module 19 male genital Flashcards
older adults changes
change in sexual desire or activity change in sexual response longer time to achieve full erection less forceful ejaculation longer interval between erections
infants and children
congenital anomalies/incomplete development sexual ambiguity urethral placement retractability of foreskin (after 4) testicles descended masses
older adults physical exam
pubic hair finer and less abundant
pendulous scrotum
hernia patho
protrusion of the peritoneal-lined sac through some defect in the abdominal wall
Inguinal hernia
arise along the course that the testicle traveled as it exited the abd and entered the scrotum during intrauterine life.
femoral hernia
occur at the fossa ovalis, where the femoral artery exits the abdomen
strangulated hernia
occur when the blood supply to the protruded tissue is compromised
hernia subjective
soft swelling or bulge in inguinal area
may have pain on straining (indirect, femoral)
hernia objective
indirect: soft swelling in area of internal ring: hernia comes down canal and touches fingertip on exam
direct: bulge in area of hesselbach triangle, easily reduced, hernia bulges anteriorly, pushes against side of finger on exam
paraphimosis patho
inability to replace the foreskin to ususual position after it has been retracted behind the glans
paraphimosis subjective
retraction of foreskin during exam, cleaning, urethral cath, or cystoscopy
penile pain and swelling
children may report obstructive voiding s/s
paraphimosis objective
glans penis congested and enlarged
foreskin edematous
constricting band of tissue directly behind the head of the penis
chancre patho
skin lesion associated with primary syphilis
- generally appears 2wks after exposure
chancre subjective
painless lesion on penis
hx of sexual contact
chancre objective
solitary lesion - firm, round, small, commonly located on the glans but can be on foreskin indurated borders with a clear base scrapings from the ulcer -> microscope: spirochetes
genital herpes patho
STI caused by HSV
- most transmission of HSV occurs when individuals shed virus in the absence of s/s
genital herpes subjective
painful lesion on penis, genital area, perineum
hx of sexual contact
poss. burning or pain with urination
genital herpes objective
superficial vesicles on the glans, penile shaft, at the base of the penis, or around the anus
often assoc. with inguinal lymphadenopathy and systemic s/s including fever
condyloma acuminata patho
genital warts caused by HPV
- invades basal layer of epidermis, penetrates through skin and causes mucosal microabrasions.
Latent phase: no s/s month to several years
condyloma acuminata subjective
soft painless wart like lesions on penis
hx of sexual contact
condyloma acuminata objective
single or multiple papular lesions
- pearly, filiform, fungating cauliflower, or plaquelike
- smooth, verucous, or lobulated
- same color as skin, or reddish, or hyperpigmented
- lesions could be present within the urethra as well
lymphogranuloma venereum patho
STI of the lympatics
- caused by chlamydia trachomatis
- enters through skin breaks
- > initial lesion at site of entry
- > travels via lymphatics to regional lymph nodes
lymphogranuloma venereum subjective
painless lesion on penis
s/s: fever, malaise
hx sexual contact
lymphogranuloma venereum objective
initial lesion is painless erosion at or near the coronal sulcus
enlarged regional lymph nodes
- drainage blocked: penile and scrotal edema
draining sinus tract in untreated infection
molluscum contagiosum patho
viral infection of the skin and mucous membranes
STI in adults
- poxvirus that infects only the skin
molluscum contagiosum subjective
painless lesions on penis
contact with infected person
molluscum contagiosum objective
lesions are pearly gray, often umbilicated, smooth, dome-shaped and with discrete margins
peyronie disease patho
fibrous band in the corpus cavernosum
- dense, fibrous scar tissue forms in the tunica albuginea
- interferes with expansion of the corpus cavernosum during erection
peyronie disease subjective
bending and/or indentation of the erection
loss of penile length
poss. pain with erection
family hx. of conditon
hx of dupuytren contraction (finger joint flexion)
peyronie disease objective
one or more palpable hardened area
reduced elastitiy of the flaccid penis
radiography or US show plaque calcification
Penile cancer patho
almost all cases are squamous cell carcinoma usually originating in the glans or foreskin
- HPV: 16 and 18
- superficial neoplasms of prepuce or glans penis -> corpora cavernosa and urethra -> metastases to the inguinal lymph nodes
penile cancer subjective
painless ulceration that fails to heal
uncircumcised
poor penile hygiene
penile cancer objective
lesion, usually on glans
papule or pustule
warty growth, shallow erosion, or deep ulceration with rolled edges
may have phimosis that obscures the lesion
