Male reproductive system- Introduction and assessment.

1. MALE REPRODUCTIVE
SYSTEM: INTRODUCTION,
ASSESSMENT &
DIAGNOSTIC TOOLS
Ms. Alisha Talwar

3. General Physical Changes
◦ Enlargement of the external and internal genitalia
◦ Voice changes
◦ Hair growth
◦ Mental changes
◦ Changes in body conformation and skin
◦ Sebaceous gland secretions thicken/increase  acne

5. MALE REPRODUCTIVE SYSTEM
External Organs
1) Penis
2) Scrotum
Internal Organs
1) Testes
2) Epididymis
3) Vas Deferens
4) Ejaculatory Duct
5) Seminal Vesicle
6) Prostate Glands
7) Cowper’s Gland

6. An Overview of the Male
reproductive system
◦ Gonads :- Testis
◦ Accessory sex glands :-
Seminal Vesicles
Prostate Gland
Bulbourethral Glands
◦ Ducts :-
Epididymis,
Vas deferens,
Ejaculatory ducts
Urethra
◦ Supporting structures :-
Internal: Spermatic Cord
External: Scrotum, Penis

8. Testes/testicles
◦ Primary reproductive organs or gonads.
◦ Paired oval gland in the scrotum
◦ Correspond with ovaries
◦ They are about 4.5cm long, 2.5 cm wide, and 3cm thick.

9. Testes/Testicles
◦ Each testis has a mass of 10-15gm.
◦ Made up of small, coiled tubes – seminiferous tubules.
◦ Seminiferous tubules contains 2 types of cells.
◦ Spermatogenic cells: sperm-forming cells.
◦ Sertoli cells: provides nourishment to sperm

11. ◦ There are about 250 lobules in each testis.
◦ Each lobule contains 1 to 4 - seminiferous tubules that
converge to form a single straight tubule, which leads into
the rete testis.
◦ Between the seminiferous tubules are interstitial cells called
Leydig cells, are the source of testosterone.

12. Testes/Testicles
◦ Functions --
◦ Production of sperm, and Immature sperm made here.
◦ Secrete androgenic hormone: Testosterone.

13. Testosterone
◦ The male reproductive hormone made by the testicles
which causes the changes of puberty.
◦ This hormone causes secondary sex characteristics,
production of sperm and sexual urge.
◦ It is produced in the testicles.

14. SPERMATOGENESIS
◦ Formation of spermatozoa
from spermatogonia.
◦ In humans, spermatogenesis
takes 65–75 days.

16. SPERM
◦ Three regions
◦ Head with acrosome
◦ Mid-piece or body
◦ Tail
◦ Approximately 100 to 300 million sperm are produced each
day,
◦ whereas women typically ovulate only one oocyte per
month.

19. Epididymis
◦ Coiled tube attached to the testis where newly formed
sperm continue to mature.
◦ Its head cover the upper end of the testicle and its tail
becomes continuous with the vas deferens.
◦ It takes an average of 12 days for sperm to move through the
coils of the epididymis.
◦ Head of epididymis contains 12 to 20 testicular efferent
ducts.

20. Epididymis
◦ Function:
◦ Site of sperm storage and maturation
◦ Also helps propel sperm into the vas deferens.

22. Vas Deferens/Ductus deferens
◦ Continuation of tail of epididymis
◦ About 45 cm long, ascends along the posterior border of the
epididymis through the spermatic cord and then enters the
pelvic cavity.
◦ The dilated terminal portion of the ductus deferens is the
ampulla.
◦ Route of exit of sperm
◦ Vasectomy – ligated and sectioned

23. Vas Deferens/Ductus deferens
◦ Function: Transport sperm to urethra,
◦ ductus deferens also can store sperm for several months.

25. Ejaculatory Duct
◦ A short structure formed from the ampulla of the ductus
deferens and the duct of the seminal vesicle.
◦ The ejaculatory ducts are two tubes about 2 cm long.
◦ The paired ejaculatory ducts transport the seminal fluid into
the next structure, the prostate gland.

26. Accessory glands
◦ It includes:
◦ Seminal vesicles
◦ Prostate gland
◦ Bulbourethral glands
◦ These glands secrete fluids that enter the urethra.

27. SEMINAL VESICLES
◦ Pouch like structures, about 5 cm in length
◦ Lying posterior to the base of the urinary bladder and
anterior to the rectum.
◦ Do not store sperm
◦ Provide the bulk of the semen, a mixture of secretions,
sperm and mucous
◦ Fructose and prostaglandins from seminal vesicles.

29. Function
◦ Seminal vesicles contract and expel their stored contents,
seminal fluid, during ejaculation.
◦ The seminal vesicles secrete alkaline, viscous fluid into the
ejaculatory duct, that helps neutralize acidic envt. Of the
male urethra and female reproductive tract.
◦ contributes to sperm motility, and helps semen coagulate
after ejaculation.
◦ Its secretion is thick and viscid and provide energy for
sperm
◦ Produce 60% of alkaline semen including fructose.

30. SEMEN
◦ It is a mixture of sperm and seminal fluid, a liquid that
consists of the secretions of the seminiferous tubules,
seminal vesicles, prostate, and bulbourethral glands.
◦ Fluid ejaculated during orgasm.
◦ Volume 2-5 ml/ejaculate with 50–150 million sperm per mL.
◦ When the number falls below 20 million/mL, the male is likely
to be infertile.
◦ pH -7.5, slightly alkaline in nature.
◦ Life span of the sperm in the vagina 1-2 days.

32. PROSTATE GLAND
◦ Largest accessory glands
◦ Single, doughnut-shaped gland, about the size of a golf ball
◦ It measures about 4 cm thick, 3 cm long, and about 2 cm
wide.
◦ It is inferior to the urinary bladder and surrounds the
prostatic urethra.
◦ The prostate slowly increases in size from birth to puberty.

33. PROSTATE GLAND
◦ Function: Produces up to 25% of vol. of semen & includes
nutrients & enzymes to activate sperm and contribute to
sperm motility and viability.

34. Bulbourethral glands (Cowper’s
glands)
◦ Pea size, paired and homologous to Bartholin’s glands in
female
◦ located inferior to the prostate on either side of the urethra
within the deep muscles of the perineum, and their ducts
open into the spongy urethra.

35. Bulbourethral glands (Cowper’s
glands)
Function:
◦ secrete mucus that lubricates the end of the penis and the
lining of the urethra, decreasing the number of sperm
damaged during ejaculation.

37. Urethra
◦ The urethra is the shared terminal duct of the reproductive
◦ and urinary systems;
◦ About 20 cm long, it passes through the prostate, the deep
muscles of the perineum, and the penis,
◦ It serves as a passageway for both semen and urine.

38. SPERMATIC CORDS
◦ The spermatic cord is a supporting structure of the male
reproductive system that suspend the testes in the scrotum.
◦ It consists of the ductus (vas) deferens as it ascends
through the scrotum.
◦ Each cord contains a testicular artery, testicular veins,
lymphatics, a deferent duct and testicular nerves, which
come together to form the cord from their various origins in
the abdomen.

40. Scrotum
◦ A sac-like pouch of pigmented skin, fibrous and connective
tissue and smooth muscle.
◦ It is divided into two compartments, each of which contains
one testis, one epididymis and the testicular end of a
spermatic cord.
◦ It lies below the symphysis pubis, in front of the upper parts
of the thighs and behind the penis.
◦ helps regulate temperature for sperm production.
◦ Normal sperm production requires a temperature about 2–3
degree Celsius below core body temperature.

42. Penis
◦ It is cylindrical in shape and consists of a body, glans penis,
and a root.
◦ located anterior to the scrotum,
◦ Dual states:
◦ Flaccid
◦ Erect: Due to spongious tissues
◦ Dual functions:
◦ Expulsion of urine
◦ Expulsion of semen

45. FUNCTIONS OF MALE
REPRODUCTIVE SYSTEM
◦ 1. The testes produce sperm and the male sex hormone
testosterone.
◦ 2. The ducts transport, store, and assist in maturation of
sperm.
◦ 3. The accessory sex glands secrete most of the liquid
portion of semen.
◦ 4. The penis contains the urethra, a passageway for
ejaculation of semen and excretion of urine.

47. ASSESSMENT
& DIAGNOSTIC
TESTS

48. 1. History collection : Chief complaint, family history, present
illness, pain, tenderness, discharge, or any other symptom.
2. ASSESSMENT:
◦ Discharge
◦ Swelling
◦ Ulcerations
◦ Nodules
◦ Masses
◦ Tenderness
◦ Pain

49. PHYSICAL ASSESSMENT
◆ Inspection
 Observe the patient’s general appearance, noting behaviors
and mental status
 Inspect the external genitalia and pubic hair, noting any
swelling, lumps, discharge, rashes, lesions, lice, or odors
Assess the male patient for inguinal and femoral hernias
during Valsalva’s maneuver and while coughing

50. ◆ Palpation
 Palpate the external genitalia, noting any areas of
swelling, tenderness, or hardness
Palpate the male patient’s scrotal sac, noting the size and
shape of the testicles and the presence of masses or
tenderness.
 For male, palpate the inguinal area, and check for
hernias.

51. PHYSICAL ASSESSMENT: Male
◦ Assessment: General Pubic Region, Penis, Urethra,
Scrotum, Testes, Inguinal Region.
◦ Digital rectal examination(DRE)
◦ Testicular examination (TSE)/ Testicular self examination

52. TESTICULAR EXAMINATION
◦ The male genitalia are inspected for abnormalities and for
palpated for masses.
◦ The scrotum is palpated carefully for nodules, masses or
Inflammation.
◦ Examination of the scrotum can reveal such disorder as
hydrocele, hernia or tumour of the testis.
◦ The penis is inspected and palpated for ulcerations,
nodules, inflammation and discharge.

53. ◦ Stand in front of a mirror. Check for
any swelling on the scrotal skin.
◦ Examine each testicle gently with
both hands. The index and middle
fingers should be placed under the
testicle while the thumbs are placed
on top.
◦ Roll the testicles gently between the
thumbs and fingers. One testicle may
feel longer than the other, this is
normal.

54. ◦ Feel for changes in the testicles that were not there
before.
◦ The epididymis can be felt on the top and back of the
testicles.
◦ It stores and moves sperm and it may be tender to the
touch.
◦ It is the location of most non-cancerous problems. Do
not confuse the epididymis with a lump.

55. DRE (Digital rectal examination)
◦ The DRE is recommended as part of the regular health
check up for every men older than 40 years of age.
◦ The DRE enables the examiner to assess the size, shape,
and consistency of the prostate gland.
◦ Tenderness of the prostate gland on palpation and the
presence and consistency of any nodules are noted.

56. DIAGNOSTIC TESTS FOR MALE
Noninvasive Tests
◦ Radiography:
◦ CT & MRI
◦ Ultrasonography:
◦ Scrotal ultrasound
◦ Transrectal ultrasound: may performed in patients with
abnormalities detected by DRE and in those with
elevated PSA levels.
◦ Radionuclide Imaging : to assess the testicular
abnormalities.

57. Invasive Tests
◦ Urodynamic assessment: Cystometry, uroflowmetry – to
determine the cause of frequency and decreased urine.
◦ Cystoscopy
◦ Prostatic biopsy
◦ Testicular biopsy
Laboratory Tests:
◦ Prostate Specific Antigen (PSA) Testing :
normal PSA level: 0.2 to 4.0ng/ml
◦ Semen examination: to evaluate fertilty
◦ Culture analysis

58. REFERENCES
◦ Brunner and Suddarth’s., Medical Surgical Nursing., Twelfth
Edition,2011., Published by Wolters Kluwer India.636-640.
◦ Tortora,G.J, Derrickson,B, (2009), Principles of Anatomy
and Physiology(12 th ed.), John Willey & Sons, Inc. Vol.
(2), 732-734
◦ https://www.emedicinehealth.com/understanding_the_male_
anatomy/article_em.htm