Week 13: Assessing the Penis, Rectum, and Prostate

Question 1

Structure and function

Answer 1

External genitalia: Penis – urination, reproduction, and pleasure

Inguinal area – frequent site of hernia development

Question 2

Chief concerns

Answer 2

CC:
1. Pain

2. Hematuria
3. Voiding symptoms
4. Erectile dysfunction

Question 3

Prostate CA

Answer 3

PRIMARY risk factors:

1. Increased age
2. Black ancestry – societal factors and access to quality care (rather than genetics)
3. FHX

MODIFIABLE risk factors:

1. Decrease BMI
2. Increase physical activity
3. Increase ejaculation frequency

Prostate CA S/S:

1. Trouble urinating
2. Decreased force in stream of urine
3. Hematuria
4. Hematospermia
5. Swelling in the legs
6. Discomfort in the pelvic area
7. Bone pain

Question 4

Trans pts

Answer 4

Special considerations
1. BINDING of the chest (trans men) – skin breakdown

2. TUCKING of the testicles and penis (trans females) – complications of skin breakdown at perineum

**No difference in CA rates – if an individual has a particular body part or organ and meets screening criteria based on risk factors and symptoms, screening should proceed regardless of hormone use

Question 5

Testicular CA

Answer 5

Carries a high mortality rate, especially if not detected early

Recommend: Testicular exam as part of routine CA-related check-up AND monthly TSE

Question 6

Physical assessment: Penis

Answer 6

Penile abnormalities:
1. SYPHILITIC CHANCRE – Painless small, silvery-white papule that develops into red, oval ulceration; May be misdiagnosed as herpes

2. HERPES PROGENITALIS – Painful cluster of clear, pimple-like, vesicles that erupt and become ulcers; Caused by HSV 1 or 2; Disappear, and infection remains dormant with frequent/minimally episodic recurrences
3. GENITAL WARTS – Painless single or multiple, moist, fleshy papules; Caused by HPV
4. CA of the GLANS PENIS – Painless hardened nodule or ulcer on the glans; Occur primarily in uncircumcised men
5. PHIMOSIS: Foreskin cannot be retracted
6. PARAPHIMOSIS: Foreskin cannot return when retracted
7. HYPOSPADIAS: Opening of the urethra is on the underside of the penis (EPISPADIAS – top of glans)
8. PEYRONIE’S DISEASE: Painful abnormal curvature of an erect penis

Question 7

Physical assessment: Scrotum

Answer 7

Scrotal abnormalities:
1. HYDROCELE – Collection of serous fluid in the scrotum; Will transilluminate (HEMATOCELE – blood)

2. TESTICULAR TUMOR – Initially small, firm, nontender nodule; S/S: Heavy feeling
3. SCROTAL HERNIA – Loop of bowel protrudes into the scrotum, appearing as swelling in scrotum
4. CRYPTOCHIDISM – Failure of one or both testes to descend into scrotum; Increased risk of testicular CA
5. EPIDIDYMITIS – Scrotum appears enlarged, reddened, swollen, and tender upon palpation; Usually associated with prostatitis or bacterial infection

Question 8

Physical assessment: Anus and rectum

Answer 8

Anorectal abnormalities:
1. ANAL FISSURE – Caused by trauma and often presents with a swollen skin tag (sentinel tag) below the fissure; S/S: Pain, itching, bleeding

2. ANORECTAL FISTULA – Small round opening from the anus or rectum out to the skin
3. RECTAL PROLAPSE – Mucosa of the rectum protrudes out through the anal opening, appearing as a red, doughnut-like mass
4. PILONIDAL CYST – Congenital disorder characterized as a small dimple or cyst/sinus that contains hair; often by the tailbone
5. RECTAL POLYPS – Abnormal growths rising from the lining of the rectum; may be flat (sessile) or develop on a stalk (pedunculate)