Chapter 19: Assessing the Male Breasts and Reproductive System

_______________ collects mature sperm.

Epididymis

_______________ suspends the testis in the scrotum.

Spermatic cord

_________________ stores and transports sperm through the epididymis.

Vas deferens

__________________ transport sperm from the testes to the seminal vesicles.

Seminal vesicles

_____________ transports semen during sexual intercourse.

Urethra

________________ produces an alkaline fluid that nourishes and protects sperm

Prostate gland

The male hormone, ______________, inhibits the development and growth of breast tissue in males.

testosterone

Extend from the second through sixth anterior ribs with the sternum.

Male breasts

the penis is composed of three parts

•Root•Body•Glans penis

____________ is covered with loose and wrinkled skin called rugae.

Scrotum

__________ are the primary male reproductive organs responsible for sperm and testosterone production

Testes

A male patient is learning to perform a testicular self-exam. He asks you what the testes should feel like. What would be your answer?A.Firm and immobile
B.Firm and mobile
C.Soft and rubbery
D.Soft and immobile

C

Prostate specific antigen test

a blood test that measures the amount of PSA, a protein secreted by prostate epithelial cells.

prostate biopsy

removes a sample of body tissue for examination under a microscope to diagnose prostate cancer

_________________ are obtained in men with penile discharge

Urethral specimens

Health history includes

Past medical or surgical history of conditions related to kidneys, bladder, rectum, genital areaFamily history of bladder, breast, kidney, penis, prostate, and testicular cancersAll medications (prescriptive, herbal, and over-the-counter)Health Promotion •Testicular self-exams - how often?•Prostate cancer screening•Safety - protective equipment

Veterans are at risk for

•Post traumatic stress disorder (PTSD)•Post-deployment syndrome•Substance abuse disorders•Major depressive disorder

Use OLDCARTS for what type of pain

Bladder painBack painTesticular painInguinal pain

dysuria

painful urination

Urinary symptoms

Difficulty starting the streamHesitancy or urinary retention•Benign prostatic hypertrophy (BPH)FrequencyPenile lesions or discharge•Color•Amount •Consistency

Benign prostatic hypertrophy

noncancerous enlargement of the prostate gland

Hydrocele

an accumulation of fluid around the testes.

Epididymitis

inflammation of the epididymis

swelling or enlargement of the scrotum may be due to

congestive heart failure

5 P's of sexual history

•Partners - sexual relationship, number and type of sexual partners.
•Practices - types of sexual practices
•Protection - precautions and protection
•Past STIs - time frame, treatment
•Prevention of Pregnancy

_______________ occurs when a man has trouble getting or keeping an erection.

Erectile dysfunction (ED

ED is linked to a number of common diseases such as

diabetes, heart disease, hypertension

WHO has defined sexual health

a state of physical, mental, and social well-being in relation to sexuality

Cultural considerations

Cultural and racial considerations may place restrictions on discussing sexual issues.Certain cultures may only allow same-gender health care providers.

Sequence of assessment

•Inspecting and palpating the male breasts•Inspecting the male genitalia

Inspect the male breasts (in a supine position) for

•Symmetry•Color•Contour (dimpling or retraction)•Edema •Lesions•Ulcerations•Texture of skin
Inspect the areola for:•Shape•Color
Inspect the nipples for:•Size•Position•Shape•Discharge•Scaling or crusting

How do you go about inspecting/palpating the male breasts

Ask the patient to raise his arms to over his head Inspect the lateral aspect of the breasts towards the mid-axillary line for skin changes.Gently palpate each breast and axillary area using the finger pads of your 2nd, 3rd, and 4th fingers using the vertical strip pattern assessment techniques.Assess for lumps or masses.

Normal findings when inspecting/palpating the male breasts

Breasts are symmetric Skin has even colorNo lesions, dimplingNo lumps or masses.Areola is smooth, uniform color Nipple is everted, skin intact, and without drainage

Abnormal findings when inspecting/palpating the male breasts

Lump or mass is palpatedGynecomastiaErythema of the skin, scaling of the nipple, or nipple discharge

Inspecting Male genitalia

1. Lift scrotum to assess posterior side
2. Tell patient to lay on side, spread buttocks and inspect anus
3. While patient is standing ask him to hold his penis up
4. Compare left and right scrotal sacs

Inspect the following parts of male genitalia

•Penis‒Ventral, lateral, and dorsal sides
•Prepuce‒Circumcised or not
•Urethral meatus‒ Note location of the urethral opening
•Pattern of pubic hair
•Skin - assess for irritation, erythema, or pubic lice

Normal findings of the penis

•Caucasians: pink to light brown•Dark skinned or African Americans light-to-dark brown•Smooth, no hair•Dorsal vein is visible•No lesions; no discharge; no nits or lice

Normal findings of the prepuce

•Circumcised foreskin is smooth and pink•Uncircumcised foreskin easily retracts•Smegma may or may not be present

Normal findings for Urethra meatus

•Pink, smooth•Located at the center of the glans

Normal findings for pubic hair

•Distribution is in a triangular pattern consistent with age

Normal findings for anus

Darker color skin

Normal finding for the scrotum

•Skin is a darker pigmentation•Left testis hangs lower that the right testis

Normal findings for inguinal areas

•Skin is smooth•Free from lumps or bumps

Tanner scale

measures progression through puberty and attainment of sexual maturity; prepubertal to adult secondary sexual characteristics

Abnormal findings of penis

Skin has lesions or sores. Lesions indicative of common STIs •Syphilis chancre •Condyloma acuminatum (genital warts) •Herpes lesions •Chancroid lesion Tinea cruris Penile cancer

Tinea cruris

jock itch; fungal infection of groin presenting as a bright red rash

Phimosis

stenosis of the preputial orifice so that the foreskin cannot be pushed back over the glans penis; abnormal

Balanitis

inflammation of the skin covering the glans penis; abnormal

Paraphimosis

uncircumcised penis that may be covered with foreskin that once retracted, now cannot be returned to its original position; abnormal

Epispadias

urethral opening is located dorsally on the penis; abnormal

Hypospadias

Urethral opening is located ventrally on the penis; abnormal

abnormal findings of the anus

•Hemorrhoids•Rectal bleeding•Protrusion of rectal mucosa

Abnormal findings of the scrotum

•Swelling•Lesions•Empty scrotal sac•Small testes

Inguinal hernia

protrusion of a loop of the intestine through layers of the abdominal wall in the inguinal region

Obtaining urethral culture

Put on gloves.Open up the culturette tube and remove the swab.Maintaining sterility of the swab tip, hold the shaft of the penis. Insert the tip of the swab about 2 to 4 cm into the urethra.

Healthy people 2020 goal

Promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STIs and their complications.
Routine HIV screening for teens and adults between 15 and 65 years of age
Advise protection through use of condoms

You are inspecting the male breasts and note bilateral enlargement of the breast tissue. What is the name of this condition?A.Gynecomastia
B.Fibrocystic breast disease
C.Benign hypertrophy
D.Mastitis

A.Gynecomastia

Testicular cancer peaks between _______ years

20-39

____________ cancer has no early symptoms

Testicular

What does TSE stand for

T = Timing - every month
S = Shower, warm water relaxes scrotal sac
E = Examine, check for changes, report changes immediately