MALE GENITAL SYSTEM PREMED H&P

Shaft ( long, narrow portion) of penis consists of the vascular erectile tissue – corpus spongiosum (urethra) and corpus cavernosa Penis ends at the “glans” *In uncircumsized men, the glans is covered by loose, fold of skin called “prepuce” or foreskin The secretions of glans will collect in the prepuce Urethra is also located in the shaft of the penis, it opens into the “urethral meatus”located at the tip of the glans

Scrotum – loose, wrinkled pouch divided into two compartments that hold the “testis” or testicle Left side of the scrotum usually lies lower than the right Epididymis – Long, narrow tube located behind the testis connecting to the vas deferens. Collects sperm from the testicle during maturation

Testes produce spermatoza and testoserone which stimulates puberty (pubertal growth of male genitalia, prostate and seminal vesicles). Also the secondary sexual characteristics such as beard, body hair, musculoskeletal development and low-pitched voice

Vas deferens - Cord-like structure that begins at the tail of the epididymis and ascends upward into the urethra and the prostate gland and empties into the ejaculatory duct Spermatic Cord – Blood vessels, nerves and muscle fibers

Erection – Venous engorgement of the corpora cavernosa Male sexual function depends on levels of testoserone and arterial blood flow Erection – Venous engorgement of the corpora cavernosa Stimuli are auditory, visual, erotic cues and tactile Lymphatics – Drain into the inguinal nodes Except testes drain into the abdomn Assess for enlargement and tenderness to this region when suspicious for inflammation or malignant lesion

Inguinal Hernia “Inguinal Canal” – found parallel to the inguinal ligament, forms a tunnel for the vas deferens to pass through the abdominal muscles “External inguinal ring” is a triangular, exterior opening to the tunnel “Internal inguinal ring” is the internal opening to the tunnel * When there is a weakness in the inguinal canal, bowel loops can force through these weak areas resulting in “Inguinal Hernia”

“Femoral Canal” – Located below the inguinal ligament, also a route for hernia

Aging With age, testosterone decline affecting their sexual function Erection becomes dependent on tactile stimulation and less responsive to erotic stimuli Penis decreases in size and testicles drop lower into the scrotum Pubic hair is less and turns gray

INSPECTION Skin – Lift scrotum up to see the posterior or back Scrotum - Inspect the contours for swelling, lumps or veins Prepuce – Patient should retract the foreskin back for detecting sores and carcinomas. Cheesy whitish material may also accumulate under the skin * Phimosis – Tight prepuce that the patient cannot retract back Glans – Inspect for ulcers, scars, nodules or signs of inflammation * Balanitis – Inflammation of the glans

Inspect the location of the urethral meatus * Hypospadias – Congenital, ventral displacement of the meatus on the penis

Discharge Compress the glans gently between fingers to open the urethral meatus and inspect for any discharge * Gonococcal infections present with yellow discharge (Gonococcal urethritis) Diagnosis requires gram stain and culture of the discharge * If patient reports discharge but not present currently, ask patient to milk the shaft from the base to the glans

PALPATE Palpate each testis and epidydmis between thumb and first two fingers Note for size, shape, tenderness and nodules * Nodule that is painless in the testis may become suspicious for testicular cancer

Palpate each spermatic cord, vas deferens between the epidydmis and inguinal ring Note for any nodules or swelling * Swelling in scrotum can be identified by transillumination – (Darken the room and shine a strong light from behind the scrotum through the mass) Swellings contain serous fluid that light up with red glow or transilluminate. If contains mass it does not transilluminate.