1. Male Reproductive Disorders & STD’s Chapters 39, 41 & 42 By Angie Lawson RN, BSN

2. Male A&P Review  External Structures Penis Scrotum  Internal Structures Testes Epididymidis Vas deferens Seminal vesicles Prostate gland Bulbourethral glands

3. Assessment  History Risk for STD’s Contraceptive use Ability to achieve & sustain an erection Pain during intercourse Premature ejaculation Infertility Prior surgeries or treatments

4. Assessment cont:  Physical Examination Transillumination Testicular self – exam Breast self -exam  Diagnostic Tests Ultrasound Cystourethroscopy Fertility tests

5. Prostatitis  Inflammation of the prostate gland Pain/discomfort Low back pain Fever Chills Dysuria Urethral discharge

6. Benign Prostatic Hyperplasia  An increased number of noncancerous cells in the prostate bland  Symptom onset is gradual  Inability to void  Medications & Treatments TURP Terazosin (Hytrin) Finasteride (Proscar)

7. Prostate Cancer  Prostatic cancer grows slowly and has a high survival rate if detected early.  No symptoms at first, later – urinary frequency, nocturia and dysuria

8. Penile Disorders  Peyronies’s Disease  Priapism  Phimosis & Paraphimosis

9. Priapism Persistent Engorgement of the penis without sexual stimulation Causes – drug side effects or vascular problem

10. Phimosis Paraphimosis  Pain with erection and intercourse  Unable to retract the foreskin  Painful swelling of the glans, severe edema and urinary retention.  Strangulation of the glans penis by the foreskin

11. Penile Cancer  Rare, possibly cause by chronic skin irritations  Lesion on the penis, that may become infected over time.

12. Testicular Disorders  Cryptorchidism  Hydrocele  Varicocele

13. Cryptorchidism  No signs and symptoms noted  Scrotum feels empty

14. Hydrocele, Spermatocele & Varicocele  All present as swelling of the scrotum  Hydrocele fluid around testicles-no teatment  Spermatocele cystic mass on epididymis - no teatment  Varicoceles dilated veins – untreated causes infertility

15. Epididymitis Orchitis  Inflammation of the epididymis Pain, swelling, fever, chills, scrotal skin red and tense  Inflammation of the testis

16. Testicle Cancer  Cancer in the testicle, that is a highly metastasizing cancer  Swelling of the scrotum, a noticeable lump, abdominal pain, weakness & aching in the testes.

17. Sexual Functioning  Vasectomy  Erectile dysfunction Impotence  Inability to achieve or maintain an erection  Causes – aging, testosterone insufficiency, drug side effects, atherosclerosis, hypertension, diabetes, anxiety or depression  Infertility

18. Vasectomy  Done in a Dr. Office, ligation of the vas deferens  Vasovasostomy – a surgical attempt to reverse a vasectomy

19. Sexually Transmitted Diseases (STD’s)

20. Common STD’s  Chlamydia  Gonorrhea  Herpes Infection  Venereal Warts

21. Chlamydia  Most common, fastest spreading, caused by chlamydia trachomatis  Most are asymptomatic, if they occur, clear urethral discharge, redness, irritation, dysuria, lower abd pain, or testicular pain

22. Gonorrhea  High incidence in 15-24 yr olds, caused by Neisseria Gonorrhoeae  Many women are asymptomatic, but may have white/yellow discharge, cervicitis, dysuria, men have urethritis

23. Syphilis  Curable, transmitted from blood, caused by the spirochete, Treponema pallidum  Early-painless papule, later-papule ulcerates, fever, malaise, rash, headache, sore throat, lymph node enlargement

24. Trichomonas  May also be transmitted through nonsexual contact  Redness, swelling, itching, and burning

25. Herpes Infection  Highly contagious, not curable, caused by herpes simplex virus type 2  Vesicles on the penis, prepuce, buttocks, thighs, introitus, or cervix, burning itching, ulcerations, flu symptoms, headache

26. Genital Warts  Called condylomas, reoccuring, more susceptible in immunodeficient people  Painless, single or in a cluster, soft, fleshy growths, turn white when vinegar is applied

27. Hepatitis B  Early signs - loss of appetite, rashes, malaise, pain, headaches, nausea, vomiting  Hepatitis B & liver cancer  Late signs – dark urine, light stool, jaundice, spleen enlargement, liver tenderness cirrhosis, coma, death

28. Genital Parasites  Not a true STD, but can be transmitted through close body contact  Lice Scabies

29. Pharmacology  Penecillin Uses : syphilis, gonorrhea Adverse reactions: glossitis, stomatitis, gastritis, furry tongue, nausea & vomiting  Norfloxacin Uses: uncomplicated gonorrhea, prostatitis Adverse reactions: diarrhea, headache, abdominal discomfort, superinfections

30. Pharmacology Cont:  Metronidazole (flagyl) Uses – trichomonas Adverse reactions- nausea, anorexia, seizures, numbness  Spectinomycin (trobicin) Uses – gonorrhea Adverse reacions – soreness at inj. site. urticaria, sudden decrease in blood pressure.

31. Pharmacology Cont:  Acyclovir (Zovirax) Uses: herpes simplex, herpes zoster Adverse Reactions: N & V, diarrhea, headache, dizziness, lethargy, rashes  Docosanol (Abreva) Uses: HSV types 1&2 Adverse reactions: headache, skin rash

32. Pharmacology Cont:  Imiquimod – Uses: external genitalia and perianal warts Adverse reactions: local skin irritations, itching, excoriation  Indinavir Uses: HIV infections Adverse reactions: headache, N&V, diarrhea, cough, dysuria, acne

33. Pharmacology Cont:  Valacyclovir (valtrex) Uses: HSV type 2: herpes zoster Adverse reactions: N&V, headache, dizziness, anorexia, diarrhea  Zidovudine AZT (retrovir) Uses: HIV infection Adverse reactions: asthenia, malaise, weakness, headache, anorexia, diarrhea, N&V, dizziness, insomnia, anemia, agranulocytosis

34. Pharmacology Cont:  Fluconazole (diflucan) Uses: vaginal candidiasis Adverse reactions: headache, N&V, diarrhea, skin rash  Ibuprofen (motrin, advil) Uses: painful dysmenorrhea Adverse reactions: nausea, dizziness, dyspepsia, gastric/duodenal ulcer formation, GI bleeding, headache

35. Pharmacology Cont:  Naproxen (aleve, anaprox) Uses: dysmenorrhea Adverse reactions: dizziness, visual disturbances, headache, N&V, gastric/duodenal ulcers  Rofecoxib (vioxx) Uses: primary dysmenorrhea Adverse reactions: headache, dizziness, insomnia, rash, dyspepsia, fatigue

36. Pharmacology Cont:  Urofollitropin (Fertinex) Uses: induction of ovulation Adverse reactions: ovarian enlargement, N&V, breast tenderness, ectopic pregnancy, abdominal discomfort  Methyltestosterone (Android) Uses: hypogonadism, impotence, postpubertal cryptochidism, female breast cancer Adverse reactions: gynecomastia, testicular atrophy, impotence, enlargement of penis, nausea, male pattern baldness, amenorrhea

37. Pharmacology Cont:  Finasteride (Proscar) Uses: BPH, prevention of male pattern baldness Adverse reactions: impotence, decreased libido, decreased volume of ejaculate  Conjugated estrogens (Premarin) Uses: problems assoc. with menopause Adverse reactions: headache, migraine, dizziness, depression, insomnia, cramps, spotting, edema, breast pain, HTN, gallbladder disease

38. Pharmacology Cont:  Medroxyprogesterone (Provera) Uses: amenorrhea, endometrial hypoplasia Adverse reactions: spotting, amenorrhea, breast tenderness, weight gain, depression  Estrogens & Progestins Combo (Prempro) Uses: treament of moderate to severe symptoms of menopause Adverse reactions: same as premarin and provera

39. Pharmacology Cont:  Contraceptives (oral) Ortho novum’s, Desogen, Triphasil, Ortho Tri-Cyclen,  Contraceptives (implantable and injectable Norplant – surgical incision with implantation of 6 hormone capsules Depo-provera – given IM every 3 months Ortho evra - patch applied each week times 3 then off for 1 week.

40. Pharmacology Cont:  Hepatitis B Vaccine (Engerix – B) Uses: immunity against hepatitis b infections Adverse reactions: headache, vertigo, dizziness, paresthesia, insomnia, pruritus, nausea, dyspepsia, diarrhea, local pain at site, flu like symptoms, fatigue and earache