Urinary Health and Sexual Wellbeing Quiz

Assessing Male Genitalia and Rectum - NUR 313

• Objectives: List the structures of the male genitals, name the major structures of the penis, describe the function of the cremaster muscle, identify structures for sperm transport, explain the significance of inguinal and femoral canals, discuss the importance of testicular self-examination, describe the prostate gland, outline structures examined through the rectum, and incorporate health promotion when assessing the anus, rectum, and prostate.

Male Genitalia: Structure & Function

• External genitalia: The penis is used for urination and reproduction. The scrotum is a loose sac that helps maintain a cooler temperature.
• Internal genitalia: The testes produce sperm. The epididymis is the primary sperm storage site. The vas deferens transport sperm and the spermatic cord transports sperm.

Male Genitalia: Structure & Function - Inguinal area

• Located between the anterior superior iliac spine and symphysis pubis
• Potential site of hernia development
• Contains inguinal and femoral canals (sperm transport)

Male Genitalia: Structure & Function - Anus and Rectum

• Prostate Gland: A bilobed structure (round or heart-shaped)
• Surrounds the bladder neck & urethra
• Palpable through anterior rectal wall (rectal exam)
• Secretes milky, alkaline fluid for sperm support

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.
• Bladder outlet obstruction: Causes symptoms like hesitancy of urine stream, dribbling, urinary frequency, and weak urine stream.
• Normal prostate: Heart-shaped with a palpable central groove. Smooth, rubbery, and mobile.
• BPH: Enlarged, smooth, firm. Central groove obliterated.
• Prostate cancer: Hard, fixed, irregular area.

Developmental Considerations

• Tanner staging (puberty/sexual development)
• Puberty in the U.S. begins around 9-10 years of age.
• First sign is testicular enlargement, followed by pubic hair development, and increased penis size.

Male Genitalia: Subjective Data (PG 690-694)

• Biographical data
• Past history (prostate cancer, cancer, blood in stool)
• Family history (cancer)
• Chief complaint (followed by HPI) (urinary obstruction, retention, swelling, lumps, pain)
• Functional assessment (Lifestyle/health practices): sexual activity, last exam, STI's/STD's, contraceptive use, colonoscopies.

Objective Data

• Purpose of exam?
• Prepare the client (may be anxious/embarrassed, empty bladder, gown)
• Equipment needed (gloves, flashlight, stethoscope, lubricant)
• Examination positions (supine, left lateral, standing)
• Examinations and palpation of the rectum, anus, and prostate.

Inspect & Palpate Penis

• Normal findings: Wrinkles, hairless, dorsal vein may be apparent.
• Abnormal findings: Inflammation, lesions, nodules, ulcers.
• Considerations: Pubertal mutilation, cultural considerations.

Inspect & Palpate Scrotum

• Normal findings: Size varies, asymmetry (left half lower than right), no lesions.
• Abnormal Findings: Inflammation, absent/atrophic/fixed testicle, nodules, tenderness (testicular twisting)
• Considerations: Older male - scrotal droop and fewer rugae, testes may be smaller and feel softer.

Prostate Cancer

• Most frequently diagnosed cancer in men
• Easily treatable (in early stages)

Testicular Cancer

• Rare, (8000 new cases annually)
• Often affects younger males (15-35 years)
• Often asymptomatic in early stages
• High mortality rate if not detected early
• Risk factors: undescended testicle, family history, cancer in other testicle.
• Importance of monthly testicular self-examination

Testicular Self-Exam

• Early detection enhanced if familiar with normal consistency.
• Points for health teaching: Timing (monthly), Shower (warms scrotum), Examine (check for changes, report immediately)

Hernias

• Inspect & palpate inguinal & femoral areas for bulges while client stands & strains.
• Normal: No bulge.
• Abnormal: Bulge = hernia.

Hernia - Normal vs. Abnormal

• Normal: Soft, squishy, reducible (can push bowel contents back)
• Abnormal: Colicky abdominal pain, nausea/vomiting, hard, irreducible (bowel contents cannot be pushed back), strangulated hernia (blood supply cut off to bowel)

Hemorrhoids

• Papules caused by varicose veins
• Internal or External
• Thrombosed
• Causes: straining with stooling, 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 the urine stream
• Blood in semen
• Swelling in the legs
• Bone pain
• Erectile dysfunction

Prostate Cancer Risk Reduction

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