Assessing Male Genitalia in Health Assessment

Scrotal Contents and Abnormalities

• Scrotal swelling can be caused by heart failure, renal failure, local inflammation, or lesions
• Inflammation, absent testes, temporary migration, or true cryptorchidism can be abnormal findings
• Atrophied testes are small and soft, while fixed testes are abnormal
• Nodules on testes or epididymis, marked tenderness, and epididymitis can be signs of abnormalities
• Epididymitis is characterized by an indurated, swollen, and tender epididymis
• Thickened cord, soft, swollen, and tortuous can be signs of abnormalities
• Abnormalities in the scrotum can include hernia, tumor, orchitis, epididymitis, hydrocele, spermatocele, and varicocele

Transillumination

• Serous fluid does not transilluminate and shows a red glow, indicating hydrocele or spermatocele
• Solid tissue and blood do not transilluminate, indicating hernia, epididymitis, or tumor

Testicular Self-Examination

• Testicular cancer is the most common cancer in men aged 15-34
• Testicular self-examination should be performed once a month, ideally after a warm bath or shower while standing in front of a mirror
• Any hard lump, absent or enlarged testicle, painful or swollen scrotum, or other abnormality should be reported to a doctor

Male Genitalia Anatomy

• The penis is the freely movable male reproductive organ with a role in both reproduction and urination
• The shaft is composed of three cylindrical masses of vascular erectile tissues: corpus cavernosa (2) and corpus spongiosum (1)
• The glans is the acorn-shaped structure at the end of the penis
• The prepuce is the hood-like fold of skin that covers the glans in uncircumcised men
• The urethra is in the center of the corpus spongiosum and opens as a slit at the tip of the glans

Scrotal Anatomy

• The scrotum is a thin-walled, darkly pigmented sac that contains the testes, epididymis, spermatic cord, and muscle layer
• The scrotum has sweat and sebaceous glands and consists of folds of skin (rugae) and cremaster muscles
• The scrotum is sensitive to temperature changes and contracts when too cold, raising the scrotum and testes upward for body warmth
• The scrotum relaxes when warm, lowering the scrotum and testes away from the heat of the body

Testes Anatomy

• The testes are paired, ovoid-shaped organs that produce spermatozoa and testosterone
• The testes are 3.7-5cm long, 2.5cm wide, and 2.5cm deep
• The tunica vaginalis is a serous membrane that separates the testis from the scrotal sac and protects the testes from injury

Spermatic Cord and Epididymis

• The spermatic cord helps suspend the testes in the scrotum and contains blood vessels, lymphatic vessels, nerves, and the vas deferens
• The epididymis is a comma-shaped, coiled, tubular structure where spermatozoa mature

Inspection and Palpation of Male Reproductive System

• Normal findings of the penis include wrinkled skin, no lesions, and retractable foreskin
• Normal findings of the scrotum include rugae, no lesions, and normal testicular shape and size

Abnormal Findings

• Indirect inguinal hernia is above the inguinal ligament, near the inguinal ring, and often extends into the scrotum
• Direct inguinal hernia occurs above the inguinal ligament, near the pubic tubercle, and usually affects men over 40 years
• Phimosis is the inability to retract the foreskin, while paraphimosis is the inability to return the foreskin to its original position
• Hypospadias is a ventral location of the meatus, while epispadias is a dorsal location of the meatus
• Pubic lice or nits can cause excoriated skin, and pediculosis pubis can cause itching, excoriations, and erythematous areas