Male Genitalia Flashcards
In uncircumsized males, the ______ is covered by loose hood-like fold of skin called ____________
glans, prepuce
Secretions of the glans can collect here_________. In uncircumscibed males it can get trapped in foreskin and can be a harbor of infection
Smegma
tunnel where vas deferens runs
inguinal canal.
The _________ is not palpable
inguinal canal
Triangular, slit-like just palpable just above and lateral to pubic tubercle
External opening- external inguinal ring
Phimosis
not able to retract foreskin over the glans
Paraphimosis
not able to retract the foreskin back down towards base of penis usually a lot of edema
Balanititis
inflammation of the glans
Balanoposthitis
glands and foreskin inflammation. Inflammation turns into bacterial or fungal infection
…………
congenital abnormality, seen after recurrent urethral infections and sexually transmitted pts
Priapism
prolonged penile erection, often painful. Most idiopathic but can occur in patients with leukemia and sickle cell disease or medications for impotence
Peyronie’s
curved penis
Two ways to palpate testes
- use thumb and first 2 fingers
- two handed technique
Testes should be sensitive to gentle compression but not:
tender, should feel smooth and rubbery and free of nodules
Transgender women may have testicles that have decreased in _________or completely_________
size , retracted
How do you compare spermatic cords?
cords at the neck of the scrotum by compressing each cord between the thumb and forefinger
Vas deferens should be smooth and discrete, should _______be beaded or lumpy in its course
NOT
Usually asymmetric left testicle has a longer spermatic cord and therefore is often _________
lower
The color of the scrotum is more ________than the rest of the body’s skin. If reddened could indicate ________ process
pigmented, inflammatory
Edema does not imply disease related to genitalia, but more likely consequence of general fluid retention associated with _______, ________ or _______
cardiac, renal or hepatic disease
Should the Epididymis be tender?
no
What do painless nodules indicate?
testicular cancer
Hernias
lifetime risk, more common in male population
Most hernias are _________
inguinal
Femoral hernias are more at risk for becoming
strangulated, worry about blood supply being compromised
Indirect inguinal hernia
inserting finger in external ring, have pt cough and if you feel a hernia bulge against tip of finger because its within the inguinal canal. It may appear within the scrotum itself because it can drop. The pt able to reduce it themselves by laying position etc
Direct inguinal hernia
come through the side of inguinal canal (medial) You feel it on the side of your finger
Femoral Hernia
palpate femoral artery then NAVEL this type is much less common than the first two. But this is a higher likelihood of strangulation and this is a surgical emergency.
Genital Warts (Condylomata Acuminata)
Single or multiple papules or plaques of variable shapes
Round, flat, pointed or thin
Genital Herpes Simplex
Small scattered or grouped vesicles
1-3mm on glans or shaft
other systemic sx
Distinguish between herpes zoster occurring in dermatomal pattern
Primary Syphilis
Small red papule that becomes a chancre- painless erosion
Heals in 4-8 weeks
Chancroid
Red papule or pustule initially then forms painful deep ulceration with ragged margins
Peyronie disease
irregular curvatre of penis
Fibrous band in the corpus cavernosum; may have pain with erection. H/o dupuytren contracture
Penile cancer is a _____________ carcinoma originating in the ________ or ____________. Painless _____________ fail to heal
Squamous cell carcinoma, glans or foreskin, ulceration
Spermatocele
Benign cystic accumulation of sperm occurring on the epididymis
Varicocele
Abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord. Usually asymptomatic. Classically described as “bag of worms”
Orchitis
Acute inflammation of the testis secondary to infection. Acute onset of testicular pain and swelling. Enlarged tender testis, erythematous and edematous scrotal skin
Epididymitis
Inflammation of the epididymis. Painful scrotum, urethral discharge, fever, pyuria. Epididymis feels firm and lumpy, tender
Testicular cancer
Classified by the cells from which the cancer arises. Painless mass on testicle, sensation of heaviness in the scrotum. Irregular, nontender mass fixed on the testis. Does not transilluminate(taking pen light and shining it obliquely through a fluid filled structure like a varicoclce, it will transilluminate you will see light go through fluid collection, if it hits a fixed mass it wont light up)
irregular non tender fixed mass=
cancer
Hypospadias
Congenital defect in which the urethral meatus is located on ventral surface of the glans penile shaft/base of penis
Hydrocele
Fluid accumulation in the scrotum. Painless enlargement or swelling. Common in infancy. Nontender, smooth, firm mass superior and anterior to the testes. + Transilluminates
Testicular torsion
Twisting of testis on spermatic cord; testicular torsion is a surgical emergency. Acute onset of scrotal pain + with N/V.
In _________ and ___________ the testis may be insensitive to painful stimuli
syphilis and diabetic neuropathy
Lumps on the scrotum is commonly associated with __________________
sebaceous cysts (epidermoid cysts)
One hand technique palpation of scrotum
Palpate each testis and epididymis
Two handed technique of scrotum
Cradle testis at both poles using thumb and fingertips
Slide contents back and forth without changing hand position
Name the hernia: most common, all ages and sexes. often in children, may occur in adults
indirect
Name the hernia: less common, usually in men older than 40 years old, rare in women
direct
Name the hernia: least common, more common in women than males
femoral
Name the hernia: above the inguinal ligament near its midpoint, the internal inguinal ring
indirect
Name the hernia: above the inguinal ligament, close to the pubic tubercle near the external inguinal ring
direct
Name the hernia: below the inguinal ligament, appears more lateral than an inguinal hernia. Can be hard to differentiate from lymph nodes
femoral`
Name the hernia: often into the scrotum
indirect
Name the hernia: rarely into the scrotum
direct
Name the hernia: nerve into the scrotum
femoral
Name the hernia: it comes down to the inguinal canal and touches the fingertip
indirect
Name the hernia: it bulges anteriorly and pushes the side of the finger forward
direct
Name the hernia: the inguinal canal is empty
femoral
Medications to be aware of if a patient presents with any s/s related to genitals
ED agents
Antidepressants
Antipsychotics
Recreational drugs
Testosterone supplementation (gels/ pellets, injection)
Penile cancer risk factors
Infection with high-risk type of HPV
Lack of circumcision with failure to maintain good hygiene
Phimosis
Age – risk inc with age
Smoking (smokers with HPV even higher risk)
HIV infection
UV light treatment for psoriasis if genitalia exposed
Testicular cancer risk factors
Undescended testicle – higher risk for both testes
Personal history of testicular cancer
Family history of testicular cancer
HIV infection
Age 20-34 years
Race: white 5 times that of blacks and more than 3 times of Asian Americans and native Americans
Androgen suppression
The hernia is described as indirect if it lies __________ the inguinal canal
within
Indirect hernia on one side strongly suggests a possibility of __________________ herniation
bilateral
If a bulge is felt from medial to external canal, it is a _______________ inguinal hernia
direct
Secretions from the prostate, vas deferans, and seminal vesicles contribute to the __________________
seminal fluid
Systemic illnesses to look out for in patients with STI’s
fever
dysuria
joint pain
conjunctivitis
