1. MALE GENITAL SYSTEM
PREMED H&P

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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”

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

11. 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

12. 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

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

14. 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

15. 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

16. 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.