assessment of the male genitalia

Male Genitalia

Maria Carmela Lacsa Domocmat, RN, MSN
Instructor, School of Nursing
Northern Luzon Adventist College

Male Genitalia
Anatomy and Physiology
Techniques of Examination
Related Abnormalities

Male Genitalia
Anatomy and Physiology

Maria Carmela L. Domocmat, RN, MSN

Male Genitalia
The Penis


Internal Structure


Testicles


Uncircumcised Circumcised
Penis Penis


Inguinal ring


Assessment
General 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.
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

Tanner’s Sexual Maturity Rating
The five stages of male genital development.
Stage 1 shows the undeveloped genitals of
childhood.
In Stage 2, pubic hair growth begins and the
testicles begin to enlarge.
By Stage 3, the penis grows longer and
wider. The testicles continue to enlarge.


The five stages of male genital development.

In Stage 4, the penis and testicles continue
to enlarge while the head of the penis
becomes more developed.
In Stage 5, the genitals have become their
adult size, and pubic hair covers the region.


Hair Distribution
Normal 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.

Hair Distribution
Normal Findings (cont’d)
• Sparsely distributed
on the scrotum and
inner thigh and
absent on penis.
• More coarse than
scalp hair.
• No nits or lice.

Geriatric Variation
Thinner
Sometimes gray


Abnormal Findings
Pediculosis Pubis
Herpes Simplex

Crab lice, Pthirus pubis
with reddish-brown crab feces.
reddish-


HSV Vesicles


The Penis
Inspection
Palpation

Inspection
•Examine the glans of the penis.

If the patient is
uncircumcised,
ask him to retract
the foreskin so that
the underlying
area can be
inspected.

• 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.

Normal Findings
Penis:
• Cylindrical in shape.
• Skin – free from
lesions and
inflammation.
• Shaft skin – appears
loose and wrinkled
without erection.

Normal Findings
Penis: (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.


Normal Findings
Glans penis – smooth, pink, bulbous
• Varies in size and shape.
• May appear round or
broad.
• Without lesions, swelling,
and inflammation


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
• Should retract easily
• Smegma (white, cottage-
cottage-
cheese-
cheese-like substance) may be
seen over the glans

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.)

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,
tenderness, masses,
or plaques.

Normal Findings
• Pulsations may be present
on the dorsal sides of the
penis.
• Non-tender.
Non-
• No masses or firm
plaques are palpated.


Make sure that you return the foreskin
(if uncircumcised) to its normal place at
the 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.


Geriatric Variation
Decrease in size of penis


Abnormal Findings
Chordee
Priapism
Phimosis
Paraphimosis

Abnormal Curvature

Congenital: Chordee
Acquired: caused by Peyronie’s Disease


Congenital Chordee


Congenital
Chordee


Acquired curvature
caused by Peyronie’s disease


Priapism


Phimosis Paraphimosis


Abnormal Findings
Penile Trauma:
Human Bite
Trauma-
Trauma-induced Fistula
Glanular Amputation
Penile Strangulation
Blast Injury

Human Bite Trauma-
Trauma-induced
fistula

Urethro-cutaneous fistula developed as a
result of circumcision injury

Glanular Penile
Amputation Strangulation

Complete loss of the glans In this child, a penile
resulting from electrocautery strangulation injury was
injury during a circumcision caused by a rubber band.

Blast Injury results in
no salvageable testicular
tissue

Gunshot Wound
through the right thigh
and penis


Diseases
Tinea Cruris
Urethritis
Syphilitic Chancre
Chancroid
Condyloma acuminatum or genital warts
Herpes
Candidiasis
Donovanosis or granuloma inguinale
Lypmphogranuloma Venereum
Penile Tumor and Cancer

Tinea Cruris or Jock itch


Balanitis Balanitis gangraenosa

Marked inflammation of the head of the penis This patient was diagnosed with balanitis
and foreskin, in this case caused by fungal gangraenosa, which was first thought to be a
dermatitis syphilis infection
infection.
Maria Carmela L. Domocmat, RN, MSN .

Syphilitic Ulcer Syphilitic Chancre


Condyloma
Penile
acuminatum
Condyloma
or Genital Warts

Growth at edge of glans due to HPV infection


Secondary Syphilis: includes multiple
lesions located on the penis and scrotum.
Secondary
syphilis is the
most contagious
of all the stages,
and is
The secondary
characterized by
maculopapular rash
a systemic
usually causes no
spread of the
itching, and can
Treponema
appear as the
pallidum
chancre, or
bacterium.
chancres found
during the primary
stage of syphilis are
healing, or several
weeks after the
chancres have
healed.

Chancroid

.
The differential diagnosis proved to be chancroid,
caused by Haemophilus ducreyi, and not syphilis.

Genital Herpes Candidiasis

Maculopapular herpetic rash on the
penile shaft and corona of the
glans penis. Maria Carmela L. Domocmat, RN, MSN

Donovanosis, or Lymphogranulom
granuloma a venereum
inguinale

A “genital ulcerative disease”
caused by the intracellular Gram-
negative bacterium
Calymmatobacterium granulomatisL. Domocmat, RN, MSN
Maria Carmela

Penile tumor Penile Cancer

differentially diagnosed as
giant condyloma of Buschke The erythematous patch on the glans penis
and Löwenstein (GCBL) was diagnosed as Bowen's disease, or
squamous cell carcinoma in situ.

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 discharge present
• Nontender

Compression of the glans to open
the urethral meatus
• Hold the glans
between the
thumb and the
forefinger and
gently squeeze
to expose the
meatus.

• 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.


Abnormal Findings
Hypospadias
Epispadias
Urethritis

Hypospadias

The 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

Epispadias

The opening of the urethra is on the
dorsal surface of the penis

Chemical Urethritis
Nonspecific
Urethritis

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.

Scrotum
Inspection
Palpation
Auscultation
Transillumination

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.

• 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.

Normal
appearance
of the
scrotum in
an adult
male


Normal Findings
• Skin of the scrotum is
normally loose.
• Surface may be coarse
• Size varies, may appear
pendulous


• Skin color: often more
deeply pigmented than
body skin. Often
reddened in red-haired
red-
individuals.
• Sac is divided in half
by septum.


• Left scrotal sac may
be longer than right
• Contracts in cold
temperature; relaxes
in warm temperature.
• Deeply pigmented
• Hairless or with
infrequent hair


• Rugose surface
• Nontender
• Thin loose skin over
muscular layer
• No Pitting.



• If scrotal mass or
enlargement is
detected, the scrotum
should be auscultated
and transilluminated


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

Abnormalities
Scrotum and its Structures
Sebaceous Cyst Varicocele
Cryptorchidism Elephantiasis
Prepenile Scrotum Carcinoma
Orchitis Testicular Torsion
Scrotal Edema Testicular Lump
Hydrocele Epididymitis
Spermatocele


Sebaceous Cyst Orchitis
on Scrotum


Cryptorchidism Prepenile
scrotum (PPS)

also known as Penoscrotal
Transposition


Scrotal Edema


Hydrocele


Elephantiasis
of the
Scrotum


Carcinoma
of the
Scrotum


Testicular Palpation
• Between the
thumb and the
first two fingers,
gently palpate
the left testicle
• Note the size,
shape,
consistency,
presence of
masses.

Testicular Exam
• Palpate the
epididymis
Note the
consistency
and
presence of
tenderness
or masses.


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.

Normal Findings
Testicle:
• 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).

Normal Findings
Testicle: (cont’d)
• Mildly sensitive to
gentle/ moderate
compression but
not tender
• Equal in size
• Firm but not hard

Normal Findings
Testicle: (cont’d)
• Smooth, rubbery, ovoid
in shape, and free from
nodules
• Movable
• Geriatric Variation : testes
may feel slightly softer
and smaller.

Let’s Watch:
Palpating the Testes
and Related Structures

Abnormal Finding
Testicular Lump

Testicular Lump


Normal Findings
Epididymis:
• Comma shaped
and
distinguishable
from the testicle.
• Nontender,
resilient


Normal Findings
Epididymis: (cont’d)
• Usually located
on posterolateral
surface of each
testis
• Discretely palpable,
smooth


Normal Findings
Epididymis: (cont’d)
• Insensitive to
pressure
• Lies towards the
top and back of
each testis


Abnormal Finding
Epididymitis

Epididymitis


Normal Findings
Spermatic cord:
cord:
• Smooth and round
• Located above each
testicle
• Composed of vas
deferens
testicular artery/vein,
ilio-
ilio-inguinal nerve.


Normal Findings
Spermatic cord:
cord:

• Lies along the
posterior aspect
of the bundle
• Feels firm and
wire-
wire-like


Normal Findings
Spermatic cord:
cord:
• Nontender,
movable
• Discretely palpable
from epididymis to
external inguinal
ring


Normal Findings
Spermatic cord:(cont’d)
cord:
• Smooth and cordlike,
without nodules or
swelling
• You will normally be
unable to specifically
identify the
remaining structures.

Abnormal Findings
Spermatocele
Varicocele

Spermatocele


Varicocele


Assess for Cremasteric
Reflex

Assess for Cremasteric reflex
• Cremasteric
reflex – the
temporary
migration of
the testis

•the cremaster muscle surrounding the testes contracts
in response to such stimuli as cold air, cold water, or
touching the inner thigh. This contraction raises the
contents of the scrotum toward the inguinal canal)

Assess for Cremasteric reflex cont’d
Stroke
the inner
thigh
with the
handle of
a reflex
hammer


Normal Finding

• Testicle
and
scrotum
rise on
the
stroked
side


Abnormal Finding
Testicular torsion

Testicular torsion


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.

Normal Finding
• No bowel sounds are present in the
scrotum.


Abnormal Findings
Hernia

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.


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

Normal Finding

Normal testicle
does not illuminate
(i.e., there is no
glow)


Abnormal Findings
(+) transillumination:
transillumination:
Serous Fluid such as in Hydrocele and
Spermatocele

(-) transillumination:
transillumination:
Vascular structures such as in
Varicocele,
Varicocele, Hernia, Epididymitis and
Tumor

Varicocele Hydrocele


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.


Normal Findings

• Inguinal area is free from any
swelling or bulges.


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.

Palpation of Lymph Nodes

Note the size,
consistency,
tenderness, and
mobility.


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 with
enlarged lymph nodes)

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).

Examination for an Hernia


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.

Normal Findings
• Finger follows
spermatic cord
upward to
triangular
slitlike opening.
(Which may or
may not admit
finger).

Normal Findings
As the client
strains, no
bulging will be
felt against
fingertips;
a tightening
around the
finger is
normal. Maria Carmela L. Domocmat, RN, MSN

Palpation for Femoral Hernia

•Palpate
the femoral
canal.
•Ask the
client to
bear down.


Normal Findings
• No bulging or
swelling
• Abdominal
muscle tightens
and scrotum
lowers as client
bears down.


Let’s Watch:
Palpating for Hernia

Large Right
Indirect Inguinal
Hernia


Left
Inguinal
Hernia


Direct
Inguinal
Femoral Hernia Hernia


Giant
Scrotal
Hernia


assessment of the male genitalia

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (8)

Similar to assessment of the male genitalia

Similar to assessment of the male genitalia (10)

More from Carmela Domocmat

More from Carmela Domocmat (20)

Recently uploaded

Recently uploaded (20)

assessment of the male genitalia