PHYSICAL EXAMINATION OF THE MALE GENITALIA Flashcards
HPI considerations
Difficulty achieving or maintaining erection.
Ask patients about
- pain with erection,
- pattern of erection with one or more partners,
- alcohol and medication ingestion,
- erections unrelated to sexual stimulation,
- curvature of erect penis.
HPI considerations
Difficulty with ejaculation
Pertinent data include:
- painful or premature ejaculation
- color and consistency of fluids,
- medications used on a regular basis.
HPI considerations
Discharge or lesions on the penis.
Note the…
- character of lesion (lumps, sores, rashes)
- discharge (color, consistency, odor).
- Record any associated symptoms (e.g., itching or burning),
- exposure to sexually transmitted infections,
- medications used.
HPI considerations
Infertility.
Patients reporting problems with conceiving should be assessed for
- lifestyle factors (e.g., hot tub use),
- length of time attempting pregnancy,
- knowledge of fertile period of woman’s reproductive cycle,
- incidence of undescended testes,
- previous diagnostic studies (e.g., semen analysis or sperm antibody titers)
- medications used.
HPI considerations
Enlargement in inguinal area.
Questions relevant to:
- enlarged inguinal area address pain associated with lifting,
- change in size or character of mass,
- groin pain,
- use of truss or other treatment,
- medications used.
HPI considerations
Testicular pain or mass.
Patients should be assessed for:
- changes in testicular size,
- events surrounding onset (e.g., sporting event),
- any irregular lumps,
- soreness,
- heaviness of testes,
- medications used.
Past Medical History considerations
Pertinent data include:
- previous genitourinary tract surgeries (e.g., surgery to correct hypospadias or hernia),
- sexually transmitted infections
- chronic illnesses (e.g., prostatic cancer, arthritis, or neurologic or -vascular impairment).
Family History Considerations
Data should be collected on:
- any infertility problems in siblings,
- hernias in family members,
- family history of prostate, testicular, or penile cancer.
Personal and Social History
Relevant data include
- employment risks (e.g., exposure to toxins),
- exercise patterns,
- concerns about genitalia,
- testicular self-examination practices,
- concerns about sexual practices,
- reproductive function (number of children, form of contraceptive use),
- use of medications, alcohol, or street drugs that may interfere with sexual response.
HPI considerations in older adults
Relevant data include:
- sexual activity patterns
- any changes in sexual response or desire.
HPI considerations in Adolescents.
Relevant data include knowledge of:
- reproductive function,
- presence of nocturnal emissions,
- enlargement of genitalia,
- sexual activity patterns,
- use of contraceptives,
- concerns of sexual abuse.
HPI considerations for Infants and children
-Information should be gathered on maternal use of sex hormones or birth control pills during pregnancy.
-Circumcised infants should be assessed for any complication from the procedure.
-Pertinent data for uncircumcised infants include hygiene measures and retractability of foreskin.
-Congenital anomalies (e.g., epispadias) and any incidence of scrotal swelling when infant is crying or having bowel movements
should be recorded.
-Notation should also be made of any swelling, discoloration, sores on penis or scrotum, and genital pain.
-Questions should be asked about any concerns with masturbation, sexual exploration, or sexual abuse.
Erection of the penis occurs when the two corpora cavernosa become engorged with _______ mL of blood in response to the autonomic nervous system.
20 to 50 mL
True/False
Examination
Patient may be lying or standing.
Examination of the genitalia involves…
- inspection,
- palpation, and
- transillumination of any mass found.
Findings associated with disorders: Adults
Pinpoint opening suggests…
meatal stenosis
Findings associated with disorders: Adults
a prolonged and often painful penile erection, may suggest a more serious condition.
Priapism
Findings associated with disorders: Adults
Beaded or lumpy vas deferens suggests…..
diabetes, tuberculosis, or inflammatory changes.
Findings associated with disorders: Adults
The hernia is described as _____ if it lies within the inguinal canal.
indirect
_______ is the inability to replace the foreskin to its usual position after it has been retracted behind the glans.
Paraphimosis
Findings associated with disorders: Adults
Uncircumcised males may have ______ as a result of nonretractable foreskin.
-this results from infection.
-Penile discharge suggests inflammation or infection
balanoposthitis
_______ is a congenital defect in which the urethral meatus is located on the ventral surface of the glans, penile shaft, or the perineal area.
Hypospadias
__________ generally occurs 2 weeks after exposure. Most commonly located on the glans. Painless lesion has indurated borders with a clear base.
Syphilitic chancre lesion of primary syphilis
_______ is a viral infection that appears as superficial vesicles. Lesions may be located on the glans, penile shaft or base. Painful and associated with inguinal lymphadenopathy
Herpes
_______ is a soft, reddish lesion that arises because of infection with a papovavirus. The lesions are commonly present on the prepuce, glans penis. The lesions may undergo malignant degeneration to squamous cell carcinoma.
Condyloma acuminatum
_________ is an STI caused by a chlamydial organism. The lesions appear on the genitalia. The initial lesion is a painless erosion at or near the coronal sulcus.
Lymphogranuloma venereum
_______ is an STI caused by a poxvirus. The lesions are pearly gray, often umbilicated, smooth, dome shaped, with discrete margins.
Molluscum contagiosum
__________ is characterized by a fibrous band in the corpus cavernosum that results in deviation of the penis during erection.
Peyronie disease
__________ is cancer of the penis. Generally squamous and tend to occur in uncircumcised men, who practice poor hygiene. Often appears as a painless ulceration.
Penile carcinoma
is a nontender, smooth, firm mass that results from fluid accumulation in the tunica vaginalis. The mass will transilluminate.
Hydrocele
_________ is a cystic swelling occurring on the epididymis.
Spermatocele
___________ is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord. Most common on the left side and is painful. Occurs in boys and young men and associated with reduced fertility.
Varicocele
_____________ an acute inflammation of the testis, orchitis is uncommon except as a complication of mumps in the adolescent or adult.
Orchitis
________ is inflammation of the epididymis is often seen in association with a urinary tract infection. The epididymis is exquisitely tender and overlying scrotum may be marked erythematous.
Epididymitis
____________________ is a surgical emergency occurring most commonly in adolescents. It has acute onset and is often accompanied by nausea and vomiting.
Testicular torsion
___________________ is a neoplasm arising from the testicle appears as an irregular, nontender mass fixed on the testis. It does not transilluminate and is the most common in males.
Testicular tumor
Varying degrees of maturation should be classified according to the _________
Tanner stages.
Femoral hernias occur at the______, where the femoral artery exits the abdomen and are more common in __________
- fossa ovalis
- females than males.
