Male Reproductive System Chapter 28 Male Reproductive System

Anatomy of Male Reproductive System External anatomy Penis Delivery of semen into female reproductive tract via vagina Glans (head) Corpus cavernosum Corupus spongiosum Urethra

Anatomy of Male Reproductive System External anatomy Testes Secretion of hormones Responsible for spermatogenesis Held within soft tissue structure (scrotum) Scrotum made of two layers

Anatomy of Male Reproductive System External anatomy Epididymis Attached to each testicle Spermatazoa produced in testes Enters epididymis for storage Attached to epididymis is vas deferens Conducts mature sperm to penis during ejaculation

Anatomy of Male Reproductive System Internal anatomy Vas deferens attaches to urethra inside body of prostate Prostate plum-sized gland at base of urinary bladder Provides 1/3 of fluid that composes semen Seminal vesicles make 70% of fluid portion of semen

Anatomy of Male Reproductive System Internal anatomy Vasectomy: surgical interruption of vas deferens to disrupt pathway of sperm to outside of body Vasectomy (one side)>> [FIGURE 28-1]

Anatomy of Male Reproductive System Internal anatomy Cowper’s or bulbourethral glands located internally at base of penis Manufactures and discharges clear viscous secretion (pre-ejaculate)

Disorders of the Penis Priapisam Erection lasting more than 4 hours Can occur with or without sexual stimulation Can result in tissue death and permanent erectile dysfunction (See Table 28-1: Male Reproductive System Diseases and Disorders)

Disorders of the Penis Priapisam Predisposing factors: sickle cell disease; use of pharmacologic agents to enhance sexual function Treatment: ice packs to groin area, increased physical activity, emergency medical treatment

Disorders of the Penis Erectile dysfunction Impotence occurs when man unable to achieve or sustain erection of penis Not normal at any age Inability to achieve erection more than 50% of the time

Disorders of the Penis Erectile dysfunction Treatment based on cause Referral to urologist, psychologist, or both Treatment: oral medications, penile injections, sex therapy, surgery, vacuum pumps, lifestyle changes

Disorders of the Penis Penile cancer Incidence greater in uncircumcised men Symptoms: lesions that do not heal on penis, penile pain, bleeding Psychologically devastating disease Treatment: chemotherapy, radiation, surgery, total removal of penis (penectomy)

Disorders of the Penis Other disorders of the penis Peyronie’s disease: curvature of penis during erection Balanitis: swelling and/or inflammation of glans penis Phimosis: tightening of foreskin that does not allow retraction; common in children

Disorders of the Testes Testicular trauma Direct blow to area Object that penetrates scrotum Injury that involves removal of protective integument Treatment: scrotal support, methods to decrease inflammation, bed rest, surgical intervention

Disorders of the Testes Testicular torsion Twisting of spermatic cord Emergency situation if not resolved, with or without medical intervention Common in males between 12 to 18 years

Disorders of the Testes Testicular cancer Young men between ages of 15 and 40 At higher risk with family history Seminoma cancer spreads via lymph system; highly curable if detected early Monthly testicular self-exams recommended

Testicular Self-Examination [FIGURES 28-4A, 28-4B, 28-4C, 28-4D] (See Procedure 28-1: Instructing Patient in Testicular Self-Examination)

Disorders of the Testes Testicular cancer Nonseminoma: testicular tumors Treatment depends on extent of metastasis Treatment: radical orchiectomy, radiation, chemotherapy

Disorders of the Testes Hypogonadism Testes produce little or no testosterone Often result of chromosomal abnormality, Klinefelter syndrome Other factors: cyrptorchisism, infection of testicles from mumps, injury to testicles, cancer treatment Treatment: testosterone replacement therapy

Disorders of the Prostate Prostatitis Inflammation of prostate gland Can be acute or chronic Causes: Bacterial infection Immune or nervous system disorder Irritation of gland itself by insertion of foley catheter Anal intercourse Some types of athletic activities

Disorders of the Prostate Benign prostatic hyperplasia (BPH) Enlargement of prostate gland not due to infection or cancer Common in men over age of 50 Nocturia: not being able to sleep through night due to frequent urination Treatment based on severity of symptoms

Disorders of the Prostate Benign prostatic hyperplasia (BPH) Prostate-specific antigen (PSA) Rectal digital exam Urinalysis Treatment: medications that relax bladder neck or shrink prostate

Disorders of the Prostate Benign prostatic hyperplasia (BPH) TURP or transurethral resection of prostate>> [FIGURE 28-5]

Disorders of the Prostate Prostate cancer Leading cause of cancer-related death in men 75 and older Symptoms similar to those associated with BPH Staged to determine prognosis and treatment plan Treatment: prostatectomy, chemotherapy, radiation, hormone therapy

Other Disorders of the Male Reproductive System Sexually transmitted diseases STDs affect men and women Can damage health and become life-threatening (See Table 28-2: Sexually Transmitted Diseases)

Other Disorders of the Male Reproductive System Infertility Inability or diminished ability to conceive Sperm not of sufficient number or quality Infection in genitourinary tract Presence of STD Injury to blood or nerve supply in area Radiation exposure Stress Hormonal imbalances

Other Disorders of the Male Reproductive System Infertility Treatment depends on cause Surgery to remove blockage Antibiotics to treat infection Artificial insemination Use of pharmaceuticals

Assisting with the Male Reproductive Examination Female medical assistant usually not required to assist Conduct yourself in respectful, appropriate manner, including nonverbal communication Provider examines penis and foreskin of penis in uncircumcised patient

Assisting with the Male Reproductive Examination Remember that cultural norms vary from country to country Penis and testes examined for swelling, masses, discomfort Provider performs digital rectal examination

Assisting with the Male Reproductive Examination [FIGURE 28-6]