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Male GenitaliaMaria Carmela Lacsa Domocmat, RN, MSNInstructor, School of NursingNorthern Luzon Adventist College
Male Genitalia Anatomy and PhysiologyTechniques of Examination  Related Abnormalities
Male GenitaliaAnatomy and Physiology          Maria Carmela L. Domocmat, RN, MSN
Male GenitaliaThe Penis      Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Internal Structure           Maria Carmela L. Domocmat, RN, MSN
Testicles            Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Uncircumcised                              Circumcised    Penis                                        Penis            Ma...
Inguinal ringMaria Carmela L. Domocmat, RN, MSN
AssessmentGeneral Pubic Region   Penis, Urethra  Scrotum, Testes  Inguinal Region
General Pubic Region   Sexual Maturity Rating     Hair Distribution
Sexual Maturity Rating  Using the Tanner Stages, assess the  developmental stage of the pubic hair,  penis, and scrotum.No...
Tanner’s Sexual Maturity RatingThe five stages of male genital development.Stage 1 shows the undeveloped genitals ofchildh...
Tanner’s Sexual Maturity RatingThe five stages of male genital development.In Stage 4, the penis and testicles continueto ...
Tanner’s Sexual Maturity Rating          Maria Carmela L. Domocmat, RN, MSN
Hair DistributionNormal Findings:• Diamond shape  (triangular form)• Abundant in the  pubic region.• May continue in a  na...
Hair DistributionNormal Findings (cont’d)• Sparsely distributed  on the scrotum and  inner thigh and  absent on penis.• Mo...
Geriatric VariationThinnerSometimes gray          Maria Carmela L. Domocmat, RN, MSN
Abnormal Findings   Pediculosis Pubis    Herpes Simplex
Crab lice, Pthirus pubiswith reddish-brown crab feces.     reddish-         Maria Carmela L. Domocmat, RN, MSN
HSV VesiclesMaria Carmela L. Domocmat, RN, MSN
The Penis Inspection  Palpation
Inspection•Examine the glans of the penis.    If the patient is    uncircumcised,  ask him to retractthe foreskin so that ...
• Inspect the  anterior surface  of the penis  first. Ask the  client to lift the  penis to check  the posterior  surface....
Normal FindingsPenis:• Cylindrical in shape.• Skin – free from  lesions and  inflammation.• Shaft skin – appears  loose an...
Normal FindingsPenis: (cont’d)• Pink to light brown in  Whites and light brown to  dark brown in Blacks.• Surface vascular...
Normal FindingsGlans penis – smooth, pink, bulbous• Varies in size and shape.• May appear round or  broad.• Without lesion...
Foreskin or prepuce• Retracts easily to  expose glans and  returns to original  position with ease.• No discharge.        ...
a. Uncircumcised:  • Prepuce fold wrinkled,    loosely attached to the    underlying glans  • Darker in color than glans  ...
b. Circumcised:  • Prepuce often absent,    or small flaps remain    at corona.  • No smegma.  • (Note: circumcised    pen...
Let’s Watch:Inspecting the Penis
Palpation• Between the thumb  and the first two  fingers, palpate the  entire length of the  penis.• Note any pulsations, ...
Normal Findings• Pulsations may be present  on the dorsal sides of the  penis.• Non-tender.  Non-• No masses or firm  plaq...
Make sure that you return the foreskin(if uncircumcised) to its normal place atthe end of the exam.          If not return...
Geriatric VariationDecrease in size of penis            Maria Carmela L. Domocmat, RN, MSN
Abnormal Findings      Chordee      Priapism      Phimosis      Paraphimosis
Abnormal CurvatureCongenital: ChordeeAcquired: caused by Peyronie’s Disease           Maria Carmela L. Domocmat, RN, MSN
Congenital Chordee   Maria Carmela L. Domocmat, RN, MSN
Congenital Chordee             Maria Carmela L. Domocmat, RN, MSN
Acquired curvaturecaused by Peyronie’s disease       Maria Carmela L. Domocmat, RN, MSN
Priapism       Maria Carmela L. Domocmat, RN, MSN
Phimosis                           Paraphimosis           Maria Carmela L. Domocmat, RN, MSN
Abnormal Findings Penile Trauma:  Human Bite  Trauma-  Trauma-induced Fistula  Glanular Amputation  Penile Strangulation  ...
Human Bite                Trauma-                          Trauma-induced                          fistula                ...
Glanular                                         PenileAmputation                                       StrangulationCompl...
Blast Injury results in                         no salvageable testicular                                  tissueGunshot W...
Penile Diseases
DiseasesTinea CrurisUrethritisSyphilitic ChancreChancroidCondyloma acuminatum or genital wartsHerpesCandidiasisDonovanosis...
Tinea Cruris or Jock itch      Maria Carmela L. Domocmat, RN, MSN
Balanitis                                      Balanitis gangraenosaMarked inflammation of the head of the penis          ...
Syphilitic Ulcer                     Syphilitic Chancre             Maria Carmela L. Domocmat, RN, MSN
Condyloma    Penile                                                      acuminatum    Condyloma                          ...
Secondary Syphilis: includes multiple   lesions located on the penis and scrotum.Secondarysyphilis is themost contagiousof...
Chancroid.The differential diagnosis proved to be chancroid,caused by Haemophilus ducreyi, and not syphilis.              ...
Genital Herpes                                   CandidiasisMaculopapular herpetic rash on thepenile shaft and corona of t...
Donovanosis, or                           Lymphogranulomgranuloma                                 a venereuminguinaleA “ge...
Penile tumor                             Penile Cancerdifferentially diagnosed asgiant condyloma of Buschke             Th...
Urethra
Inspection• Note the location of the urethral  meatus.• Observe for discharge.• Obtain a culture of any discharge.        ...
Normal Findings• Central• At the distal tip  of the glans• Opening is glistening,  smooth and pink• Slit-like  Slit-• No d...
Compression of the glans to open      the urethral meatus• Hold the glansbetween thethumb and theforefinger andgently sque...
• If a discharge is seen, a culture should  be taken• If the client complains of penile  discharge but none is present, as...
Abnormal Findings     Hypospadias      Epispadias      Urethritis
HypospadiasThe termination of the urethra is on the ventral surface of the penis    Categorized as glandular (involving th...
Maria Carmela L. Domocmat, RN, MSN
EpispadiasThe opening of the urethra is on thedorsal surface of the penis                             Maria Carmela L. Dom...
Chemical UrethritisNonspecificUrethritis                                 This 44-year-old man developed several itchy red ...
ScrotumInspectionPalpationAuscultationTransillumination
Inspection• Displace the penis to one side in order  to inspect the scrotal skin.• Lift up the scrotum to  inspect the pos...
• The client should stand with  legs slightly spread apart.• Have the client  perform the Valsalva  maneuver.• Observe for...
Normal                                     appearance                                        of the                       ...
Normal Findings• Skin of the scrotum is  normally loose.• Surface may be coarse• Size varies, may appear  pendulous       ...
Normal Findings (cont’d)• Skin color: often more  deeply pigmented than  body skin. Often  reddened in red-haired         ...
Normal Findings (cont’d)• Left scrotal sac may  be longer than right• Contracts in cold  temperature; relaxes  in warm tem...
Normal Findings (cont’d)• Rugose surface• Nontender• Thin loose skin over  muscular layer• No Pitting.                Mari...
Normal Findings (cont’d)• If scrotal mass or  enlargement is  detected, the scrotum  should be auscultated  and transillum...
Normal Findings (cont’d)Geriatric Variation : scrotal sac may appear elongated or more pendulous• Elderly clients  sometim...
Abnormal Findings
Abnormalities       Scrotum and its StructuresSebaceous Cyst                        VaricoceleCryptorchidism              ...
Sebaceous Cyst                   Orchitison Scrotum          Maria Carmela L. Domocmat, RN, MSN
Cryptorchidism                  Prepenile                                scrotum (PPS)                                    ...
Scrotal Edema           Maria Carmela L. Domocmat, RN, MSN
Hydrocele            Maria Carmela L. Domocmat, RN, MSN
Elephantiasisof theScrotum           Maria Carmela L. Domocmat, RN, MSN
Carcinomaof theScrotum            Maria Carmela L. Domocmat, RN, MSN
Testicular Palpation
Testicular Palpation                                   • Between the                                     thumb and the    ...
Testicular Exam                                       • Palpate the                                         epididymis    ...
Testicular Exam (cont’d)• Between the thumb  and the first two  fingers, palpate the  spermatic cord  from the epididymis ...
Normal FindingsTesticle:• Present in each sac• Left testis may  normally lower than  the right• Approximately:  4 x 3 x 2 ...
Normal FindingsTesticle: (cont’d)• Mildly sensitive to  gentle/ moderate  compression but  not tender• Equal in size• Firm...
Normal FindingsTesticle: (cont’d)• Smooth, rubbery, ovoid  in shape, and free from  nodules• Movable• Geriatric Variation ...
Let’s Watch: Palpating the Testesand Related Structures
Abnormal Finding    Testicular Lump
Testicular Lump Maria Carmela L. Domocmat, RN, MSN
Normal FindingsEpididymis:• Comma shaped  and  distinguishable  from the testicle.• Nontender,  resilient               Ma...
Normal FindingsEpididymis: (cont’d)• Usually located  on posterolateral  surface of each  testis• Discretely palpable,  sm...
Normal FindingsEpididymis: (cont’d)• Insensitive to  pressure• Lies towards the  top and back of  each testis             ...
Abnormal Finding    Epididymitis
Epididymitis         Maria Carmela L. Domocmat, RN, MSN
Normal FindingsSpermatic cord:          cord:• Smooth and round• Located above each  testicle• Composed of vas  deferens  ...
Normal FindingsSpermatic cord:          cord:• Lies along the  posterior aspect  of the bundle• Feels firm and  wire-  wir...
Normal FindingsSpermatic cord:          cord:• Nontender,  movable• Discretely palpable  from epididymis to  external ingu...
Normal FindingsSpermatic cord:(cont’d)          cord:• Smooth and cordlike,  without nodules or  swelling• You will normal...
Abnormal Findings     Spermatocele      Varicocele
Spermatocele           Maria Carmela L. Domocmat, RN, MSN
Varicocele             Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Assess for Cremasteric        Reflex
Assess for Cremasteric reflex• Cremasteric  reflex – the  temporary  migration of  the testis•the cremaster muscle surroun...
Assess for Cremasteric reflex cont’dStrokethe innerthighwith thehandle ofa reflexhammer            Maria Carmela L. Domocm...
Normal Finding• Testicle  and  scrotum  rise on  the  stroked  side               Maria Carmela L. Domocmat, RN, MSN
Abnormal Finding  Testicular torsion
Testicular torsion Maria Carmela L. Domocmat, RN, MSN
Advanced Techniques
Auscultation*   Performed when a scrotal mass is    found on inspection or palpation.• Place the client in a supine positi...
Normal Finding• No bowel sounds are present in the  scrotum.             Maria Carmela L. Domocmat, RN, MSN
Abnormal Findings      Hernia
Transillumination
Transillumination*   Performed when a scrotal mass is found    on inspection or palpation.• Tell the patient what you are ...
Transillumination                          (cont’d)• Light the unaffected side  behind the scrotum and  direct it forward....
Normal FindingNormal testicledoes not illuminate(i.e., there is noglow)           Maria Carmela L. Domocmat, RN, MSN
Abnormal Findings(+) transillumination:    transillumination:  Serous Fluid such as in Hydrocele andSpermatocele(-) transi...
Varicocele                              Hydrocele             Maria Carmela L. Domocmat, RN, MSN
Inguinal Region
Inspection• If the client is at supine, ask the  client to stand.• Stand or sit facing the client.• Observe for swelling o...
Normal Findings• Inguinal area is free from any  swelling or bulges.         Maria Carmela L. Domocmat, RN, MSN
Palpation of Lymph Nodes• With the index  and middle  fingers of the  right hand,  palpate the skin  overlying the  inguin...
Palpation of Lymph NodesNote the size,consistency,tenderness, andmobility.             Maria Carmela L. Domocmat, RN, MSN
Normal Findings• Movable• Small, size of pea  or baked bean• Nontender• Typically less than  1 cm in diameter(Note: Do not...
Palpation for Indirect          Inguinal Hernia• Ask the patient to bear down while you  palpate the inguinal area.• Place...
Examination for an Hernia       Maria Carmela L. Domocmat, RN, MSN
Palpation for      Indirect Inguinal Hernia• If the inguinal area is large enough,  continue to advance the finger along  ...
Normal Findings• Finger follows  spermatic cord  upward to  triangular  slitlike opening.  (Which may or may not admit fin...
Normal Findings As the clientstrains, nobulging will befelt againstfingertips;a tighteningaround thefinger isnormal.     M...
Palpation for Femoral Hernia•Palpatethe femoralcanal.•Ask theclient tobear down.              Maria Carmela L. Domocmat, R...
Normal Findings• No bulging or  swelling• Abdominal  muscle tightens  and scrotum  lowers as client  bears down.          ...
Let’s Watch:Palpating for Hernia
Abnormal Finding      Hernia
Large RightIndirect InguinalHernia            Maria Carmela L. Domocmat, RN, MSN
LeftInguinalHernia           Maria Carmela L. Domocmat, RN, MSN
Direct                                              InguinalFemoral Hernia                                 Hernia         ...
GiantScrotalHernia          Maria Carmela L. Domocmat, RN, MSN
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assessment of the male genitalia

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  1. 1. Male GenitaliaMaria Carmela Lacsa Domocmat, RN, MSNInstructor, School of NursingNorthern Luzon Adventist College
  2. 2. Male Genitalia Anatomy and PhysiologyTechniques of Examination Related Abnormalities
  3. 3. Male GenitaliaAnatomy and Physiology Maria Carmela L. Domocmat, RN, MSN
  4. 4. Male GenitaliaThe Penis Maria Carmela L. Domocmat, RN, MSN
  5. 5. Maria Carmela L. Domocmat, RN, MSN
  6. 6. Internal Structure Maria Carmela L. Domocmat, RN, MSN
  7. 7. Testicles Maria Carmela L. Domocmat, RN, MSN
  8. 8. Maria Carmela L. Domocmat, RN, MSN
  9. 9. Uncircumcised Circumcised Penis Penis Maria Carmela L. Domocmat, RN, MSN
  10. 10. Inguinal ringMaria Carmela L. Domocmat, RN, MSN
  11. 11. AssessmentGeneral Pubic Region Penis, Urethra Scrotum, Testes Inguinal Region
  12. 12. General Pubic Region Sexual Maturity Rating Hair Distribution
  13. 13. Sexual Maturity Rating Using the Tanner Stages, assess the developmental stage of the pubic hair, penis, and scrotum.Normal Findings• Males usually begin puberty between the ages of 9 ½ and 13 ½ .• Average male proceeds through puberty in about 3 years, with possible range of 2 to 5 years. Maria Carmela L. Domocmat, RN, MSN
  14. 14. Tanner’s Sexual Maturity RatingThe five stages of male genital development.Stage 1 shows the undeveloped genitals ofchildhood.In Stage 2, pubic hair growth begins and thetesticles begin to enlarge.By Stage 3, the penis grows longer andwider. The testicles continue to enlarge. Maria Carmela L. Domocmat, RN, MSN
  15. 15. Tanner’s Sexual Maturity RatingThe five stages of male genital development.In Stage 4, the penis and testicles continueto enlarge while the head of the penisbecomes more developed.In Stage 5, the genitals have become theiradult size, and pubic hair covers the region. Maria Carmela L. Domocmat, RN, MSN
  16. 16. Tanner’s Sexual Maturity Rating Maria Carmela L. Domocmat, RN, MSN
  17. 17. Hair DistributionNormal Findings:• Diamond shape (triangular form)• Abundant in the pubic region.• May continue in a narrowing midline pattern to the umbilicus, around the scrotum to the anal orifice. Maria Carmela L. Domocmat, RN, MSN
  18. 18. Hair DistributionNormal Findings (cont’d)• Sparsely distributed on the scrotum and inner thigh and absent on penis.• More coarse than scalp hair.• No nits or lice. Maria Carmela L. Domocmat, RN, MSN
  19. 19. Geriatric VariationThinnerSometimes gray Maria Carmela L. Domocmat, RN, MSN
  20. 20. Abnormal Findings Pediculosis Pubis Herpes Simplex
  21. 21. Crab lice, Pthirus pubiswith reddish-brown crab feces. reddish- Maria Carmela L. Domocmat, RN, MSN
  22. 22. HSV VesiclesMaria Carmela L. Domocmat, RN, MSN
  23. 23. The Penis Inspection Palpation
  24. 24. Inspection•Examine the glans of the penis. If the patient is uncircumcised, ask him to retractthe foreskin so that the underlying area can be inspected. Maria Carmela L. Domocmat, RN, MSN
  25. 25. • Inspect the anterior surface of the penis first. Ask the client to lift the penis to check the posterior surface.• Note the shape of the penis. Maria Carmela L. Domocmat, RN, MSN
  26. 26. Normal FindingsPenis:• Cylindrical in shape.• Skin – free from lesions and inflammation.• Shaft skin – appears loose and wrinkled without erection. Maria Carmela L. Domocmat, RN, MSN
  27. 27. Normal FindingsPenis: (cont’d)• Pink to light brown in Whites and light brown to dark brown in Blacks.• Surface vascularity may be apparent. Dorsal vein is sometimes visible. Maria Carmela L. Domocmat, RN, MSN
  28. 28. Normal FindingsGlans penis – smooth, pink, bulbous• Varies in size and shape.• May appear round or broad.• Without lesions, swelling, and inflammation Maria Carmela L. Domocmat, RN, MSN
  29. 29. Foreskin or prepuce• Retracts easily to expose glans and returns to original position with ease.• No discharge. Maria Carmela L. Domocmat, RN, MSN
  30. 30. a. Uncircumcised: • Prepuce fold wrinkled, loosely attached to the underlying glans • Darker in color than glans • Should retract easily • Smegma (white, cottage- cottage- cheese- cheese-like substance) may be seen over the glans Maria Carmela L. Domocmat, RN, MSN
  31. 31. b. Circumcised: • Prepuce often absent, or small flaps remain at corona. • No smegma. • (Note: circumcised penises have varying lengths of foreskin remaining; some have multiple folds and others have few or none.) Maria Carmela L. Domocmat, RN, MSN
  32. 32. Let’s Watch:Inspecting the Penis
  33. 33. Palpation• Between the thumb and the first two fingers, palpate the entire length of the penis.• Note any pulsations, tenderness, masses, or plaques. Maria Carmela L. Domocmat, RN, MSN
  34. 34. Normal Findings• Pulsations may be present on the dorsal sides of the penis.• Non-tender. Non-• No masses or firm plaques are palpated. Maria Carmela L. Domocmat, RN, MSN
  35. 35. Make sure that you return the foreskin(if uncircumcised) to its normal place atthe end of the exam. If not returned, it can cause paraphimosis - severe venous and arterial obstruction, leading to necrosis of the glans of the penis. Maria Carmela L. Domocmat, RN, MSN
  36. 36. Geriatric VariationDecrease in size of penis Maria Carmela L. Domocmat, RN, MSN
  37. 37. Abnormal Findings Chordee Priapism Phimosis Paraphimosis
  38. 38. Abnormal CurvatureCongenital: ChordeeAcquired: caused by Peyronie’s Disease Maria Carmela L. Domocmat, RN, MSN
  39. 39. Congenital Chordee Maria Carmela L. Domocmat, RN, MSN
  40. 40. Congenital Chordee Maria Carmela L. Domocmat, RN, MSN
  41. 41. Acquired curvaturecaused by Peyronie’s disease Maria Carmela L. Domocmat, RN, MSN
  42. 42. Priapism Maria Carmela L. Domocmat, RN, MSN
  43. 43. Phimosis Paraphimosis Maria Carmela L. Domocmat, RN, MSN
  44. 44. Abnormal Findings Penile Trauma: Human Bite Trauma- Trauma-induced Fistula Glanular Amputation Penile Strangulation Blast Injury
  45. 45. Human Bite Trauma- Trauma-induced fistula Urethro-cutaneous fistula developed as a result of circumcision injury Maria Carmela L. Domocmat, RN, MSN
  46. 46. Glanular PenileAmputation StrangulationComplete loss of the glans In this child, a penileresulting from electrocautery strangulation injury wasinjury during a circumcision caused by a rubber band. Maria Carmela L. Domocmat, RN, MSN
  47. 47. Blast Injury results in no salvageable testicular tissueGunshot Woundthrough the right thigh and penis Maria Carmela L. Domocmat, RN, MSN
  48. 48. Penile Diseases
  49. 49. DiseasesTinea CrurisUrethritisSyphilitic ChancreChancroidCondyloma acuminatum or genital wartsHerpesCandidiasisDonovanosis or granuloma inguinaleLypmphogranuloma VenereumPenile Tumor and Cancer Maria Carmela L. Domocmat, RN, MSN
  50. 50. Tinea Cruris or Jock itch Maria Carmela L. Domocmat, RN, MSN
  51. 51. Balanitis Balanitis gangraenosaMarked inflammation of the head of the penis This patient was diagnosed with balanitisand foreskin, in this case caused by fungal gangraenosa, which was first thought to be adermatitis syphilis infection infection. Maria Carmela L. Domocmat, RN, MSN .
  52. 52. Syphilitic Ulcer Syphilitic Chancre Maria Carmela L. Domocmat, RN, MSN
  53. 53. Condyloma Penile acuminatum Condyloma or Genital WartsGrowth at edge of glans due to HPV infection Maria Carmela L. Domocmat, RN, MSN
  54. 54. Secondary Syphilis: includes multiple lesions located on the penis and scrotum.Secondarysyphilis is themost contagiousof all the stages,and is The secondarycharacterized by maculopapular rasha systemic usually causes nospread of the itching, and canTreponema appear as thepallidum chancre, orbacterium. chancres found during the primary stage of syphilis are healing, or several weeks after the chancres have healed. Maria Carmela L. Domocmat, RN, MSN
  55. 55. Chancroid.The differential diagnosis proved to be chancroid,caused by Haemophilus ducreyi, and not syphilis. Maria Carmela L. Domocmat, RN, MSN
  56. 56. Genital Herpes CandidiasisMaculopapular herpetic rash on thepenile shaft and corona of theglans penis. Maria Carmela L. Domocmat, RN, MSN
  57. 57. Donovanosis, or Lymphogranulomgranuloma a venereuminguinaleA “genital ulcerative disease”caused by the intracellular Gram-negative bacteriumCalymmatobacterium granulomatisL. Domocmat, RN, MSN Maria Carmela
  58. 58. Penile tumor Penile Cancerdifferentially diagnosed asgiant condyloma of Buschke The erythematous patch on the glans penisand Löwenstein (GCBL) was diagnosed as Bowens disease, or squamous cell carcinoma in situ. Maria Carmela L. Domocmat, RN, MSN
  59. 59. Urethra
  60. 60. Inspection• Note the location of the urethral meatus.• Observe for discharge.• Obtain a culture of any discharge. Maria Carmela L. Domocmat, RN, MSN
  61. 61. Normal Findings• Central• At the distal tip of the glans• Opening is glistening, smooth and pink• Slit-like Slit-• No discharge present• Nontender Maria Carmela L. Domocmat, RN, MSN
  62. 62. Compression of the glans to open the urethral meatus• Hold the glansbetween thethumb and theforefinger andgently squeezeto expose themeatus. Maria Carmela L. Domocmat, RN, MSN
  63. 63. • If a discharge is seen, a culture should be taken• If the client complains of penile discharge but none is present, ask the client to milk the penis from the shaft to the glans. This maneuver may express a discharge that can be cultured. Maria Carmela L. Domocmat, RN, MSN
  64. 64. Abnormal Findings Hypospadias Epispadias Urethritis
  65. 65. HypospadiasThe termination of the urethra is on the ventral surface of the penis Categorized as glandular (involving the glans penis), penile, or perineoscrotal Maria Carmela L. Domocmat, RN, MSN
  66. 66. Maria Carmela L. Domocmat, RN, MSN
  67. 67. EpispadiasThe opening of the urethra is on thedorsal surface of the penis Maria Carmela L. Domocmat, RN, MSN
  68. 68. Chemical UrethritisNonspecificUrethritis This 44-year-old man developed several itchy red scaly patches on the glans and distal penile shaft and a clear urethral discharge shortly after the application of a spray before sex used to delay ejaculation. Screening studies for sexually transmitted diseases were negative and contact dermatitis and chemical urethritis were diagnosed. Maria Carmela L. Domocmat, RN, MSN
  69. 69. ScrotumInspectionPalpationAuscultationTransillumination
  70. 70. Inspection• Displace the penis to one side in order to inspect the scrotal skin.• Lift up the scrotum to inspect the posterior side.• Observe for lesions, inflammation, swelling, and nodules.• Note the size and shape. Maria Carmela L. Domocmat, RN, MSN
  71. 71. • The client should stand with legs slightly spread apart.• Have the client perform the Valsalva maneuver.• Observe for any mass of dilated testicular veins in the spermatic cord above and behind the testes. Maria Carmela L. Domocmat, RN, MSN
  72. 72. Normal appearance of the scrotum in an adult maleMaria Carmela L. Domocmat, RN, MSN
  73. 73. Normal Findings• Skin of the scrotum is normally loose.• Surface may be coarse• Size varies, may appear pendulous Maria Carmela L. Domocmat, RN, MSN
  74. 74. Normal Findings (cont’d)• Skin color: often more deeply pigmented than body skin. Often reddened in red-haired red- individuals.• Sac is divided in half by septum. Maria Carmela L. Domocmat, RN, MSN
  75. 75. Normal Findings (cont’d)• Left scrotal sac may be longer than right• Contracts in cold temperature; relaxes in warm temperature.• Deeply pigmented• Hairless or with infrequent hair Maria Carmela L. Domocmat, RN, MSN
  76. 76. Normal Findings (cont’d)• Rugose surface• Nontender• Thin loose skin over muscular layer• No Pitting. Maria Carmela L. Domocmat, RN, MSN
  77. 77. Normal Findings (cont’d)• If scrotal mass or enlargement is detected, the scrotum should be auscultated and transilluminated Maria Carmela L. Domocmat, RN, MSN
  78. 78. Normal Findings (cont’d)Geriatric Variation : scrotal sac may appear elongated or more pendulous• Elderly clients sometimes have a problem of sitting on the scrotum resulting in trauma or excoriation of the surface Maria Carmela L. Domocmat, RN, MSN
  79. 79. Abnormal Findings
  80. 80. Abnormalities Scrotum and its StructuresSebaceous Cyst VaricoceleCryptorchidism ElephantiasisPrepenile Scrotum CarcinomaOrchitis Testicular TorsionScrotal Edema Testicular LumpHydrocele EpididymitisSpermatocele Maria Carmela L. Domocmat, RN, MSN
  81. 81. Sebaceous Cyst Orchitison Scrotum Maria Carmela L. Domocmat, RN, MSN
  82. 82. Cryptorchidism Prepenile scrotum (PPS) also known as Penoscrotal Transposition Maria Carmela L. Domocmat, RN, MSN
  83. 83. Scrotal Edema Maria Carmela L. Domocmat, RN, MSN
  84. 84. Hydrocele Maria Carmela L. Domocmat, RN, MSN
  85. 85. Elephantiasisof theScrotum Maria Carmela L. Domocmat, RN, MSN
  86. 86. Carcinomaof theScrotum Maria Carmela L. Domocmat, RN, MSN
  87. 87. Testicular Palpation
  88. 88. Testicular Palpation • Between the thumb and the first two fingers, gently palpate the left testicle • Note the size, shape, consistency, presence of masses. Maria Carmela L. Domocmat, RN, MSN
  89. 89. Testicular Exam • Palpate the epididymis Note the consistency and presence of tenderness or masses. Maria Carmela L. Domocmat, RN, MSN
  90. 90. Testicular Exam (cont’d)• Between the thumb and the first two fingers, palpate the spermatic cord from the epididymis to the external ring Note the consistency and presence of tenderness or masses. Maria Carmela L. Domocmat, RN, MSN
  91. 91. Normal FindingsTesticle:• Present in each sac• Left testis may normally lower than the right• Approximately: 4 x 3 x 2 cm (1 ½ x 1 x ¾ inches). Maria Carmela L. Domocmat, RN, MSN
  92. 92. Normal FindingsTesticle: (cont’d)• Mildly sensitive to gentle/ moderate compression but not tender• Equal in size• Firm but not hard Maria Carmela L. Domocmat, RN, MSN
  93. 93. Normal FindingsTesticle: (cont’d)• Smooth, rubbery, ovoid in shape, and free from nodules• Movable• Geriatric Variation : testes may feel slightly softer and smaller. Maria Carmela L. Domocmat, RN, MSN
  94. 94. Let’s Watch: Palpating the Testesand Related Structures
  95. 95. Abnormal Finding Testicular Lump
  96. 96. Testicular Lump Maria Carmela L. Domocmat, RN, MSN
  97. 97. Normal FindingsEpididymis:• Comma shaped and distinguishable from the testicle.• Nontender, resilient Maria Carmela L. Domocmat, RN, MSN
  98. 98. Normal FindingsEpididymis: (cont’d)• Usually located on posterolateral surface of each testis• Discretely palpable, smooth Maria Carmela L. Domocmat, RN, MSN
  99. 99. Normal FindingsEpididymis: (cont’d)• Insensitive to pressure• Lies towards the top and back of each testis Maria Carmela L. Domocmat, RN, MSN
  100. 100. Abnormal Finding Epididymitis
  101. 101. Epididymitis Maria Carmela L. Domocmat, RN, MSN
  102. 102. Normal FindingsSpermatic cord: cord:• Smooth and round• Located above each testicle• Composed of vas deferens testicular artery/vein, ilio- ilio-inguinal nerve. Maria Carmela L. Domocmat, RN, MSN
  103. 103. Normal FindingsSpermatic cord: cord:• Lies along the posterior aspect of the bundle• Feels firm and wire- wire-like Maria Carmela L. Domocmat, RN, MSN
  104. 104. Normal FindingsSpermatic cord: cord:• Nontender, movable• Discretely palpable from epididymis to external inguinal ring Maria Carmela L. Domocmat, RN, MSN
  105. 105. Normal FindingsSpermatic cord:(cont’d) cord:• Smooth and cordlike, without nodules or swelling• You will normally be unable to specifically identify the remaining structures. Maria Carmela L. Domocmat, RN, MSN
  106. 106. Abnormal Findings Spermatocele Varicocele
  107. 107. Spermatocele Maria Carmela L. Domocmat, RN, MSN
  108. 108. Varicocele Maria Carmela L. Domocmat, RN, MSN
  109. 109. Maria Carmela L. Domocmat, RN, MSN
  110. 110. Assess for Cremasteric Reflex
  111. 111. Assess for Cremasteric reflex• Cremasteric reflex – the temporary migration of the testis•the cremaster muscle surrounding the testes contractsin response to such stimuli as cold air, cold water, ortouching the inner thigh. This contraction raises thecontents of the scrotum toward the inguinal canal) Maria Carmela L. Domocmat, RN, MSN
  112. 112. Assess for Cremasteric reflex cont’dStrokethe innerthighwith thehandle ofa reflexhammer Maria Carmela L. Domocmat, RN, MSN
  113. 113. Normal Finding• Testicle and scrotum rise on the stroked side Maria Carmela L. Domocmat, RN, MSN
  114. 114. Abnormal Finding Testicular torsion
  115. 115. Testicular torsion Maria Carmela L. Domocmat, RN, MSN
  116. 116. Advanced Techniques
  117. 117. Auscultation* Performed when a scrotal mass is found on inspection or palpation.• Place the client in a supine position.• Stand at the client’s right side at the genital area.• Place the stethoscope over the scrotal mass.• Listen for the presence of bowel sounds. Maria Carmela L. Domocmat, RN, MSN
  118. 118. Normal Finding• No bowel sounds are present in the scrotum. Maria Carmela L. Domocmat, RN, MSN
  119. 119. Abnormal Findings Hernia
  120. 120. Transillumination
  121. 121. Transillumination* Performed when a scrotal mass is found on inspection or palpation.• Tell the patient what you are going to do and inform that it is not be painful.• Darken the room. Maria Carmela L. Domocmat, RN, MSN
  122. 122. Transillumination (cont’d)• Light the unaffected side behind the scrotum and direct it forward.• Light the side of the scrotal enlargement or mass. Note whether there is a transmission of a red glow. Maria Carmela L. Domocmat, RN, MSN
  123. 123. Normal FindingNormal testicledoes not illuminate(i.e., there is noglow) Maria Carmela L. Domocmat, RN, MSN
  124. 124. Abnormal Findings(+) transillumination: transillumination: Serous Fluid such as in Hydrocele andSpermatocele(-) transillumination: transillumination: Vascular structures such as inVaricocele,Varicocele, Hernia, Epididymitis andTumor
  125. 125. Varicocele Hydrocele Maria Carmela L. Domocmat, RN, MSN
  126. 126. Inguinal Region
  127. 127. Inspection• If the client is at supine, ask the client to stand.• Stand or sit facing the client.• Observe for swelling or bulges.• Ask the client to bear down.• Observe for swelling or bulges. Maria Carmela L. Domocmat, RN, MSN
  128. 128. Normal Findings• Inguinal area is free from any swelling or bulges. Maria Carmela L. Domocmat, RN, MSN
  129. 129. Palpation of Lymph Nodes• With the index and middle fingers of the right hand, palpate the skin overlying the inguinal and femoral areas for lymph nodes. Maria Carmela L. Domocmat, RN, MSN
  130. 130. Palpation of Lymph NodesNote the size,consistency,tenderness, andmobility. Maria Carmela L. Domocmat, RN, MSN
  131. 131. Normal Findings• Movable• Small, size of pea or baked bean• Nontender• Typically less than 1 cm in diameter(Note: Do not confuse Poupart’s ligament withenlarged lymph nodes) Maria Carmela L. Domocmat, RN, MSN
  132. 132. Palpation for Indirect Inguinal Hernia• Ask the patient to bear down while you palpate the inguinal area.• Place the right index finger in the client’s right scrotal sac above the right testicle and invaginate the scrotal skin.• Follow the spermatic cord until you reach a triangular, slitlike opening (the external inguinal ring). Maria Carmela L. Domocmat, RN, MSN
  133. 133. Examination for an Hernia Maria Carmela L. Domocmat, RN, MSN
  134. 134. Palpation for Indirect Inguinal Hernia• If the inguinal area is large enough, continue to advance the finger along the inguinal canal and ask the client to turn his head and cough. Note any masses felt against the finger.• Repeat on the left side using the left hand to perform the palpation. Maria Carmela L. Domocmat, RN, MSN
  135. 135. Normal Findings• Finger follows spermatic cord upward to triangular slitlike opening. (Which may or may not admit finger). Maria Carmela L. Domocmat, RN, MSN
  136. 136. Normal Findings As the clientstrains, nobulging will befelt againstfingertips;a tighteningaround thefinger isnormal. Maria Carmela L. Domocmat, RN, MSN
  137. 137. Palpation for Femoral Hernia•Palpatethe femoralcanal.•Ask theclient tobear down. Maria Carmela L. Domocmat, RN, MSN
  138. 138. Normal Findings• No bulging or swelling• Abdominal muscle tightens and scrotum lowers as client bears down. Maria Carmela L. Domocmat, RN, MSN
  139. 139. Let’s Watch:Palpating for Hernia
  140. 140. Abnormal Finding Hernia
  141. 141. Large RightIndirect InguinalHernia Maria Carmela L. Domocmat, RN, MSN
  142. 142. LeftInguinalHernia Maria Carmela L. Domocmat, RN, MSN
  143. 143. Direct InguinalFemoral Hernia Hernia Maria Carmela L. Domocmat, RN, MSN
  144. 144. GiantScrotalHernia Maria Carmela L. Domocmat, RN, MSN
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