendulous scrotal sac and contents
Abnormalities
Abnormalities
Hernia
Protrusion of a peritoneal-lined sac through some defect in the abdominal wall
Indirect: soft swelling in area of internal ring
Direct: soft swelling that bulges anteriorly
Femoral: occurs at the fossa ovalis, where the femoral artery exits the abdomen
Abnormalities (Cont.)
Strangulated hernia
Nonreducible hernia in which the blood supply to the protruded tissue is compromised
Requires prompt surgical intervention
Penis
Paraphimosis
Inability to replace the foreskin in its usual position after it has been retracted behind the
glans
Hypospadias
Congenital defect in which the urethral meatus is located on the ventral surface of the
glans penile shaft or the base of the penis
Penis (Cont.)
Syphilitic chancre
Skin lesion associated with primary syphilis
Penis (Cont.)
Herpes
Genital herpes is sexually transmitted infection caused by herpes simplex virus (HSV-2)
Penis (Cont.)
Condyloma acuminata
“Genital warts” caused by human papillomavirus (HPV)
Penis (Cont.)
Lymphogranuloma venereum
Sexually transmitted infection of the lymphatics caused by Chlamydia trachomatis
Penis (Cont.)
Molluscum contagiosum
Benign skin infection caused by a poxvirus that infects only the skin
Penis (Cont.)
Peyronie disease
Fibrous band in the corpus cavernosum causing bending and/or indentation of the
erection
Penile cancer
Squamous cell carcinoma usually originating in the glans or foreskin
Scrotum
Hydrocele
Fluid accumulation in the scrotum
Scrotum (Cont.)
Spermatocele
Benign cystic accumulation of sperm occurring on the epididymis
Scrotum (Cont.)
Varicocele
Abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic
cord
Scrotum (Cont.)
Orchitis
Acute inflammation of the testis secondary to infection
Scrotum (Cont.)
Epididymitis
Inflammation of the epididymis often seen in association with a urinary tract infection
Testicular torsion
Twisting of testis on spermatic cord
Surgical emergency
Scrotum (Cont.)
Testicular cancer
Seminomas and nonseminomas arise from germ cells (sperm-producing cells).
Scrotum (Cont.)
Klinefelter syndrome
Congenital anomaly associated with XXY chromosomal inheritance
Infants
Ambiguous genitalia
Newborn’s genitalia are not clearly either male or female.
Presence or absence of male hormones controls the development of the sex organs
during fetal development.
Question 1
Foreskin of the penis that cannot be retracted over the glands is called:
A. Balanitis
B. Balanoposthitis
C. Phimosis
D. Preputial ring
Question 2
The greatest contribution to the volume of ejaculate comes from the:
A. Prostate
B. Epididymis
C. Seminal vesicles
D. Corpus cavernosa
Question 3
A hernia that protrudes through the external inguinal ring, located in the region of Hesselbach
triangle is called:
A. Direct hernia
B. Femoral hernia
C. Indirect hernia
D. Ventral hernia
Question 4
Expected genitalia changes that occur as men age include:
A. Ejaculatory volume decreases with age
B. Erections develop more quickly
C. Viability of sperm increases
D. The scrotum becomes more pendulous
Question 5
Dense fibrous scar tissue forms in the tunica albuginea, and results in loss of penile length and
pain on erection is called:
A. Balanitis
B. Paraphimosis
C. Peyronie disease
D. Phimosis