Male Genitourinary System Chapter 24 Edition Change: The title of this chapter has been changed from “Male Genitalia”

Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings

Subjective Data— Health History Questions Frequency, urgency, and nocturia Dysuria Hesitancy and straining Urine color Genitourinary history

Subjective Data— Health History Questions (cont.) Penis—pain, lesion, and/or discharge Scrotum—self-care behaviors; lump Sexual activity and contraceptive use Sexually transmitted disease contact

Principles of interviewing adolescent male patients: Ask questions that seem appropriate for boy’s age but be aware that norms vary widely. Ask direct, matter-of-fact questions. Avoid sounding judgmental. Start with a permission statement. “Often boys your age experience…” Try the ubiquity approach, “When did you…” rather than “Do you…” Sometimes all you do is “open the door” to later conversation

Additional History for the Aging Adult Any difficulty urinating?... Do you need to get up at night… A man in his 70s, 80s, or 90s… Any difficulty urinating? Any hesitancy and straining? A weakened force of stream? Any dribbling? Or any incomplete emptying? Do you need to get up at night to urinate? What medications are you taking? What fluids do you drink in the evening? A man in his 70s, 80s, or 90s may notice changes in his sexual relationship or in his sexual response and wonder if it is normal. For example, it is normal for an erection to develop slowly at this age. This is not a sign of impotence, but a man might wonder if it is.

Objective Data—The Physical Exam (cont.) Penis—Inspect and palpate Skin Glans Urethral meatus Pubic hair Urethral discharge Shaft

Objective Data—The Physical Exam (cont.) Scrotum—Inspect and palpate Skin Testis Epididymis Spermatic cord Any mass Note characteristics Transillumination

Abnormal Findings Male Genital Lesions Herpes progenitalis Syphilitic chancre Condylomata acuminata (genital warts) Carcinoma Urethritis (urethral discharge and dysuria)

Abnormal Findings (cont.) Abnormalities of the Penis Phimosis Paraphimosis Hypospadias Epispadias Peyronie’s disease Priapism Urethral stricture

Abnormal Findings (cont.) Abnormalities in the Scrotum Early testicular tumor Diffuse tumor Hydrocele Scrotal hernia Orchitis Scrotal edema

Abnormal Findings (cont.) Inguinal and Femoral Hernias Indirect inguinal Direct inguinal Femoral