1. Structure and Function N1037
Male Genitalia
Structure and Function
N1037

2. Structure and Function
Inguinal Area (groin)
Juncture of the lower abdominal wall and the thigh
Inguinal ligament (Poupart’s ligament) lies between the anterior superior iliac spine and the symphysis pubis.
Superior to the ligament lies the inguinal canal
Inguinal Canal
Narrow tunnel passing obliquely between layers of abdominal muscle
4 to 6 cm long
Openings are the internal and external ring
Femoral canal is inferior to the inguinal ligament. Femoral artery is used as a landmark for this site.
Landmarking is important as these sites have potential for hernia formation (loop of bowel protruding through the musculature)

3. *

4. Anatomy Essential Organs: Testes Sperm production= spermatogenesis
Solid oval shape
4- 5 cm long by 3 cm wide.
Tunica vaginalis separates testes from the scrotal wall
Tunica albuginea divides the testes into lobules which contain seminiferous tubules which produce sperm.
Capped by the epididymis.
L testis is lower than the R, L spermatic cord is longer

5. Anatomy Accessory Organs: Seminal vesicles
2 pouches located posterior to bladder
Contain 60% of semen
Fluid is rich in fructose for sperm metabolism
Prostaglandins produced here contribute to sperm motility & viability
Bulbourethral glands or Cowpers Glands
Two Bulbourethral (Cowper’s) glands are the size of a pea and located inferior to the prostate on either side of the urethra

6. Anatomy Ducts Epididymis coiled duct system that stores sperm.
Continuous with vas deferens.
Ductus (vas) deferens
approximates with other vessels (arteries, veins, lymphatic, nerves) to form the spermatic cord.
Ejaculatory ducts
2 tubules posterior to bladder, descend through the prostrate gland and terminate at the urethra
Ducts eject spermatozoa into prostatic urethra just prior to ejaculation
Urethra
Terminal duct for seminal fluid passageway
Measures 20cm (8inches)
Passes through the prostrate, penis and terminates at the external urethral orifice

8. Anatomy Supporting Structures Scrotum
Pouchlike structure supporting testes, rugated, deeply pigmented, loose skin
Production and survival of sperm requires temp that is < 1° cooler than normal body temperature (37°C)
Penis
3 columns of erectile tissue: two corpora cavernosa (dorsal side), corpus spongiosum (ventral side)
Corpus spongiosum expands distally to form the glans.
Glans Penis – bulbous end of penis, may be circumcised
Prepuce – loose skin (foreskin) covers the glans penis if uncircumcised
Spermatic cord
Spermatic cord ascends along the post border to the testis and through the inguinal tunnel into the abdomen, continues back and down behind the bladder and joins the duct of the seminal vesicle to form the ejaculatory duct.
Cremaster muscle -elevates the testes toward the body when temp is cool (keeps sperm viable)

9. CROSS-SECTION

10. Developmental Considerations
Puberty begins sometime between ages 9 ½ and 13 ½
See Table 21-1 page 741 for sex maturity ratings in boys
The complete change in male genitalia development from preadolescent to adult takes around 3 years (2 to 5 years).
The older male is capable of sexual function as long as he is in reasonably good health and has an interested willing partner.

11. Physiology Spermatogenesis Male sexual function – 4 stages
Spermatogenesis – secretion of testosterone (male hormone) which is responsible for male sexual feelings, performance & muscle development; begins sperm production at age 13.
Male sexual function – 4 stages
Erection
Lubrication
Emission
Ejaculation

12. Structure and Function
Lymphatics of the penis and scrotal surface drain into the inguinal lymph nodes
Testis drain into the abdomen
Abdominal lymph nodes are not accessible to clinical examination

13. Health History Age Race Adolescent to young adult
Middle to older adulthood
Race
Caucasian

14. Common Chief Complaints
Urethral discharge
Palpable mass
Scrotal pain
Erectile dysfunction
Penile lesion
Characteristic of Chief Complaint
Quality
Quantity
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing

15. Past Health History Medical history Surgical history Medications
Male genitalia specific
Nonmale genitalia specific
Surgical history
Medications
Antibiotics, antihypertensives, psychotropics
Communicable diseases
STDs, penile lesions

16. Past Health History Allergies Injuries and accidents Special needs
Spermicides
Injuries and accidents
Special needs
Childhood illnesses
Mumps
Orchitis
Family history

17. Social History Alcohol, drug, tobacco use Sexual practice
Work environment

18. Health Maintenance Activities
Sleep
Diet
Exercise
Use of safety devices; safe sex
Routine testicular exams

19. Assessment Equipment General approach Nonsterile gloves
Culture supplies
General approach
Physical environment
Assess and reduce apprehension
Privacy

20. Subjective Data Frequency, urgency and nocturia Dysuria
Hesitancy and straining
Urine colour
Past genitourinary hx
Penis-pain, lesions discharge
Scrotum-self-care behaviours, lump
Sexual activity and contraceptive use
STD contact

21. Inspection Sexual maturity rating Hair distribution Normal Findings:
Assess the development of pubic hair, penis, scrotum - Tanner stages in Table 21-1
Hair distribution
Pattern and presence of nits or lice
Normal Findings:
Triangle-shaped distribution of pubic hair
Abnormal Findings: Alopecia, Lice or nits present

22. Inspection Penis Normal Findings: Abnormal Findings:
Size, shape, lesions, swelling, inflammation
Normal Findings:
Penile skin is free of lesions and inflammation
Penile shaft skin is loose and wrinkled
Foreskin retracts easily
No discharge from foreskin
Abnormal Findings:
Penile lesions : Syphilitic chancre, Genital warts, Herpes simplex virus, HSV, Candida, Phimosis (inability to retract foreskin), Epispadias,Hypospadias

23. Inspection
Scrotum
Size, shape, lesions, inflammation, swelling, nodules
Normal Findings:
Scrotal skin is rugated, thin, and pigmented
No lesions, nodules, swelling, or inflammation are present in the scrotal area
Left scrotal sac is lower than the right
Abnormal Findings:
Hydrocele,
Spermatocele
Varicocele

24. Inspection Urethral meatus Location, discharge
Normal Findings: Urethral meatus is centrally located, pink, and without discharge
Abnormal Findings: Urethral discharge
Inguinal area
Swelling, bulges
Normal Findings:No bulges or swelling are present in the inguinal area
Abnormal Findings:Hernias

26. Palpation Penis Normal Findings Abnormal Findings
Assess for tenderness, masses
Don gloves, palpate using thumb and fist 2 fingers
Palpate entire length of penis
Note pulsations , tenderness, masses
Normal Findings
Penis is nontender
Pulsations are present on dorsal side of the penis
Abnormal Findings
Vascular insufficiency = no pulse
Penile edema = fluid accumulation dt obstruction of veins

28. Palpation Urethral meatus Normal Findings Abnormal Findings
Assess for discharge
Grasp glans and gently squeeze to expose the meatus
Normal Findings
Urethral meatus free of discharge and drainage
Abnormal Findings
Urethral discharge of pus and mucus = bacterial infection …need swab for C & S

29. Palpation Scrotum Abnormal Findings…pg 755
Assess for masses, tenderness, spermatic cord
Palpate testicles
Palpate spermatic cord for epididymis to external inguinal ring
Note size, shape, consistency, masses
Normal Findings
Testicles are firm, ovoid, smooth, and equal in size
Spermatic cord is smooth and round
Abnormal Findings…pg 755
Tumor = maligancy
Testicular Torsion = surgical emergency = Prehn’s Sign = pain remains even when scrotum elevated
Epididymitis = infection dt Chlamydia, Neisseria gonorrhoeae
Cryptorchidism = undescended testicle

30. Auscultation Scrotum Abnormal findings
Performed if scrotal mass has been found
Abnormal findings
Presence of bowel sounds may indicate indirect inguinal hernia

31. Testicular Self-exam Last page of your handout. Perform monthly
To detect any abnormalities (lumps, masses)
Easily performed in the shower
Report any changes to the physician ASAP

34. Palpate testis and penile discharge
Testicular Self Examination
Palpate testis and penile discharge

35. Palpation Inguinal area Normal Findings Abnormal Findings
Assess for hernias
The inguinal area is free of bulges or palpable masses
Normal Findings
Abnormal Findings
Hernias

36. Gerontological Variations
Thinner pubic hair
Decreased testosterone levels
Penile and testicular atrophy
Slightly reduced spermatogenesis
Reduced ability to attain or maintain erection
Possible anxiety about changes