Male

1
Male Female Genitalia Assessment

• Week 9

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Male Genitalia Assessment
3
Male Genitalia Assessment

• Physical structures for assessment in male
  genitalia include
• Externally penis scrotum
• Internally testis, epididymis vas deferens
• Glandular structures accessory to genital organs
  are Prostate, seminal vesicles and
  bulbourethral glands (which we just discussed in
  anal, rectal prostate assessment).

4
Figure 24-1. p. 722
5
Figure 24-2. p. 723.
6
Figure 24-3. p. 723.
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Developmental Considerations

• Prenatally testes develop in abdomen near kidneys
  late in gestation the testes migrate, pushing
  abdominal wall in front of them dragging vas
  deferens, blood vessels nerves behind
• They descend inguinal canal into scotum before
  birth
• At birth each testis measures 1.5 2.0 cm long
  1 cm wide same till adolescence.

8
Developmental Considerations

• At puberty (ages 9½ to 13½) first sign is
  enlargement of the testes next pubic hair
  then penis size increases takes about 3 years
  (2 5) for complete maturation
• Tanners sexual maturity ratings (see Table 24-1
  on pg. 725) consistent across socio-economic
  status culture although timing can be different.

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Developmental Considerations

• 40 yrs ? production sperm starts ? 80s or 90s
• gt 55-60 yrs testosterone production gradually ?
• Changes also due to ? muscle tone, subcutaneous
  fat cellular metabolism
• Pubic hair ?, remaining hair turns grey penis
  size ?
• Scrotal contents hang lower due to ? tone of
  muscle
• Testes ? in size are less firm to palpation ?
  connective tissue in the tubules so they become
  thickened produce less sperm.

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Normal Sexual changes r/t Aging in Male

• Slower less intense sexual response although
  wide range of variation exists
• Erection takes longer is not as full or firm
• May hold erection longer without ejaculation
• May be shorter or less forceful ejaculation
• Volume of seminal fluid is less than when younger
• After ejaculation rapid detumenscence after 60
  yrs
• Refractory period lasts longer from 12 24 hours
  as compared with 2 minutes in younger male.

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Transcultural Considerations

• Circumcision
• Tends to be done for more cultural or religious
  reasons than for health
• In US 70 80 of newborn males are circumcised,
  in Canada, Great Britain, Australia Sweden only
  20 of newborn males are circumcised
• Jews Muslims practice circumcision as part of
  their religious value system.

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Subjective Data Collection

• Frequency, urgency, nocturia /or dysuria?
• Hesitancy /or straining?
• Urine colour amount?
• Past genitourinary history?
• Penis pain, lesion, discharge?
• Scrotum - self-care behaviours, lesions?
• Sexual activity contraceptive use, STD contact?.

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Objective Data Collection

• Penis should look wrinkled, hairless without
  lesions, dorsal vein may be apparent
• Glans looks smooth, compress to detect d/c
• Urethral meatus is positioned centrally
• Scotal size varies with room temperature
  asymmetry is normal, free of lesions, contents
  should slide easily, testes feel oval, slightly
  tender, each epididymis feels discrete, softer
  than the testes, smooth nontender.

14
Testicular Self-Examination

• Encourage every male age 13 14 to adulthood to
  examine testicles every month
• T timing once a month
• S shower, warm water relaxes scrotal sac
• E examine, check for changes, report changes
  immediately.

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Female Genitalia Assessment
16
Figure 24-1. p. 798.
17
Figure 24-2. p. 799.
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Dev. Considerations

• At birth, external genitalia engorged due to
  maternal estrogen, structures recede in few weeks
• Ovaries located in abdomen during childhood,
  uterus is small with straight axis
• Puberty estrogens stimulate growth of cells
  dev. of secondary sex characteristics 8 ½ 13
  yrs - takes about 3 years to complete
• Irregularity of menstrual cycle is common during
  adolescence
• With menarche uterus flexes on cervix ovaries
  are now in pelvic cavity.

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Developmental Considerations

• Menopause occurs around 48 to 51 yrs, ovaries
  stop producing progesterone estrogen
• Uterus shrinks in size, ovaries atrophy
• Sacral ligaments relax - pelvic musculature
  weakens uterus droops
• Cervix shrinks, looks paler
• Vagina shorter, narrower, less elastic, drier, pH
  more alkaline - ? risk for vaginitis
• Mons pubis fat pad atrophies
• Labia clitoris decrease in size, hair becomes
  thin sparse.

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Subjective Data Collection

• Past hx
• Sexual activity
• Contraceptive use
• Sexually transmitted disease contact
• STD risk reduction
• Medications.

• Menstrual hx (LMP)
• Obstetric hx
• Menopause
• Self-care behaviours
• Urinary symptoms
• Vaginal discharge

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Objective Data Collection external inspection

• Note skin colour, hair distribution
• Labia majora normally symmetric, plump, well
  formed
• Nulliparous woman labia meet in midline,
  following vaginal delivery labia gaping
  slightly shrivelled
• No lesions, except for occasional sebaceous cysts
  yellowish, 1-cm nodules firm, nontender
  multiple
• Examine clitoris, labia minora, urethral opening
  vaginal opening for inflammation, lesions or
  foul-smelling discharge.

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Developmental Considerations of Exam

• In adolescent take more time, assess independent
  of mother, provide health education discussion
  of pubertal progress
• Pelvic exam is indicated when contraception is
  desired, when sexual activity included
  intercourse or at age 18.