Questions and Answers
What is testicular torsion?
Sudden twisting of the spermatic cord, usually due to direct trauma.
What are common symptoms of testicular torsion?
Excruciating unilateral pain, usually sudden onset, lower abdominal pain, nausea/vomiting.
At what age do most testicular cancers typically occur?
Which of the following increases the risk of hernias? (Select all that apply)
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What are the three columns of tissue in the shaft of the penis?
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Undescended testis does not increase the risk of testicular cancer.
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What is the average size of the ovaries?
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What are common symptoms of prostatitis?
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What is a common symptom of benign prostatic hypertrophy (BPH)?
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The __________ is the tissue between the introitus and anus.
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The glans of the penis is covered by a loose fold of skin called the prepuce only if the penis is circumcised.
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Most prostate cancers are diagnosed after age ______.
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Which demographic is most likely to be diagnosed with prostate cancer?
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What is the term for the hollow tube extending upward and posteriorly between the urethra and rectum?
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What is the average age of menopause in the US?
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What should you note during a perianal inspection?
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What examination technique is performed for the prostate exam?
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The two lateral lobes of the prostate are separated by the __________.
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What should the external genitalia of the biologic female appear like after vaginal birth?
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The anal canal is about 3.8 cm long in adults.
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What is the term for when loops of bowel force their way through weak areas of the inguinal canal?
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Which of the following is NOT a part of the female external genitalia?
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What is the primary function of the Bartholin's glands?
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Study Notes
Biologic Female External Genitalia
- Mons pubis is a fat pad covered with hair, located over the symphysis pubis.
- Labia majora are rounded fat-folds, while labia minora are thinner and form the prepuce and clitoris anteriorly.
- Vestibule is the space between the labia minora, and includes the vaginal opening (introitus), which can be covered by the hymen in some individuals.
- The perineum is the tissue between the introitus and anus.
- Urethral meatus opens into the vestibule, located between the clitoris and vagina; Bartholin’s glands open near the vaginal opening to secrete lubricating mucus.
Biologic Female Internal Structures
- Vagina is a hollow tube extending from the urethra to the rectum, lined with transverse folds (rugae).
- Uterus is a fibromuscular structure shaped like an inverted pear, divided into body and cervix.
- Fallopian tubes extend from the uterus to the ovaries, which are almond-shaped, approximately 3.5 x 2 x 1.5 cm, and usually palpable during reproductive years.
- Adnexa refers to ovaries, fallopian tubes, and supporting tissues.
Biologic Male Anatomical Structures
- Penile shaft consists of three columns of tissue: one corpus spongiosum and two corpora cavernosa.
- The glans penis is the expanded end of the corpus spongiosum, covered by the prepuce if uncircumcised, where smegma may accumulate.
- Urethra opens into the vertical urethral meatus.
Biologic Male Lower Genitourinary Tract
- Testes are ovoid structures, approximately 4.5 cm long, where the left testis typically lies lower than the right; they produce sperm and testosterone.
- Scrotum is a pouch divided into two compartments, each containing a testis, with the epididymis located on the posterolateral surface for sperm storage and maturation.
- Vas deferens ascends within the spermatic cord and connects to the seminal vesicle before entering the urethra.
Inguinal Area
- Key landmarks: anterior superior iliac spine, pubic tubercle, inguinal ligament.
- Inguinal canal forms a tunnel for the vas deferens; hernias can occur if loops of bowel push through weak areas.
Anus & Rectum
- The rectum is approximately 12 cm long and dilates to form the rectal ampulla.
- Anal canal, about 3.8 cm long, is lined with modified skin and merges with rectal mucosa at the anorectal junction.
- Surrounding sphincters: internal (involuntary) and external (voluntary).
- Anal columns are folds of mucosa that contain associated arteries and veins, which can enlarge and form hemorrhoids.
Biologic Male Prostate and Rectal Structures
- The prostate is a rounded, heart-shaped gland about 2.5 cm long, located against the anterior rectal wall, palpable on examination.
History and Culturally Sensitive Interview Tips
- Establish patient’s name and pronouns; be respectful and avoid assumptions.
- Explore gender identity and sexual history with open-ended questions, ensuring comfort.
- Inquire about physical, sexual, or emotional violence, concerns for safety, and mental health.
- Assess history of genitourinary issues, sexual partners, practices, and parental desire.
Menstrual and Physical Exam History
- Document age of menarche; normal occurrence is 9-16 years.
- Patterns include cycle frequency (healthy range: 24-32 days), duration (3-7 days), and flow heavy criteria (pads/tampons).
- Evaluations should involve pelvic or rectal examinations in appropriate positions while ensuring patient comfort and privacy.
Abnormal Conditions
- Testicular torsion: excruciating unilateral pain; high urgency for surgical intervention.
- Varicocele: dilated internal spermatic vein presenting as a dragging sensation.
- Testicular cancer: firm, painless lump; greater incidence in males aged 18-35 with family history.
- Hernias more likely in biologic males, exacerbated by age and heavy lifting.
Transgender Patient Considerations
- Trans males may experience anxiety during pelvic exams; hypo-estrogen states can lead to vaginal issues.
- Trans females may require special instruments to assess vaginoplasty results and inspect for skin changes.
Rectal Health Assessment
- Routine bowel habits and colorectal screening should be discussed alongside medications and family history to identify potential rectal conditions.### Self-Care Behaviors
- A diet rich in high-fiber foods is recommended to promote bowel health.
- Recent examinations are crucial for monitoring gastrointestinal changes.
Review of Systems
- Monitor for alterations in bowel habits, such as frequency and consistency.
- Symptoms to note include rectal bleeding, itching, pain, constipation, diarrhea, and stool incontinence.
Perianal Inspection
- Skin around the anus should appear smooth and without lesions.
- Anal opening characteristics include moisture, coarse folded skin, and pigmentation darker than surrounding skin.
- The anal opening should be tightly closed, without lesions or protrusions.
Anus and Rectum - Palpation
- Palpation involves gently inserting a gloved finger into the anus to check for hemorrhoids and masses.
- Occult blood screening may be conducted using a hemoccult test, if necessary.
- Discuss findings with the patient only after they are dressed.
Biologic Male - Prostate Exam
- First prostate exam recommended at age 50, per American Cancer Society (ACS) guidelines.
- Palpation requires locating the median sulcus and examining the prostate in a fanlike motion.
- A normal prostate is approximately 2.5 cm by 4 cm, non-protruding, heart-shaped, and slightly mobile.
Prostate Abnormalities
- Prostatitis: Characterized by a tender, enlarged prostate and dull perineal pain, often due to bacterial infection.
- Benign Prostatic Hypertrophy (BPH): Presents with urinary frequency, urgency, and symmetric enlargement, typically in middle-aged men.
- Prostate Cancer: Symptoms include weak urinary stream, nocturia, and continuous pain; detected initially as a hard nodule, leading to an asymmetrical examination.
Prostate Cancer Risk Factors
- Age: Most diagnoses occur in men over 50, particularly after age 65.
- Family History: Increased risk when a family member was diagnosed before age 60; 5-10% of cases have a genetic link.
- Ethnicity: Higher incidence in Black/African American individuals, who also face later stage diagnoses.
- Lifestyle: Being overweight and consuming a high-fat diet can increase risk.
Documentation
- Patient history includes menarche at age 11 and menstrual cycles occurring every 28 days with moderate flow.
- No sexual activity or interest reported, with a history of sexual abuse and lack of STI testing.
- Physical examination findings include normal vulva, mild cystocele, and no abnormalities in the rectal exam. Hematest for stool is negative, indicating no blood present.
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Description
This quiz focuses on the anatomy of the biologic female external genitalia, including the vulva, labia, clitoris, and vestibule. It is designed for healthcare professionals and students studying anatomy and physiology. Enhance your understanding of female anatomy with this comprehensive review.
