Assessing Male Genitalia and Rectum

Assessing Male Genitalia and Rectum - Objectives

• List the structures of the male genitals
• Name the major structures of the penis
• Describe the function of the cremaster muscle
• Identify the structures that transport sperm
• Relate the significance of the inguinal canal and femoral canal
• Discuss the importance of teaching testicular self-examination as health promotion
• Describe the prostate gland
• Outline structures that can be examined through the rectum
• Health promotion concepts for assessment (anus, rectum, and prostate)

Male Genitalia: Structure & Function

• External genitalia: Penis (urination, reproduction); Scrotum (loose sac maintains cooler temperature)
• Internal genitalia: Testes (sperm production); Epididymis (main sperm storage); Vas deferens (transports sperm); Spermatic cord (transports sperm)

Inguinal Area and Anus/Rectum

• Inguinal area: Located between the anterior superior iliac spine laterally and the symphysis pubis medially; potential hernia development site
• Anus and rectum: Rectal exam access to prostate
• Prostate Gland: Bilobed, round/heart-shaped, surrounds bladder neck and urethra; palpable through the anterior rectal wall; secretes thin, milky, alkaline fluid for sperm

Benign Prostatic Hyperplasia (BPH)

• Enlarged prostate gland
• Present in 80-90% of men over 60
• Hyperplasia is an imbalance between cell proliferation and programmed cell death.
• Creates bladder outlet obstruction
• Symptoms: hesitancy/dribbling/urinary frequency/weak urinary stream
• Normal prostate: heart-shaped, palpable central groove, smooth, rubbery & mobile
• BPH: enlarged, smooth, firm, central groove obliterated
• Prostate cancer: hard/fixed/irregular area

Developmental Considerations

• Tanner staging: puberty/sexual development
• Puberty typically begins in the U.S. at 9-10 years of age.
• First sign: testicle enlargement, then pubic hair development, then penis size increase.

Male Genitalia: Subjective Data (PG 690-694)

• Biographical data
• Chief complaint (followed by HPI)
• Past history (prostate cancer, blood in stool)
• Family history (cancer)
• Functional assessment (lifestyle/health practices): sexual activity, last exam, STIs/STDs, contraceptive use, colonoscopies

Objective Data

• Purpose of exam? Impairment of normal function/abnormalities
• Client preparation: May be anxious/embarrassed, empty bladder, change into gown
• Positioning: Supine, left lateral, standing
• Examination areas: Rectal, anus, prostate

Inspect & Palpate: Penis

• Inspect skin: Look for wrinkles, hairlessness, and absence of lesions.
• Inspect glans: (uncircumcised: retract foreskin) look for smoothness / lesions / inflammation
• Inspect urethral meatus: Position centrally
• Inspect pubic hair: consistent with age and no pest infestations
• Palpate glans: Meatus pink, smooth, no discharge
• Palpate shaft: Smooth, semifirm, and nontender
• Abnormal Findings: Inflammation, lesions, nodules, ulcers

Inspect & Palpate: Scrotum

• Inspect the scrotum: Size varies, asymmetry (left lower than right); no lesions
• Palpate testicles: Oval-shaped, firm/rubbery/smooth/equally sized/mobile/slightly tender
• Palpate spermatic cord & epididymis: Smooth/nontender, absent testicles, atrophied or fixed testicles, nodules

Prostate Cancer

• Most frequently diagnosed cancer in men.
• Easily treatable

Testicular Cancer

• Overall incidence is rare (8,000 new cases annually)
• Affects younger males (15-35 years)
• Often asymptomatic in early stages
• High mortality rate
• Risk factors: undescended testicle, family history of testicular or other cancers
• Monthly testicular self-examinations are crucial

Testicular Self-Exam

• Timing: once a month
• Preparation: Shower—warm water relaxes the scrotum
• Examination: Check for changes, report immediately

Hernias

• Exam: Inspect and palpate inguinal and femoral areas while client stands; straining down and looking for bulges.
• Normal: No bulge
• Abnormal: Bulge = Hernia
• Symptoms (Abnormal): Colicky/abnormal abdominal pain, nausea/vomiting, hard

Hemorrhoids

• Papules due to varicose veins
• Internal vs External
• Causes: straining with stool, chronic constipation, pregnancy, obesity, low-fiber diet

Prostate Cancer Risk Factors

• Increasing age
• African ancestry
• Family history
• Certain gene changes
• Obesity
• Smoking

Prostate Cancer Symptoms

• Trouble urinating
• Decreased force in urine stream
• Blood in semen
• Swelling in legs
• Bone pain
• Erectile dysfunction

Prostate Cancer Risk Reduction

• Improve diet, reduce fat intake
• Maintain a healthy weight
• Regular exercise
• Stop smoking
• Drink less
• Increase vitamin D
• Stay sexually active