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Assessment of the Male Reproductive System

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Assessment of the Male Reproductive System UNJ August 2006-290.ps 7/24/06 3:14 PM Page 290 Assessment of the Male Reproductive System Pamela D. Ceo he importance of a good Many diseases and medications can affect the urinary system and its physical examination function. Assessment of the male genitalia is accomplished with cannot be underestimat- inspection and palpation. It is important to chart what is seen, what ed. A good clinician is felt, and what the patient reports. Tmust be able to differentiate nor- mal from abnormal findings and should be familiar with both func- urinary tract infection, or treat- Cappaleri, Smith, Lipsky, & Pena, tion (see Table 1) and location (see ment for low-grade bladder can- 1999). Table 2) of the organs involved. It cer. Complaints of a lump in the may be as subtle as a mole that scrotum can be an inguinal her- Examination Basics has changed slightly from last nia. It is always important to dis- Upon entering the examina- examination or as obvious as a cuss and clarify the details of any tion room, the clinican should new lesion that is draining. previous genitourinary (GU) greet the patient appropriately surgeries, particularly if they with an introduction including Obtaining the History occurred during childhood. the clinician’s title. The patient Many diseases and medica- Details of any previous treatment should be asked what he would tions can affect the urinary sys- for GU diseases or complaints prefer to be called. This simple tem and its function. The initial should be discussed. Ask the introduction can help reduce interaction with a patient should patient whether he has been anxiety, particularly when the begin in a nonthreatening way, treated recently in an emergency specific encounter is related to a by reviewing his medical-surgi- department for the presenting man’s sexual or urological cal history and his current med- problem or any other problem. health. If a genital examination is ications. A complete assessment There are some conditions necessary, permission is asked of the male reproductive system for which a physical examination before beginning the examina- includes a thorough review of the is only modestly helpful. Erectile tion. This is especially important patient’s history, since many con- dysfunction cannot be seen or when the clinician is a female, ditions may present as com- felt during a physical examina- since it allows the patient to plaints of pain to the reproduc- tion; therefore, this issue should decline gracefully if he prefers a tive structures. Pain from a kid- be discussed with the patient. male clinician to perform this ney stone can radiate along the Ask about his relationship(s) and part of the examination. Genital spermatic cord and present as about his level of sexual satisfac- examination should be done last testicular pain. Difficulty starting tion. If the patient has diabetes, if this is a full physical examina- the urinary stream and com- hypertension, or depression and tion, in order to reduce embar- plaints of perineal tenderness takes medication for these condi- rassment and to allow time for may indicate prostatitis or tions, he may have erectile prob- the patient to become comfort- benign prostatic hypertrophy. lems but may be too embarrassed able with the overall interaction. Urethral pain can be a result of to talk about it. A statement such A parent should always be pre- prostatitis, sexually transmitted as “Diabetes often causes erectile sent when examining an infant or diseases, or recent instrumenta- dysfunction. Have you encoun- minor. The adolescent should be tion. Urgency and frequency may tered any problems getting an asked if he would like to have be due to bladder dysfunction, a erection?” or use of a standard- anyone present during the exam- ized questionnaire may encour- ination. An adult male should be age the patient to discuss the asked the same question, espe- Pamela D. Ceo, APRN,BC, CUNP, is problem more openly (for exam- cially if he is accompanied by his a Urology Nurse Practitioner, St. ple, the Sexual Health Inventory wife. Social or cultural mores Joseph Mercy Hospital, Ann Arbor, MI. for Men [SHIM] by Rosen, may dictate that the wife leave 290 UROLOGIC NURSING / August 2006 / Volume 26 Number 4 UNJ August 2006-291.ps 7/24/06 3:14 PM Page 291 Table 1. the room during her husband’s Function of Male Genital Organs examination. Assessment of the male geni- Organ Function talia (see Figure 1) is accom- Penis Protects the urethra; houses the corpora caver- plished with inspection and pal- nosum which when engorged makes the penis pation. Normally, only examina- rigid and erect; prepuce protects the glans penis. tion gloves and water-soluble Scrotum Protective loose sac divided into two compart- lubricant are needed but a stetho- ments for the internal organs: testis, epididymis, scope and flashlight may be use- and vas deferens; temperature regulation of the ful if the scrotal examination is testes. abnormal. A stethoscope can be Testes Produce spermatozoa (seminiferous tubules) and used to listen for bowel sounds if testosterone. there is a concern for a hernia within the scrotal sac. The flash- Epididymis Storage and transport of sperm cells; sperm mat- light would be used to transillu- uration. minate the scrotum during an Ductus (Vas) deferens Cord-like structure that transports sperm from evaluation for a hydrocele. Prior the testis and epididymis into the urethra. to any examination, the index Spermatic cord Protects the ductus (vas) deferens, internal and finger can be measured and used external spermatic arteries, artery of the vas, as a ruler to measure the penis, venous pampiniform plexus, lymph vessels, and testes, and prostate. nerves. With the patient in the Prostate gland Produces some of the seminal fluid; also pro- supine position, only the geni- duces a thin, white fluid that mixes with seminal talia are uncovered and two fluid to neutralize the urethra and vagina to main- sheets are used, one to cover his tain sperm viability. chest/abdomen area and the Seminal vesicles Produces most of the seminal fluid. other one to cover his legs. Privacy for the patient is always Table 2. Developmental Changes in the Appearance of the Male Genital Organs Developmental Time Pubic Hair Appearance of Penis Testes and Scrotum Stage 1 None except for fine body hair Size proportional to body Size proportional to body size as on the abdomen. size as in childhood as in childhood Stage 2 Sparse, long, slightly pigmented Slight enlargement Enlargement of testes and thin hair at the base of penis. scrotum; reddened pigmenta- tion; texture more prominent. Stage 3 Darkens, becomes more coarse Elongation Enlargement continues. and curly; growth extends over symphysis. Stage 4 Continues to darken, thicken, and Breadth and length Enlargement continues; become coarser and more curly; increase, glans develops. skin pigmentation darkens. growth extends laterally, superi- orly, and inferiorly. Stage 5 Adult distribution and appear- Adult appearance Adult appearance ance; growth extends to inner thighs, umbilicus, and anus, and is abundant. Stage 6 Sparse and gray Decrease in size Testes hang low in scrotum; (Elderly clients) scrotum appears pendulous. Source: Barkauskas, Baumann, & Darling-Fisher, 2002. UROLOGIC NURSING / August 2006 / Volume 26 Number 4 291 UNJ August 2006-292.ps 7/24/06 3:14 PM Page 292 Figure 1. provided. The room should be Male Anatomy warm enough for the patient to be comfortable. The patient should be asked if the room is warm enough. This is especially important in examining the elderly, since they may be less tolerant of the cold. The warm room will also avoid activation of the cremasteric reflex that causes the testes to ascend from the scrotum upward toward the pelvic cavity (Pulsifer, 2005). This reflex can also be provoked by touch. If possible, interrup- tions should be avoided after the examination is begun. INSPECTION Source: Marieb, 2006. Used with permission of Pearson Education, Inc. Pubic Area/Penis The patient’s hair distribu- Table 3. tion pattern is examined (see Pubic Area/Penis Hair Distribution Table 3). Does it correlate with his age? The suprapubic area is Infant/child No hair inspected for any rashes, Adolescence Few hairs on pubic area at first, then becomes fuller lesions, folliculitis, scarring, (see Table 2). nodules, bulges, or scratch Adult Abundant in pubic area, coarser than hair on other parts marks (from a parasite). If the of the body, curlier and on medial aspects of thighs hair is full it will need to be parted during the examination. Geriatric Gray and sparse The inguinal/groin area is inspected. When the patient coughs or bears down there Figure 2. should not be any bulges or Differentiating Hernias masses. If there are, this may indicate a hernia. A direct inguinal hernia would be near the external inguinal ring, while an indirect inguinal hernia would be at the internal inguinal ring (see Figure 2). Penile growth rate is progres- sive and predictable (see Table 4). An abnormally small penis may be indicative of a clitoris, Klinefelter’s or Down’s syndrome (Gomella, 2002). An obese child may appear to have a small (retracted) penis secondary to overlying skin folds and large prepubic fat pad (Engel, 2002). A penis that is large relative to stage Source: Swartz, 2002. Used with permission of W.B. Saunders Company. of development may suggest pre- cocious puberty or a possible tes- ticular tumor (Engel, 2002). 292 UROLOGIC NURSING / August 2006 / Volume 26 Number 4 UNJ August 2006-293.ps 7/24/06 3:15 PM Page 293 Table 4. from the tip of the penis to the Penis Size/Length penoscrotal junction. Both of these disorders are congenital Infant/child Size 1.9 cm newborn and up to 3 cm in young boys and are usually diagnosed at until puberty.
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