Male Genitalia Flashcards
What forms the dorsum and sides of the penis?
corpora cavernosa
Which part of the penis contains the urethra?
corpus spongiosum
The corpus spongiosum expands at its distal end to form the _____ ___.
glans penis
The urethral orifice is a slitlike opening located ____mm ____ to the tip of the glans.
2; ventral
Unless circumcised, what covers the glans?
the prepuce
In an uncircumcised penis, what is formed by the secretion of sebaceous material by the gland and the desquamation of epithelial cells from the prepuce
smegma
What is the appearance of smegma?
cheesy white lateral on the glans in the fornix of the foreskin
What is contained in each pendulous sac?
a testis
epididymis
spermatic cord
cremasteric muscle
What is the muscle that allows the scrotum to relax or contract?
cremasteric muscle
What temperature is required for spermatogenesis?
lower than 37 degrees C
What is responsible for the production of spermatozoa and testosterone?
testicles
What is the size of the adult testis?
ovoid
4x3x2 cm
What is a soft, comma-shaped structure located on the posterolateral and upper aspect of the testis?
epididymis
What is the function of the epididymis? (3)
storage
maturation
transit of sperm
The vas deferens begins at the ____ ____, ascends the ____ ___, travels through the ____ ___ and unites with the ____ ____ to form the _____ _____.
tail of the epidydimis spermatic cord inguinal canal seminal vesicle ejaculatory duct
What produces the major volume of the ejaculatory fluid which contains fibrinolysin?
prostate gland
What is the role of fibrinolysin?
an enzyme that liquefies the coagulated semen, a process that may be important for satisfactory sperm motility
Where so the seminal vesicles extend?
from the prostate onto the posterior surface of the bladder
What causes erection of the penis?
the two corpora cavernous become engorged with 20-50mL of blood
What causes the increased blood supply in erection?
arterial dilation and decreased venous outflow
the 2 processes of erection are under the control of what?
the autonomic nervous system and occur because of the local synthesis of nitric oxide
Ejaculation during orgasm consists of the emission of secretions from what?
vas deferens
epididymides
prostate
seminal vesicles
What happens after orgasm that causes subsidence of the erection?
constriction of the vessels supplying blood to the corpora cavernosa
How is pubic hair affected in older adults?
it becomes finer and less abundant, possibly pubic alopecia
How is the scrotum affected with aging?
more pendulous
How is an erection and orgasm affected in older adults?
erection may develop slowly and orgasm may be less intense
When is the HPV vaccination recommended through the age of 26?
men who have sex with men
compromised immune systems
What are common causes of change in frequency of sexual activity or desire?
loss of spouse or partner no partner restrictive environment depression physical illness resulting in fatigue, weakness or pain
What are the common causes of change in sexual response in older adults?
longer or inability to achieve full erection less forceful ejaculation rapid detumescence longer interval between erections prostate surgery
What are the risk factors of penile cancer?
infection with HPV
lack of circumcision with failure to maintain hygiene
phimosis
age
smoking
HIV infection
UV light treatment of psoriasis if genitalia exposed
What are the risk factors of testicular cancer?
undescended testicles (risk elevated for both) personal history (opposite testes) family history HIV infection 20-34 years Whites (5x blacks) androgen suppression (transgender women)
What is the biologic male escutcheon pattern?
hair abundant in the pubic region and may continue in a narrowing midline pattern to the umbilicus
What is it called when the foreskin is tight and cannot be retracted?
phimosis
What are causes of phimosis?
occur during the first 6 years of life as a result of recurrent balanitis or balanoposthitis
poorly controlled DM (MC)
previous unsuccessful efforts to retract the foreskin that have caused radial tearing of the preputial ring, resulting in adhesions
What is balanitis
inflammation of the glans penis
What is balanoposthitis?
inflammation of the glans penis and prepuce
What does bright erythema or discharge indicate of the urethral meatus?
inflammatory disease
What does a pinpoint or ROUND opening indicate of the urethral meatus?
meatal stenosis
If there is discharge with striping the urethra what might that indicate?
STI
What is prolonged penile erection called?
priapism
What are the causes of priapism?
Majority are idiopathic
leukemia
hemoglobinopathies such as sickle cell
medications for impotence
What might indicate an inflammatory process in the scrotum?
reddened scrotal skin in someone who is not red headed
What makes the scrotum asymmetric?
the left testicle has a longer spermatic cord and therefore is lower
What causes variation in the thickness of the scrotum?
temperature and age
What are small lumps on the scrotum that may enlarge and discharge oily material?
sebaceous cysts or epidermoid cysts
What is the consequence of general fluid retention associated with cardiac, renal or hepatic disease?
unusual thickening of the scrotum caused by edema, often with pitting
When examining for a hernia, what area should be inspected when the pt is bearing down?
area of the inguinal canal and the region of the fossa ovalis
After having the ft relax where should you insert your examining finger for a hernia?
into the lower part of the scrotum and carry it upward along the vas deferens into the inguinal canal
If bowel sounds are present with a hernia what does that indicate?
uncomplicated reducible hernias
If an inguinal hernia is present what will you feel when using finger to feel the oval external ring?
As the patient coughs, you will feel the sudden presence of a bulge against the finger
What is an indirect inguinal hernia?
it lies within the inguinal canal or it may come through the external canal and pass into the scrotum
An indirect hernia on one side strongly suggests…
possibility of bilateral herniation, so examine both sides
Where is a DIRECT inguinal hernia felt?
felt medial to the external canal
When might testis be totally insensitive to painful stimuli?
diseases such as syphilis and diabetic neuropathy
Irregularities in texture and size of the testes may indicate what?
infection, a cyst or a tumor
Unexpected findings of the vas deferens might indicate what?
diabetes or old inflammatory changes, especially TB
What is a protrusion of a peritoneal lined sec through some defect in the abdominal wall?
hernia
What type of hernia arise along the course that the testicle traveled as it exited the abdomen and entered the scrotum during intrauterine life
inguinal hernia
What type of hernias occur at the fossa ovalis, where the femoral artery exits the abdomen?
femoral hernia
What type of hernia occur when the blood supply to the protruded tissue is compromised?
strangulated hernias
What type of hernias may have pain on straining?
indirect or femoral
What type of hernia has soft swelling in area of internal ring; hernia comes down and touched fingertip on examination?
indirect inguinal
What type of hernia is bulge in the area of Hesselbach triangle; easily reduced; bulges anteriorly and pushes against side of finger on exam?
direct inguinal
What type of hernia had inguinal canal empty on examination?
femoral
What type of hernia is non reducible; this condition requires prompt surgical intervention?
strangulated hernia
What is the most common type of hernia; both genders are affected, often children and young males
indirect inguinal
What type of hernia occurs more often in males and those older than 40 years of age?
direct inguinal
What is the least common type of hernia that occurs more often in females?
femoral hernia
What type of hernia has a right sided presentation that is more common than left; pain may be severe?
femoral hernia
What is almost always an iatrogenically or inadvertently induced condition caused by retracting the prepuce and then inadvertently leaving it in its retracted position?
paraphimosis
What is it called when the foreskin becomes trapped behind the corona for a prolonged period, a constricting band forms around the penis and impairs blood and lymphatic flow to the glans penis and prepuce?
paraphimosis
What can happen if paraphimosis is left untreated?
necrosis and gangrene of the glans penis may be present (discolored, blackened, ulcerated)
What is a skin lesion associated with primary syphilis (bacterium Treponema palladium)?
chancre
How is chancre contracted?
through direct contact with a syphilis sore
When do lesions of primary syphilis occur?
2 weeks after exposure
What is a painless solitary lesion that is firm, round and small commonly located on the gland but can be located on the foreskin. It has indurated borders with a clear base?
chancre
When scrapings are taken from a chancre, what is seen when examined microscopically?
spirochetes
What is the most common cause of genital herpes?
HSV-2 virus
When does most transmission of HSV occur?
in the absence of symptoms
What are painful lesion of the penis, genital area, perineum and may report burning or pain with urination?
genital herpes
What are superficial vesicles on the glans, penile shaft, at the base of the penis or around the anus?
genital herpes
What is often associated with genital herpes?
inguinal lymphadenopathy and system symptoms such as fever
What is it called when HPV invades the basal layer of the epidermis; virus penetrates through skin and causes mucosal micro abrasions?
condyloma acuminata
When do condyloma acuminatas develop (HPV)?
after months to years of latency, viral DNA capsids and particles are produced. host cells become infected and develop skin lesions
What are soft painless wartlike lesions on penis, single or multiple papular lesions?
condyloma acuminata
What lesions can be pearly, filiform, fungating, cauliflower, or plaque like?
condyloma acuminata
What lesions can be smooth, verrucous, or lobulated and may be the same color as the skin or reddish or hyper pigmented?
condyloma acuminata
What is a sexually transmitted infection of the lymphatics caused by Chlamydia trachomatis?
Lymphogranuloma Venereum
What organism enters the skin through breaks and abrasions or crosses the epithelial cells of the mucous membrane, to travel via lymphatics to LN where it replicates within macrophages?
Lymphogranuloma Venereum caused by Chlamydia
What presents as an initial lesion that is a painless erosion at or near the coronal sulcus?
Lymphogranuloma Venereum caused by Chlamydia
What can be the result of Lymphogranuloma Venereum caused by Chlamydia if untreated?
if lymphatic drainage blocked penile and scrotal lymphoma may ensue
draining sinus tract
What is a viral infection of the skin and mucous membranes that is caused by poxvirus that infects only the skin? (considered STI in adults)
molluscum contagiosum
How is molluscum contagiosum spread?
skin to skin contact or by contact with an object that has touched infected skin. virus enters the skin through small breast in skin barrier
What presents as pearly gray, often umbilicate, smooth dome-shaped with discrete margins on the penis?
molluscum contagiosum
Where are molluscum contagiosum lesions most common?
glans penis
What is penile cancer associated with?
HPV 16 &18
Who rarely develops penile cancer?
pts who have been circumcised
How do penile cancer lesions start?
as superficial neoplasms of the prepuce or glans penis and then progress to invade the corpora cavernous and urethra with subsequent development of mets to inguinal LN
What is a benign cystic accumulation of sperm occurring on the epididymis?
spermatocele
What is the presentation of a spermatocele?
asymptomatic, non tender mass at epididymis usually smaller than 1 cm
What is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord?
varicocele
Why is a varicocele more common in the left testicle?
the angle at which the left testicular veins enters the left renal vein,
the lack of effective anti reflux valves at the juncture of the testicular vein and renal vein, and
the increased renal vein pressure due to its compression between the superior mesenteric artery and the aorta.
Why is a varicocele associated with reduced fertility?
from increased venous pressure and elevated testicular temperature
What is commonly called “a bag of worms”?
varicocele
What are the gradings of a varicocele?
small: palpated only during Valsalva maneuver
moderate: easily palpated without valsava
large: causing visible bulging of the scrotum
What is acute inflammation of the testis secondary to infection?
orchitis
What is acute onset of testicular pain (mild to severe) and swelling, associated with fatigue, malaise, myalgia and fever
orchitis
What can develop in older adults as a result of bacterial migration from a prostatic infection?
orchitis
Mumps orchitis follows the development of ________.
parotitis by 4-7 days
What is a major consideration in the differential of epidymitis?
testicular torsion
What is often seen with a UTI infection or STI and can be chronic as a complication of TB?
epididymitis
What is a painful scrotum, urethral discharge, fever, and pyuria
epididymitis
What type of testicular cancer arises from seminomas and nonseminomas?
germ cell
What do non-germ cell tumors arise from?
supportive and hormone producing tissue
What is the MC type of testicular cancer?
germ cell cancers
What is the most common age of germ cell tumors?
15-30 years old
