male genitalia system

external genitalia parts

1. penis

2. scrotum

3. scortal sac

penis

used for urination and reproduction

internal genitalia

•Testes

•Spermatic cord

•Epididymis

•Vas deferens

inguinal area

•Located between the anterior superior iliac spine laterally and symphysis pubis medially

•Frequent site of hernia development

anus and rectum

•Anal canal

•Anal opening

function of male GU system

•Manufacturing  (spermatogenesis) & protecting sperm

•Transporting sperm

•Secretion & regulation of male sex hormones (testosterone)

•Sexual stimulation & pleasure

•Drainage & excretion of urine

collecting subjective data

•Any concerns?

•In a non-threatening manner collect data:

•Penile pain/lesions/swelling/discharge/itching/please describe…

•Change in scrotal size

•Sexual practices

•Practice Safe Sex

•STIs

⦿Preventable/most communicable

•Urination difficulties/burning/frequency/dysuria/hematuria /hesitancy/stones

equipment and supplies physical exam

•stool, gown, disposable gloves, flashlight, stethoscope, Water-soluble lubricant, U/A C&S specimen contain

•Guaiac tests

subjective data

•Last testicular exam?

•History of STI

•Sexual practices

•Practice Safe Sex

•Preventable/most communicable

•Ever had test for blood in the stool?

•Sigmoidoscopy? Colonoscopy?

•Digital rectal exam?

mumps

– infertility  /  undescended testes & inguinal hernias– increase risk for CA

hospitalizations/surgery

•Prostatectomy / circumcision / hernia / epispadias / hypospadias repair

meds

•Current meds / HRT /  antidepressants / antipsychotics / diuretics

allergies

•Latex / nonoxynol 9 / other spermicides

Past medical history

•Immunizations / Chemical exposure

Family history

diabetes

ca

mother DES while pregnant

social

smoking/drug abuse

self care

•Nutrition / exercise / personal hygiene / powders / sprays / ointments

infants

•Prematurity – undescended & few rugae

•Scrotal edema / ecchymosis

•Hypospadias –

•Epispadias

•Hydroceles

Hypospadias –

urethral meatus opening on ventral portion of the glans

episadias

urethral meatus opening on dorsal portion of the glans

children

•Redness / swelling / discharge / odor

•Masses / asymmetry / lumps  / crying from pain

•Trauma / toilet training / urine stream straight

adolescent

•Address concerns / safe sex / tanner staging – tracks puberty development (pubic hair distribution, penile & testicular size)

older adults

•Pubic hair thins / penis & testicle atrophy / prostate larger / testosterone decrease by age 50 & time increases….

•Consider chronic diseases

culture/ethics

circumcisison

need:

•Gloves

•Water-soluble lubricant

•U/A  C&S specimen container

•Guaiac tests

collecting objective data

•Make your patient comfortable

•Take into consideration cultural differences

•Assure the patient

•Keep your nonverbals in check / face is easily seen

•Know the language

pt preparedness

•Room should be comfortable

•Ask someone to be in the room with you

•Have pt empty bladder; give a urine collection cup if needed

•Provide privacy

•Assist into supine position with legs spread slightly

•Keep patient draped for privacy

•Have a good light source

•Position – standing for majority (if able)

•Often left lateral for exam of anus, rectum, and prostate

positions

standing

left lateral for rectal

exam includes:

inspect and palpate

external genitalia

•Hair distribution (Tanner Scale), condition (Tanner scale – tracks sexual maturity in children during puberty)

•Lice

penis

•Color/swelling/discharge/retract foreskin (then return it)

abnormal findings of penis include?

•Chancre – symphysis

•Condyloma (genital warts)

•Candida

•Herpetic lesions

•Tinea Cruris

•Phimosis

•Priapism

syphilitic chancre

initially: small silvery white papula that develops a red ulceration

painless

sign of primary syphilis that spontaneously regresses

may be misdiagnsoed as herpes

herpes progentials

clusters of pimplelike clear veiscles that erupt and become ulcers

painful

initial lesions of this STI- typically caused by HSV 1 or HSV 2 disappear and the infection remains dormant for varying periods of time, recurrences can be frequently or minimally episodic

genital warts

single or multiple, moist, fleshy papules

painless

STI caused by HPV

cancer of the glans penis

appears as hardened nodule or ulcer on the gland

painless

occurs primarily uncircumcised men

phimosis

foreskin cannot be retracted over penis tip

paraphimosis

foreskin that is left in a retracted psoition leads to venous congestion and edema of the foreskin

scrotum

•Note color / hair distribution / size / shape & position

•Rugated

•Pigment

•Left sac lower than right

-Abnormal

-Masses / swelling / spermatocele /varicocele / sebaceous cyst

epispadias

urtethral meatus is located on the top of the glans, occurs rarely

congenital defect

urethral meatus

•Note position / centrally located

•Abnormal

•Epispadias

•Hypospadias

scrotal hernia

loop of bowel protrudes into the spectrum to create what is known as an indirect inguinal hernia

appears as swelling in scrotum

palpable as a soft mass and fingers cannot get above the mass

hydrocele

collection of serous fluid in scrotum, outside testes, within tunica vaginalis

appears as swelling in scrotum and usually painless

usually examiner can get fingers above this mass

will transluminate (if thete is blood in scrotum, will not transilluminate and is called a hematocele)

testiuclar tumor

initially a small firm nontender nodule on testis

as tumor grows, the scrotum appears enlarged and client complains of heavy feeling

when palpated, testis feels enlarged and smooth: tumor replaces testis

will not transilluminate

cryptorchidism

failure of one or both testicles to descend into scrotum

scrotum appears undeveloped and testis cannot be palpated

causes increased risk of testicular cancer

orchitis

inflammation of the testes, associated with mumps

client complains of pain, heaviness and fever

scrotum appears enlarged and reddenned

swollen, tender testis is palpated, examiner may have difficulty differentating between testis and epididymis

epididymitis

infection of epididymis

client usualyl complains of sudden pain

scrotum appears enlarged, reddened and swollen: tender epidiymis is palpated

usually associated with prostatiis or bacterial infection

torsion of spermatic cord

very painful bc of twisting of spermatic cord

scrotum appears enlarged or reddened

palpation reveals thickened cord and swollen, tender testis that may be higher in scrotum than normal

condition requires immediate referal for surgery bc circulation is obstructed

varicocele

abnormal dilation of veins in spermatic cord

client may complain of discomfort and tesicualr heavines

tortous veins are palpable and feel like soft, irrregular mass or “bag of worms”

infertility can be associated

spermatocele

sperm filled cystic mass located on epididymis

palpable as small and nontender and moveable above testis

mass will appear on transillumination

hypospadias

urethral meatus is lcoated undeneath glans

congenital defect

groove extends from the meatus to the normal location of urehtral meatus

inguinal area inspection

•Note skin / enlarged lymph nodes

•Note bulges

•Bulge – inguinal hernia or lymph node

rectal area inspection

•Observe for hemorrhoids / fissures / bleeding / prolapse

•Abnormal

•STD – warts / bleeding / prolapse / hemorrhoids

indirect inguinal hernia

bowel herniates through internal inguinal ring and remains in the inguinal canal or travels down into the scrotum

most common hernia

may occur in adults, but more frequent in children

anal fissure

splits in tissue of anal canal caused by trauma

swollen skin tag often prsent below the fissure on the anal margin

they cause intense pain, itching, and bleeding

rectal prolapse

occurs when the mucosa of rectum protrudes out through the anal opening

may involve only the mucosa or the mucosa adn rectal wall

appears as red, donughtlike mass with radiating folds

palpation penis

•Lightly palpate – note consistency / tenderness / nodules / pulsation

urethra meatus palpate

•Note drainage & discharge

scrotum palpation

•Use thumb & two fingers gently palpate – note size / shape / consistency / mobility / tenderness / masses or nodules

•Transillumination

•Abnormal

•Mass / enlarged testicle /  swelling /  undescended testes / red glow on transillumination

inguinal area palpate

•Palpate horizontal & vertical lymph nodes

•Palpate hernias – never force your finger / STOP if you meet resistance

•Caution with patients that have HX of hypertension

-Abnormal

-Unilateral or bilateral enlargement of lymph nodes –should be less than 1cm & mobile

-Indirect inguinal hernia

-Direct inguinal hernia

-Femoral hernia

prostate cancer risk factors

•Family history

•Advanced age

•African American

•Agent orange

•Exposure to toxicity

signs and symptoms prostate cancer

•Dysuria / frequency / nocturia / hesitancy / dribbling / hematuria & retention

•Enlarged / hard / fixed

•Back pain

prostate cancer is rare in men under ?? but rises rapidly after age ??

rare in men under 40

rises rapidly after age 50

additional symptoms of prostate cancer

•Trouble urinating

•Decrease force in the stream of urine

•Blood in the semen

•Swelling in the legs

•Bone pain

•Erectile dysfunction

testicular cancer

•Carries a high mortality rate, especially if not detected early. The American Cancer Society (ACS) recommends a testicular exam as part of a routine cancer-related check-up

•Male clients should be aware of the need for a monthly testicular self-examination and its importance in the early diagnosis and treatment of testicular cancer

risk factors of testicular cancer

•Age - 90% under age 54 (Weber & Kelley, 2018)

•Age - 50% ages 20-34 (ACS)

•Carcinoma in situ

•Family history of testicular cancer

•HIV

•Undescended testes

•Previous bout with Testicular Cancer

signs and syumptoms of testicular cancer

•Non-tender / hard / fixed mass / nodules / scrotal swelling / scrotal heaviness

•Recommend

•TSE – Testicular self-exam