Disorders of the Penis/ Genito-Reproductive Health Assessment

Prostate Cancer:

Prostate CA-most frequently diagnosed CA, not the deadliest

Risks-

• men

• increasing age

• African- American and African-Caribbean

• Family- first-degree relative (father, brother, or son)

• BRCA 1 and BRCA 2 genes mutations

• smoking

• obesity

Characteristics of Prostate Cancer

Definition: Enlargement of the prostate, resulting in compression on the urethra

Causes: At birth, the prostate is pea sized, it grows until it reaches adult size, and around 40 to 45yo benign hyperplasia begins and continues slowly until death.

Bladder outflow obstruction with compression on the urethra → S&S

Risks:

• Male- 75 yo and older- ½ with some symptoms

• aging and continued growth of the prostate

• obesity,

• westernized countries,

• race,

• family history

Benign Prostatic Hyperplasia Assessment:

S&S- history

• urinary retention

• urinary frequency

• hesitancy- delay in starting a urine stream

• urgency- feeling of needing to void

• decreased force of the urine stream

• overflow incontinence  (dribbling)

• a sense of bladder fullness (not completely empty)

• possibly nocturia

• potential for hydronephrosis

• potential infections of the bladder and kidney

• possible back pain with kidney inflammation

S&S- Exam:

• symmetric, nontender, enlarged prostate

• also smooth, rubbery and firm

What is Benign Prostatic Hyperplasia?

Penis- lesions- ulcers, vesicles, warts

phimosis, hypospadias, epispadias, stricture

inflammation of the shaft, glans or urethra

marked tenderness on exam

discharge- bloody, purulent

Scrotum-   swelling or edema (hydrocele), or varicose veins  (vericocele)

Lesions not normal

absent, atrophied, or fixed testes

nodules, thickened cord

hernia- inguinal, femoral

Testes- infection- prostatitis, epidisymitis

Torsion- twist cuts off blood supply, emergency

Kidneys- hydronephrosis - excess urine accumulation in kidney(s) from obstruction, causes swelling in the kidney(s)

Inguinal lymph nodes- enlarged, hard, matted, fixed (potential causes- infection, cancer)

Inspection and palpation: Abnormal findings

Inflammation of the urethra usually, but not always, caused by a sexually transmitted disease

• Nonsexual origins can be caused by urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma

• S&S- Meatus edges are reddened, everted, and swollen;

• purulent urethral discharge is present;

• dysuria

• urine cloudy with discharge and mucous shreds

Urethral strictures

• Fibrotic narrowing of the urethra caused by scarring

• Commonly a result of trauma or untreated or severe urethral infections

What is Urethritis?

• Inability to retract foreskin from the glans of the penis (distal to proximal)

What is Phimosis?

• Foreskin is retracted and fixed. Construction ↓circulation

• Inability to replace or cover the glans with the foreskin (proximal to distal)

• Frequently caused by poor hygiene or chronic infections

What is Paraphimosis

• congenital disorder where urethra opens on ventral surface of the penis

What is Hypospadius?

Urethra exits on dorsal surface of the penis

What is Epispadius?

Inflammation/dilation of veins in the scrotum

Incompetent venous valves in internal spermatic and renal veins; may cause infertility

Symptoms: asymptomatic or feeling of scrotal “fullness”

What is Varicocele?

Scrotal swelling- collection of fluid

Causes- infection, hernia, trauma

Symptoms- painless swelling, bulky

What is Hydrocele

Inflammation of the Prostate

What is Prostatitis?

Inflammation usually caused by GC or chlamydia or prostatitis

• Signs and Symptoms

  • Severe pain, swelling

What is Epididymitis?

acute inflammation of the testes

• Associated with epididymitis

• Probably caused by systemic infection, most common- mumps

What is Orchitis?

• Associated with Age

• Medications

• Vascular Diseases

• Alcohol Intake

What is Erectile Dysfunction?

• Painful, persistent erection >4 hours

• Involves impaired venous drainage from corpus caverosa

• Causes: Sickle cell disease, anticoagulant therapy, DM, Leukemia, some antidepressant meds unknown

What is Priapism?

• Disorders of desire (inhibited sexual desire, decreased libido

• Vaginismus

• Anorgasmia (orgasmic dysfunction)

• Dyspareunia (painful intercourse)

What is Sexual Dysfunction?

A) The testes palpate as oval, firm, smooth, freely moveable, and equal size bilaterally (Normal)

B) The testes decrease in size and are less firm to palpation for an elderly man (Normal)

C) The scrotal contents hang lower and scrotum becomes pendulous in older men (Normal)

D) The scrotum is asymmetric for most men (Normal)

E) The urethra is midline, pink, smooth, and has no discharge (Normal)

F) The Urethral meatus opens on the ventral (under) side of the glans (hypospadias)

G) The foreskin is non-retractable (phimosis)

H) The inguinal lymph nodes are not palpable (Normal)

Circle the correct normal findings anticipated for a male GR assessment

A) The testes palpate as oval, firm, smooth, freely moveable, and equal size bilaterally

B) The testes decrease in size and are less firm to palpation for an elderly man

C) The scrotal contents hang lower and scrotum becomes pendulous in older men

D) The scrotum is asymmetric for most men

E) The urethra is midline, pink, smooth, and has no discharge

F) The Urethral meatus opens on the ventral (under) side of the glans

G) The foreskin is non-retractable

H) The inguinal lymph nodes are not palpable

Gynecologic history:

• Age at onset of menarche

• Last menstrual period

• Menstrual cycle timing: regular/monthly, irregular, rare, none

• Type of contraceptive used (if applicable): Include the regularity of use

• Post-menopausal age (if applicable)

• Date of last gynecological exam/ Pap test

• Results of last Pap test

• History of surgery: including hysterectomy, oophorectomy, salpingectomy, Bilat. Tubal Ligation, LEEP cone biopsy

Gynecologic problems

• Amenorrhea

• Menorrhagia

• Dysmenorrhea

• Pelvic pain

• Premenstrual pain

• Intermenstrual spotting

• Vaginal itching

• Vaginal discharge

• Menopausal symptoms

• Post-menopausal bleeding

History: Female Genito-reproductive ROS

A) The correct order for the performance of a pelvic exam is bimanual, speculum, and rectovaginal. (no)

B) The labia minor covers the labia majora (no)

C) The cervix is at the inner back wall of the vaginal canal, if not surgically removed

D) The Cervix Appears slightly blue in color and is soft in a non-pregnant girl (no, Chadwick and Goodels sign)

E) The uterus palpates to be about 15 cms, and it is moveable, feels lumpy, and is non-tender (fibrosis)

F) The ovaries palpated equally bilaterally, measuring about 3 cms, were nontender, and had no masses (Normal)

Circle all the correct assessment techniques and/or normal findings expected for a female gynecology exam

A) The correct order for the performance of a pelvic exam is bimanual, speculum, and rectovaginal.

B) The labia minor covers the labia majora

C) The cervix is at the inner back wall of the vaginal canal, if not surgically removed

D) The Cervix Appears slightly blue in color and is soft in a non-pregnant girl

E) The uterus palpates to be about 15 cms, and it is moveable, feels lumpy, and is non-tender

F) The ovaries palpated equally bilaterally, measuring about 3 cms, were nontender, and had no masses