Male genitalia

Penis

Excretory organ for urine and introducing semen

-Thin skin, redundant to permit erection and free of subcutaneous fat

*prepuce (foreskin) covers the glans

-In the uncircumcised penis, smegma is formed by the secretion of sebaceous material by the glans and the desquamation of epithelial cells from the prepuce

Testicles

Production of spermatozoa and testosterone

Older adults

Pubic hair becomes finer and less abdudant with aging

-Pubic alopecia

-Scrotum becomes more pendulous

History of present illness

-Discharge or lesion on penis

-Swelling in inguinal area

-Testicular pain/ass

-Curvature of penis in any direction with erection

-Persistent erections unrelated to sexual stimulation

-Difficulty with ejaculation

-Difficulty achieving or mantaining erection

-Infertility

Past medical history

-Gender identity

-Organ inventory

-Congenital anomaly/surgery of genitourinary tract

-STIs

-Chronic illness

-Recent and past genitourinary/gynecologic procedures

Family history

- Infertility in siblings

-History of prostate, testicular, penile or breast 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: use of a protective device with contact sports or bicycle riding

-Concerns about genitalia: size, shape, surface characteristics, texture

-Testicular/genital self-­examination practices

-Concerns about sexual behaviors including sexual partners (single or multiple)

- Concerns about sexual orientation (heterosexual, homosexual, bisexual), or gender identity (transgender, cisgender, agender)

-Reproductive function: number of children, form of contraception used, frequency of ejaculation

-Alcohol, marijuana use: quantity and frequency

-Use of drugs

Older adults

-Change in frequency of sexual activity or desire

-Change in sexual response

*include graying and less abundant pubic hair, as well as a pendulous scrotal sac and contents

Inspection and palpation

-Genital hair distribution = coarser, abundant

-Penis = Dorsal vein apparent, circumcises/not, smegma (white chessy sebaceous matter)

-Urthral meatus = pink and glistening

-Penile shaft = tenderness and induration

-Scrotum = Deeply pigmented and coarse

*Evidence of hernia

-Testes = Smooth and rubbery, free of nodules (vas deferens, smooth)

Phimosis

foreskin is tight and cannot be retracted

Recurrent balanitis

inflammation of the glans

Balanoposthitis

inflammation of the glans penis and prepuce

- occur in uncircumcised individuals and may be caused by either bacterial or fungal infections.

-It is most commonly seen in patients with poorly controlled diabetes mellitus. 

Priapism

Prolonged penile erection

Ceremasteric reflex

Stroke the inner thigh with blunt instrument

-Testicle and scrotum should rise on stroked side

Transillumination

determine whether it is filled with fluid, gas, or solid material

-hernia or hydrocele

*mass that neither changes in size nor transilluminates may represent an

incarcerated hernia (a surgical emergency) or testicular cancer