1. Chapter 11: Male Genitalia and Hernias

2. Anatomy and Physiology
The Penis
The shaft of the penis is formed by three columns of vascular erectile tissue:
The corpus spongiosum, containing the urethra
The two corpora cavernosa
The corpus spongiosum forms the bulb of the penis, ending in the cone-shaped glans with its expanded base, or corona.

3. Anatomy and Physiology
The Penis
In uncircumcised men, the glans is covered by a loose, hoodlike fold of skin called the prepuce or foreskin where smegma, or secretions of the glans, may collect.
The urethra opens into the vertical, slitlike urethral meatus.

4. Anatomy and Physiology
The Testes
The testes are ovoid, somewhat rubbery structures approximately 4.5 cm long.
The left testis usually lies somewhat lower than the right.
The testes produce spermatozoa and testosterone.

5. Anatomy and Physiology
The Testes
The scrotum is a loose, wrinkled pouch divided into two compartments, each containing a testis.
Covering the testis, except posteriorly, is the serous membrane of the tunica vaginalis.
On the posterolateral surface of each testis is the softer comma-shaped epididymis. The epididymis provides a reservoir for storage, maturation, and transport of sperm.

6. Anatomy and Physiology
The Lower Genitourinary Tract
The vas deferens, a cordlike structure, begins at the tail of the epididymis.
It ascends within the scrotal sac (as the spermatic cord) and passes through the external inguinal ring on its way to the abdomen and pelvis.
Behind the bladder it is joined by the duct from the seminal vesicle and enters the urethra within the prostate gland.

7. Anatomy and Physiology

8. Anatomy and Physiology
The Groin
The basic landmarks of the groin are the anterior superior iliac spine, the pubic tubercle, and the inguinal ligament
The inguinal canal lies above and parallel to the inguinal ligament. It forms a tunnel for the vas deferens
The exterior opening of the tunnel is the external inguinal ring. The internal opening of the canal is the internal inguinal ring

9. Anatomy and Physiology
The Groin
When loops of bowel force their way through weak areas of the inguinal canal, they produce inguinal hernias.
Another potential route for a herniating mass is the femoral canal. Femoral hernias protrude here.

10. The Health History
Questions concerning the male genitalia may be classified into two categories:
Sexual function
Symptoms of infection

11. The Health History Sexual Function Questions
Begin with a general question, such as “How is sexual function for you?”
If there is a problem, direct questions help to assess each phase of the sexual response.
Have you maintained interest in sex? (desire)
Can you achieve and maintain an erection? (arousal)
About how long does intercourse last? (orgasm and ejaculation)

12. The Health History Symptoms of Infection Questions
Is there any discharge from the penis, dripping, or staining of underwear? If so, how much and what is its color and consistency?
Any associated fever, chills, or rash?
Any sores or growths on the penis?
Any pain or swelling in the scrotum?
Any history of or risk factors for sexually transmitted disease? (promiscuity, homosexuality, illicit drug use)

13. Techniques of Examination
In General
Many will feel uneasy about examining a man’s genitalia.
It may be reassuring to explain each step of the examination so the patient knows what to expect.
Occasionally, male patients have erections during the examination. If this happens, you should explain that this is a normal response.

14. Techniques of Examination
In General
A good genital examination may be done with the patient either standing or supine.
When checking for hernias, the patient should stand and the examiner should sit on a chair or stool.

15. Techniques of Examination
The Penis
Inspect and palpate the penis
Please pause for a moment and watch video 11-1, “Examining the Penis”

16. Techniques of Examination
The Penis
If the patient has reported a discharge that you are unable to see, ask him to milk the shaft of the penis from its base to the glans. This maneuver may bring some discharge to the urethral meatus for appropriate examination.
Lastly, palpate any abnormality of the penis, noting any tenderness or induration. Palpate the shaft of the penis, noting any induration.

17. Techniques of Examination
The Scrotum and Its Contents
Inspect and palpate the scrotum, testes, epididymis, and spermatic cord
Please pause for a moment and watch video “Examining the Scrotum and its Contents”

18. Techniques of Examination
Hernias
Inspect and palpate for inguinal and femoral hernias
Please pause for a moment and watch video 11-3, “Examining for Inguinal and Femoral Hernias”

19. Techniques of Examination
Evaluating a Possible Scrotal Hernia
If a large scrotal mass is found, ask the patient to lie down. If the mass disappears, it is a hernia.
If the mass remains:
Listen to the mass with a stethoscope. If bowel sounds are heard, it is a hernia.
Shine a strong light from behind the scrotum through the mass (transillumination). If a red glow is observed, it is probably not a hernia.

20. Techniques of Examination
The Testicular Self-Examination
Testicular cancer is the most common cancer of young men between ages 15 and 35.
When detected early, it has an excellent prognosis.
Please review the included weblinks on the testicular self-examination.