penis

3 cylindrical columns of erectile tissue

2 corpora cavemosa

make up the dorsal side of the penis

1 corpus spongiosum

make up the ventral side of the penis; expands into a cone of erectile tissue glans

glans

joins shaft at corona

urethra

goes through the corpus spongiosum and forms meatus

meatus

slit at the glans tip

foreskin/prepuce

hood or flap of skin over glans

scrotum

loose sac continuation of abdominal wall

cremaster muscle

controls the size of the scrotum in response to temperature to keep 37 degrees or lower

testis

produce sperm; solid oval shape 4-5cm long 3cm wide; suspend vertically by the spermatic cord; covered by double layer membrane separating from the scrotal wall; layers lubricated to allow testis to slide and prevent injury

left testis

the lower of the two testes

epididymis

coiled duct system that provides for storage maturation and transit of sperm ; sits atop the testis; comma shaped, curved over the top and posterior surface of the testis

vas deferens

a duct which with other vessels forms the spermatic cord

spermatic cord

ascends posterior border of testis; runs through tunnels of inguinal canal into abdomen; unites with seminal vesicle to form ejaculatory duct at level with prostate

erection

arterial dilation with concurrent venous constriction of emissary veins; sympathetic inhibition and parasympathetic activation; release of pro-erectogenic neurotransmitters

acetylcholine

parasympathetic neurotransmitter during erection

norepinephrine

sympathetic neurotransmitter during erection

smooth muscle relaxation

reduced intracellular calcium increased cGMP and increased cAMP

corpora cavernosa

fills with 20-40x blood flow during erection and pressure averages 100mmHg

corpora spongiosum

fills during erection with less blood and 1/3 the pressure of the other

ischiocavernosus and bulbospongiusus

muscles that increase pressure in all three chambers; the muscles force more blood into chamber increasing pressure to several hundred mmHg

bladder neck muscles

contract to prevent retrograde seminal flow and urinary output

7.2-8

semen pH

4.6-8

urine pH

detumescence

occurs during and after ejaculation; transient increased pressure of smooth muscle contraction against occluded venous system; emissary veins expand and allow sinusoids to drain with a fast drop in pressure; norepinephrine released as sympathetic impulse takes over; calcium channels close, smooth muscle relaxes

emissary veins

expand during and after ejaculation and allow sinusoids to drain with a fast drop in pressure

norepinephrine

released as sympathetic impulse takes over

PDE5

inhibits erection by degrading cGMP

PDE5 inhibitors

result in smooth muscle relaxation increasing cGMP and decreased intracellular calcium

complaints of frequency, burning, urgency, and pain; discharge or change in stream, hesitancy, straining, hematuria, color, odor, loss of urine when laughing or sneezing, h/o infections, lesions, lump or swelling, safety (sex issues and preference), difficulty having or maintaining erections

male genitalia health history cues

14-35

age of concern for chlamydia

12-25

age of concern for testicular torsion

15-35

age of concern for varicocele

16-35

age of concern for testicular cancer

<35

age of concern for NG urethritis

>30

age of concern for hydrocele

50+

age of concern for testicular lymphoma

50+

age of concern for erectile dysfunction

>65

age of concern for bacteriuria

STI, UTI, Tanners stage, cancer, trauma, BPH, congenital deformity (hypospadias), impotence

past medical history concerns males

varicocele, testicular cancer, hypospadias, mother's use of DES

family history concerns males

ETOH, tobacco, drugs, sexual practice, sleep, diet, exercise, self exam

social history concerns males

antibiotics, hormone replacement, HTN, psychotropic

medication concerns males

phimosis

inability to retract foreskin

paraphimosis

unable to return foreskin to original position

hypospadias

ventral location of meatus

epispadias

dorsal location of meatus

chrodee

congenital condition; downward deflection occurring on its own or with hypospadias; noticeable most from the side; a contraindication to circumcision in newborn-instead can be done at surgical correction

Peyronie's disease

fibrous scar tissue on penis causes curvature and pain with erection in adult

condyloma acuminata

genital warts caused by HPV

condyloma lata

flat warts second stage of syphilis

epididymitis

what to consider when nodule, tenderness, swelling on inspection/palpation

variocele

dilated veins in spermatic cord; bag of worms texture; with patient standing what to consider when thickened cord, soft swollen tortuous on inspection/palpation

hernia

bulge extending into scrotum

tumor

firm non tender mass that does not transilluminate

orchitis

painful swollen testes

hydrocele

serous fluid around testes, transilluminated with red glow

spermatocele

cystic mass in epididymis, transilluminates separate from testis

cryptorchidism

undescended testis (risk of cancer and infertility)

testicular torsion

excruciating one sided testicular pain, sudden swelling, testicle elevation, nausea and vomiting, sometimes abdominal pain, fever, and previous history of testicular pain; mostly in 12-18 year olds, many under 30, can be any age including newborns; urologic emergency that must be treated within 4-6 hours to spare the testicle

blue dot sign

seen with torsion of the appendix testis; mullein duct remnant superior aspect of the testicle; often treated with analgesics, cooling, and decreased activity

hydrocele

common in newborns, but usually goes away within the first year; testicle drops into scrotum, a sac from abdominal cavity travels along with testicle; fluid flows to the scrotum to surround the testicle, sac usually closes and fluid is absorbed

noncommunicating hydrocele

when sac closes and fluid remains the scrotal sac can be compressed fluid will not flow back into the abdomen; often found in newborns and fluid will usually be absorbed with time

communicating hydrocele

scrotal sac is compressed and fluid slowly goes back up into the abdomen or hydrocele changes size; usually appears after activity indicating the sac or processes vaginalis is still open and requires intervention

hernia

inspect inguinal region for bulge with standing, palpate canal on each side; start finger low on scrotal half, palpate up length of cord to external ring triangular slit like opening; if finger fits advance gently and have patient bear down or cough; normally no bulge or change, palpating mass bumps finger

no tenderness, lesions, inflammation, or discharge from circumcised penis, testes descended bilaterally, no pain, masses, transillumination, no inguinal hernia bilaterally

male genitalia documentation

prostate

3.5 x 3 cm gland below bladder encircling urethra; consists of 5 lobes; surrounds urethra at bladder neck; produces most ejaculatory fluid; secretions are thin, milky, and alkaline- the transport medium protecting sperm and preventing UTI; contains fibrolysin which liquefies semen and aids sperm motility; common site of age related issues

presents related to efficiency of urination, dull low perineal pain, rectal bleeding, change in stool, FH of cancer

health history cues for rectal, anal, prostate

50 yo, AA, FH prostate cancer, diet high in animal fat, high levels of serum testosterone

risk factors of rectum anal and prostate

50

age to begin prostate screening

45

age to begin screening if high risk: African American, 1 st degree relative diagnosed <65

40

age to begin screening if multiple first degree relatives affected at early ages

2 years

test frequency if PSA <2.5

annually

test frequency if PSA >2.5

0.2%

percentage of men and women that will be diagnosed with anal cancer at some point in their lifetime

71.3%

overall five year survival rate of anal cancer

BPH

rubbery or boggy on palpation

cancer

stony hard on palpation

prostatic abscess

fluctuant softness

2.5 x 4 cm, heart shape with palpable groove, smooth surface, elastic rubbery consistency, slightly movable, nontender to palpation

prostate exam normal findings

Grade 1

prostate protrusion 1-2cm

Grade 2

prostate protrusion 2-3cm

Grade 3

prostate protrusion 3-4cm

Grade 4

prostate protrusion >4cm