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MEDICAL AND SURGICAL NURSING Male Reproductive System Lecturer: Mark Fredderick R. Abejo RN, MAN
Anatomy and Physiology of the Male Reproductive System
Penis Both a sexual organ & an organ for urination Consists mainly of erectile tissue & urethra through which semen & urine are released via the meatus The meatus is in the glans penis The glans penis is the cone-shaped end of the penis The glans penis is enclosed by a fold of skin called the prepuce or foreskin (may be removed with circumcision) Composed erectile muscle: 2 corpus cavernosus / 1 corpus spongiosum
Scrotum Sac that lies posterior to the penis Protects the testes, the epididymis and the vas deferens in a space cooler than the abd cavity Left side normally hangs a bit lower than Right Testes (testicles) Produce testosterone & sperm
Medical and Surgical Nursing
MAN Epididymis 1st portion of a ductal system that transports sperm from the testes to the urethra Provides for storage. 2. making retraction difficult or impossible May be congenital or caused by edema or inflammation Often associated with poor hygiene beneath the foreskin (SMEGMA) Assessment Edema Erythema Tenderness Purulent Drainage Medical Management Antibiotics--systemic. If the condition persists for several hours or there is any sign of a lack of blood flow. and cannot be pulled back to its normal flaccid position covering the glans penis. as it can result in gangrene or other serious complications. for 4-6 weeks to the narrow part of the foreskin is relatively simple. PARAPHIMOSIS Is a medical condition where the foreskin becomes trapped behind the glans penis. transport & maturation of sperm Vas Deferens Continues from the epididymis Conveys sperm from the epididymis to the ejaculatory duct Seminal Vesicles Provides most of volume of ejaculate Each vesicle joins with vas deferens to form the ejaculatory duct Ejaculatory Ducts Two ducts that descend thru the prostate gland. Surgical : Circumcision Nursing Management Patient/Parent teaching re: proper cleaning Teaching re: pros & cons of circumcision Sperm Cells Sperm cells are produced in the seminiferous tubules. such as betamethasone. ending in the prostatic Prostate Gland Surrounds the urethra at the base of the bladder Produces an alkaline fld that forms part of the volume of the ejaculate Prostatic fluid aids the passage of sperm & helps keep them alive it also helps protect the sperm from the acidity of the vagina Urethra Provides for passage of semen & urine through the meatus CONGENITAL DISORDERS PHIMOSIS A condition in which the penile foreskin (prepuce) is constricted at the opening. nucleus): contains DNA Acrosome – a vesicle that contains hyaluronidase and proteinases. enzymes that aid penetration of the sperm cell into the secondary oocyte Midpiece (mitochondria) – carry on metabolism that provides ATP for locomotion Tail – a typical flagellum that propels the sperm cell along its way. Normal Number : 60 – 120 million / ml Normal Amount of Semen : 2 -6 ml Parts & Functions 1. Medical and Surgical Nursing 2 Abejo . Head (acrosome.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R.N. Sertoli cells nourish the sperm cells and produce small amounts of hormone Fructose is the main source of energy of sperm to move. local Non Surgical : Application of topical steroid cream. paraphimosis should be treated as a medical emergency. 3. less expensive than surgical treatments and highly effective.
when penile growth is minimal. Hernia repair or other surgery in the inguinal area resulted in trapping of a testis above the scrotum.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R. the urethra does not grow to its complete length. Opening of the penis is NOT at the tip of the penis but is displaced to the downward side or bottom of the penis Penis looks hooded due to malformation of the foreskin Child has to sit down to void Medical Management Usually. the foreskin may need to be cut (dorsal slit procedure) or removed by circumcision Nursing Management Prevention of recurrence is through education of the patient and his caregivers on the need to pull back the foreskin over the glans after it has been retracted (for example. At birth. Most commonly with hypospadias. near the tip. including reconstruction of the urethra. or "descend. the surgical repair is done when the child is between 6 and 12 months. CRYPTOCHIDISM (undescended testes) Is the absence of one or both testes from the scrotum. EPISPADIAS Is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis.N. as the extra foreskin may be needed for the surgical repair. Signs and Symptoms Abnormal appearance of foreskin and penis on exam. Exstrophy is a condition where the bladder may appear to be inside out and the abdominal wall is partially open leaving the bladder exposed to the exterior of the body Treatment The main treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area usually during the first 7 years of life. closure of the penile shaft and mobilisation of the corpora. Abnormal direction of urine stream. your male child will not be able to undergo circumcision. The most popular and successful technique is known as the Modified Cantwell-Ransley Approach HYPOSPADIAS Is a malformation that affects the urethral tube and the foreskin on a male's penis. As the fetus develops. when cleaning the glans or passing a Foley catheter) Risk Factors Hypospadias is a congenital (present at birth) anomaly (abnormality). Also during fetal development the foreskin does not develop completely. (1)The urethra may open on top of the head of the penis (2) The entire urethra may be open the full length of the penis (3) The entire urethra may be open with the bladder opening on the abdominal wall. Exposure to regular alcohol consumption during pregnancy (5 or more drinks per week Exposure to pesticides Gestational diabetes Being a twin Women who drink caffeine (at least 3 drinks per day) . Hypospadias is a disorder in which the male urethral opening is not located at the tip of the penis. The urethral opening can be located anywhere along the urethra. Epispadias occurs in one of three forms. The end of the penis may be curved downward. through the inguinal canal. which typically leaves extra foreskin on the topside of the penis and no foreskin on the underside of the penis. MAN Medical Management This involves compressing the glans and moving the foreskin back to its normal position." during fetal development from an abdominal position. The urethra is the tube that carries urine from the bladder to the outside of the body. into the ipsilateral scrotum Causes and Risk Factors Severely premature infants Low birthweight due to either prematurity or intrauterine growth retardation Environmental chemicals — endocrine disruptors — that interfere with normal fetal hormone balance has been proposed and is rarely possible to implicate a specific chemical exposure for an individual child. perhaps with the aid of a lubricant. which means that the malformation occurs during fetal development. If this fails. The surgical repair can usually be done on an outpatient basis. Medical and Surgical Nursing 3 Abejo . This usually represents failure of the testis to move. the opening is located along the underside of the penis.
often by a pediatric urologist or pediatric surgeon Often. The open communication between the abdominal cavity and scrotum is repaired. In some circumstances. resulting in infertility Pulling" sensation. Surgery may also improve the chance of future fertility in some cases. if inguinal testes have not descended after 4–6 months. Medical Management The primary management of cryptorchidism is surgery. MAN SCROTAL / TESTICULAR DISODERS HYDROCELE A painless collection of clear yellow to amber fluid within the scrotum Leads to scrotal swelling Can be transilluminated. Collaborative Management USUALLY NONE unless there is compromised testicular circulation Surgery is recommended during 12-18 months if hydrocele still present They should be repaired when they cause symptoms or if they are present during an inguinal hernia repair unless there is compromised testicular circulation and pain embarrassment from increased scrotal size Hydrocele Repair Hydrocele repair involves surgical correction of a birth defect in which there is an open passageway between the abdomen and scrotum which causes fluid collection around the testicle (Hydrocele) An incision is made just above the groin. the fluid is removed from the scrotum. If not. called orchiopexy. a child is watched until the age of one to see if the testicle will move into the scrotum by itself. Surgery improves cosmetic appearance and makes examination of the testicles to check for cancer easier. May be associated with infections.. trauma. ruling out the presence of a fluid or mass. systemic infections (e. Infertility or decrease sperm count and cause atrophy of the testicle. dull ache in scrotum Scrotal swelling Nursing Management Prevent trauma to the incision site Watch out for any signs of bleeding Bed rest and limit movement until wound is heal Continue medication Medical and Surgical Nursing 4 Abejo . Feeling of heaviness in the testicle(s) Atrophy (shrinking) of the testicle(s) Visible or palpable (able to be felt) enlarged vein. mumps Hydroceles are usually not painful Sign and Symptoms The testicles are noted to be absent in the scrotum by the parent or healthcare provider.N. the procedure can be done laparoscopically VARICOCELE Is an abnormal enlargement of the vein that is in the scrotum draining the testicles.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R.g. affected testicles can be brought down into the scrotum using surgery. likened to feeling a bag of worms. It is usually performed in infancy. and the incision is closed. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis Cause Thought to be incompetent venous valves or obstruction of the gonadal vein Signs and Symptoms Ragging-like or aching pain within scrotum.
Pain medications and anti-inflammatory medications When orchitis is caused by a virus. MAN Diagnosis Can be felt upon scrotal palpation (feels like a "bag of worms) Ultrasound of scrotum Doppler Clinical Manifestations/Assessment Painful scrotal swelling Pain along the inguinal canal & along the vas deferens Reddened scrotum Fever. mid-stream.may need several samples. and after prostate massage Tests to screen for chlamydia and gonorrhea (urethral smear) CBC Doppler ultrasound Testicular scan (nuclear medicine scan) Collaborative Management Antibiotics In the case of gonorrhea or chlamydia.4 weeks) Epididymectomy for recurrent/chronic epididymitis ORCHITIS or ORCHIDITIS Is a condition of the testes involving inflammation. and to relieve pain (usually about 3-5 days) Antibiotics Intermittent ice packs/cold compresses may help decrease swelling & pain **Avoid heat Avoid lifting. It can also involve swelling and frequent infection. and the scrotum (sac containing the testicles) may become red. swollen. sexual partners must also be treated. This condition may be mildly to very painful. and infrainguinal/subinguinal (below the groin). is recommended. The three most common approaches are inguinal (groin). retroperitoneal (abdominal). to facilitate venous drainage. heavy feeling in the testicle Tender. Causes Infection of the prostate Long term use of catheter Prostatic surgery Cystoscopic examination Trauma Urinary tract infection Chlamydia (most common cause in men under age 35) **The causative organism passes upward thru the urethra & the ejaculatory duct. Collaborative Management Bedrest with scrotum elevated on towel to prevent traction on the spermatic cord. It may be acute (of sudden onset) or rarely chronic. swollen groin area on affected side Fever Discharge from penis Pain with urination (dysuria) Pain with intercourse or ejaculation Groin pain Testicle pain aggravated by bowel movement or straining Blood in the semen Diagnostic Procedure Urinalysis Urine culture (clean catch) -. only analgesics (pain relievers) are prescribed. including initial stream. the surgical correction of a varicocele. is performed on an outpatient basis. It can also be seen during active mumps Inadequate immunization against mumps Being older than age 45 Recurrent urinary tract infections Congenital problems of the urinary tract Genito-urinary surgery Long term use of a Foley catheter (tube inserted into the bladder to drain urine) Clinical Manifestation Scrotal swelling Tender.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R. straining. then along the vas deferens to the epididymis Medical and Surgical Nursing . with elevation of the scrotum and ice packs applied to the area. Bed rest. Causes / Risk Factors Epididymitis Infection Sexually transmitted diseases chlamydia and gonorrhea. sexual excitement until infection completely resolved (may take 3 . The patient may be advised to wear a scrotal support for some time after surgery. bacteriuria Development of an abscess "Duck waddle" walk Diagnosis Increased WBC count Nuclear med scan with injection of radioactive dye Collaborative Management Usually treated in younger pts (to prevent infertility) and in pts with pain Spermatic vein ligation Varicocelectomy. warm and swollen. 5 Abejo EPIDIDYMITIS Is a medical condition in which there is inflammation of the epididymis (a curved structure at the back of the testicle in which sperm matures and is stored).N. chills Pyuria. Post Op Nursing Care Ice packs should be kept to the area for the first 24 hours after surgery to reduce swelling.
They should first examine each testicle separately. The result is a testicular torsion. Stage III: the cancer involves the testis and metastasis beyond the retroperitoneal and Paraaortic lymph nodes. blood in semen general weak and tired feeling Staging Stage I: the cancer remains localized to the testis. chills Collaborative Management Testicular torsion is a surgical emergency that needs immediate surgical intervention. Surgery: Orchiectomy is a relatively minor surgical procedure to remove a testicle. This is because they often happen in winter. and chemotherapy. the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. It is most common among males aged 15–40 years. and then compare them to see whether one is larger than the other. MAN TESTICULAR CANCER Cancer that develops in the testicles. feeling for lumps. when it is cold outside. Stage III is further subdivided into nonbulky stage III and bulky stage III. males will become familiar with what is normal for them. within 24 hours is 20%. Within 12 hours the rate decreases to 70%. Their testicles should be examined by a doctor if they notice any of the following: a lump in one testicle pain or tenderness blood in semen during ejaculation build-up of fluid in the scrotum a change in the size of one testicle or the relative sizes of the two TESTICULAR TORSION The spermatic cord that provides the blood supply to a testicle is twisted. or significant decrease. there is an excellent chance of saving the testicle. Some patients elect to have a prosthetic testicle inserted into their scrotum Prevention: Perform a Monthly Testicular Self Examination Men from puberty onwards should examine their testes after a hot shower or bath.) Clinical Manifestation Testicular pain Tenderness of less than 6 hrs of duration. sometimes described as a "heavy" sensation lumbago . ( The scrotum of a man who has been lying in a warm bed is relaxed. when the scrotum is looser.  Stage IV: if there is liver and/or lung secondaries Collaborative Management The three basic types of treatment are surgery. and after 24 hours the rate approaches 0% Once the testicle is dead it must be removed to prevent gangrenous infection. a part of the male reproductive system. When he arises.lower back pain An increase. Reddened scrotum Fever. If treated within 6 hours. Causes / Risk Factors Torsions are sometimes called "winter syndrome". By doing this each month. or sudden decrease in the size of one or both testes. Medical and Surgical Nursing 6 Abejo . especially following physical activity. Often it is performed as same-day surgery. often causing orchialgia (pain in the testicle ) Prolonged testicular torsion will result in the death of the testicle and surrounding tissues. known as a hydrocele a dull ache in the lower abdomen or groin. his scrotum is exposed to the colder room air.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R. particularly those in their mid-twenties. Causes / Predisposing Factors Caucasian men Men aged 15 – 35 Hereditary Sedentary lifestyle Early onset of male secondary characteristics Conditions such as: Cryptorchidism Hx of mumps orchitis Inguinal hernias Hx of testicular ca on the other testes Clinical Manifestation a lump in one testis or a hardening of one of the testicles abnormal sensitivity (either numbness or pain) loss of sexual activity or interest sexual withdrawal A burning sensation. build-up of fluid in the scrotum or tunica vaginalis. radiation therapy. If the spermatic cord is twisted while the scrotum is loose. cutting off the blood supply. with the patient returning home within hours of the procedure. The procedure is generally performed by a urologist. Stage II: the cancer involves the testis and metastasis to retroperitoneal and/or Paraaortic lymph nodes (lymph nodes below the diaphragm).N.
but believed to be hormone related Causes / Risk Factors Obesity Heavy lifting Coughing Straining during a bowel movement or urination Chronic lung disease Fluid in the abdominal cavity A family history of hernias can make you more likely to develop a hernia. Males may have a swollen scrotum. Although you may have pain or discomfort in the scrotum. straining. Heaviness. MAN INGUINAL HERNIA Is a protrusion of abdominal-cavity contents through the inguinal canal.N.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R. Groin discomfort or pain. use condom ) regimen BENIGN PROSTATIC HYPERPLASIA (BPH) An abnormal increase in the number of prostatic cells NOT an increase in cell size When the prostate enlarges. They are very common (lifetime risk 27% for men. and females may have a bulge in the large fold of skin (labia) surrounding the vagina. direct and indirect: Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring. Collaborative Management Surgical correction of inguinal hernias. swelling. it extends upward. scrotum. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring. The bulge may appear gradually over a period of several weeks or months. Many hernias flatten when you lie down. Discomfort and aching that are relieved only when you lie down. The discomfort may be worse when you bend or lift. called a herniorrhaphy or hernioplasty is a surgical procedure for correcting hernia. coughing. narrowing the urethra Clinical Manifestation Urinary frequency Nocturia Hesitancy. tender prostate Complications epididymitis cystitis decreased sexual functioning b/o pain Collaborative Management Medications: Antibiotics---Carbenicillin (Geocillin). PROSTATE GLAND DISODERS PROSTATITIS Inflammation of the prostate gland Two types: Abacterial and bacterial Abacterial Prostatitis can occur after a viral illness can occur after a sudden decrease in sexual activity. or it may form suddenly after you have been lifting heavy weights. especially young males many times cause unknown Bacterial Prostatitis usually associated with a lower UTI most common organism= E-coli Pathophysiology Although androgen levels decrease with aging. into the bladder. decreased force of stream Abd straining upon urination Post-void dribbling Sensation of incomplete emptying Dysuria Urinary retention (can be complete) Bladder distention Enlarged prostate (upon rectal exam) Medical and Surgical Nursing 7 Abejo . Clinical Manifestation Bulge in the groin or scrotum. or laughing. or inner thigh. 3% for women There are two types of inguinal hernia. Ciprofloxacin (Cipro) Analgesic Stool softeners Pt Teaching Comfort Measures---sitz baths Force Fluid to decrease chance of prostatitis causing UTI Importance of completing entire ABC (abstinence. chills urethral discharge upon prostate massage boggy. and inward Approx 80% of men over age 50 have some signs of BPH Cause ---unknown. many hernias do not cause any pain. the aging prostate appears to become more sensitive to available androgen The expanding tissue compresses surrounding tissue. be faithful. this may be caused by failure of embryonic closure of the processus vaginalis Clinical Manifestations Abacterial Prostatitis urgency. lateral to the inferior epigastric vessels. bending. and a tugging or burning sensation in the area of the hernia. frequency nocturia dysuria dull pain in perineum/rectal area back pain painful ejaculation Bacterial Prostatitis same as Abacterial AND fever.
3-6 weeks after discharge Driving. WBC. Transurethral Resection Prostatectomy (TURP) very common approach no incision resectoscope inserted thru urethra & scrapes out the enlarged portion of the gland CBI ( continuous bladder irrigation or cystoclysis is done postop B. blood) Urine C&S BUN. antihistamines. protein. Perineal Prostatectomy prostate is removed thru a perineal incision between scrotum & rectum E. D.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R. Flutamide. and silodosin. bladder is retracted. terazosin. Finasteride and dutasteride. epididymitis PROSTATE CANCER Most common male Ca Androgen – dependent adenocarcinomas Medical and Surgical Nursing 8 Abejo . Transurethral Incision of Prostate (TUIP) small incisions are made in the prostate to enlarge the prostatic urethra and relieve obstruction Nursing Management Postop Care Care of the patient with CBI Maintain patency of the catheter If drainage is reddish: increase flow rate ( by MD) If drainage is clear: decrease flow rate (by MD ) Practice asepsis Use sterile NSS to prevent water intoxication Monitor for hemorrhage Client Teaching Red to light pink urine during the 1st 24 hours Amber after 3 days postop Advise not to void around the catheter Increase fluid intake Relieve pain Avoid the following: Vigorous exercise Heavy lifting Sexual intercourse. a hormone responsible for enlarging the prostate. 2 weeks after discharge Straining with defecation Prolong sitting / standing Crossing legs Long trips and travel Observe the following complications: Hemorrhage Shock Obstruction in lower UT with clots/swelling/stricture (with TURP) Electrolyte imbalance Thrombus/Embolus Pain. Suprapubic Prostatectomy incision is made into the lower abd & bladder prostate removed thru the bladder with cystostomy tube and 2-way foley catheter postop C. other infections Release of prostatic fluid prostatic massage frequent intercourse masturbation Prevention of overdistention of bladder Avoid drinking large amount in short time Avoid diuretics. Retropubic Prostatectomy low abd incision made. alfuzosin. Proscar (antiandrogens) Antibiotics to tx UTI. Alpha blockers relax smooth muscle in the prostate and the bladder neck. this medications inhibit 5a-reductase. caffeine Void as soon as urge felt Avoid meds that can cause urinary retention : anticholinergics.N. decongestants Surgical Management Type of Surgical Procedure Depends on size of prostate location of enlargement whether surgery on the bladder is also needed pt’s age/physical condition A. which in turn inhibits production of DHT. Creatinine Cath for residual IVP Cystoscopy Rectal exam to palpate prostate Prostate-specific antigen (PSA) to help r/o prostate cancer Serum Acid Phosphatase BX of prostate Medical Management Pharmacologic Management Alpha blockers used for BPH include doxazosin. thus decreasing the blockage of urine flow. MAN Complications UTI (upper & lower) Hydroureter. bladder spasms UTI. & prostate is reached directly. tamsulosin. Hydronephrosis Urinary Calculi Possibly renal failure Epididymitis Prostatitis Diagnostic HX of S/S UA (bacteria.
Medical and Surgical Nursing 9 Abejo . such as the "Nesbit operation". are currently being prescribed to help correct the curvature of the penis Injecting medication directly into the plaque in an attempt to soften the affected tissue. and can develop into a hardened scar. Injections to plaques (scar tissue formed by the inflammation) with Verapamil may be effective in some patients. often painful erection that can last from several hours to a few days.N. a blood transfusion may be necessary. Causes / Risk Factors Unknown cause Predisposing Factors Vasculitis Connective tissue disorder Hereditary Collaborative Management A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition. The plaque often begins as a localized area of irritation and swelling (inflammation). Penile implants can be used in cases where Peyronie’s disease has affected the man’s ability to achieve or maintain an erection. rubber. forms on the penis. in the layers that contain erectile tissue. The scarring reduces the elasticity of the penis in the area affected. which have traditionally been used to treat erectile dysfunction. batteries viruses. causing pain and forcing the penis to bend or arc during erection. enlarge prostate pain in defecation elevated PSA ( prostatic specific antegin ) Collaborative Management Tx depends on staging of disease Total prostatectomy perineal or retropubic approach usually used common complications— impotence. or hard lump. STDs Clinical Manifestation urinary hesitancy hematuria urinary retention stool changes pain radiating down hips and legs cystitis dribbling sensation nocturia hard. PENILE DISODERS PRIAPISM Is a persistent. The plaque may develop on the upper (more common) or lower side of the penis. textile. If the condition is due to sickle cell disease.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R. The hardened plaque reduces flexibility. Surgery. The priapism erection is not associated with sexual activity and is not relieved by orgasm. including leukemia and sickle cell anemia Collaborative Management Goal of treatment is to relieve the erection and preserve penile function. Treating any underlying medical condition or substance abuse problem is important to preventing priapism. It occurs when blood flows into the penis but is not adequately drained Causes / Risk Factors Alcohol or drug abuse (especially cocaine) Certain medications. which decreases blood flow to the penis. including some antidepressants and blood pressure medications Spinal cord problems Injury to the genitals Anesthesia Penile injection therapy (a treatment for erectile dysfunction) Blood diseases. incontinence Radiation Chemotherapy Hormone Therapy (palliative) PEYRONIE’S DISEASE Is a condition in which a plaque. treatment involves draining the blood using a needle placed in the side of the penis. also may be used Surgery may be required to avoid permanent damage to the penis. MAN Causes / Risk Factors 50 years of age and above Genetic tendency Hormonal factors late puberty high frequency of sexual experience history of multiple sexual partners high fertility High fat diet Air pollutant Exposure to fertilizers. decrease the pain and correct the curvature of the penis. In most cases.is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques Vacuum therapy devices (or penis pumps). Medications that help shrink blood vessels.
Exercise. Alzheimer's disease. A similar condition. the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra. Lifestyle: alcohol and drugs. a circumcision may be recommended. multiple sclerosis. n most cases delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation. Other drugs such as alcohol. generalized anxiety disorder. DELAYED EJACULATION Is the inability to ejaculate or persistent difficulty in achieving orgasm despite the presence of normal sexual desire and sexual stimulation. low or abnormally high levels of the hormone testosterone). obesity. with a separate compression ring fitted to the penis to maintain it EJACULATORY DISODERS SPERM CELL / SEMEN DISORDER Aspermia: absence of semen Azoospermia: absence of sperm Oligospermia: low semen volume Oligozoospermia: low sperm count Asthenozoospermia: poor sperm motility Teratozoospermia: sperm carry more morphological defects than usual ERECTILE DYSFUNCTION Is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance. Venous leak Cavernosal Disorders (Peyronie's disease. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor. schizophrenia.) Hormonal Disorders (pituitary gland tumor. negative feelings Surgery (radiation therapy. panic disorder. balanoposthitis. In cases of severe or persistent inflammation. Normally a man can achieve orgasm within 2–4 minutes of active thrusting during sexual intercourse. cocaine. that are used to relax the muscles of the urinary tract Diabetes due to neuropathy Treatment These medications tighten the bladder neck muscles and prevent semen from going backwards into the bladder: Tricyclic antidepressants like Imipramine. MAN BALANITIS Is an inflammation of the skin covering the head of the penis. the path of least pressure. Smoking causes impotence because it promotes arterial narrowing. reduced blood flow to the penis). Arterial Disorders (peripheral vascular disease. substance abuse. Taking appropriate hygiene measures can help prevent future bouts of balanitis. personality disorders or traits. such as tamsulosin.). 10 Abejo . prostate. refers to inflammation of the head and the foreskin Causes / Risk Factors uncircumcised poor hygiene irritation by a foul-smelling substance (smegma) that can accumulate under the foreskin. Cause / Risk Factors Drugs (Anti-depressants (SSRIs) and Nicotine are most common. cigarette smoking (Incidence of impotence is approximately 85 percent higher in male smokers compared to non-smokers. Smoking is a key cause of erectile dysfunction. nerve disorders such as Parkinson's disease. and heroin negatively impact male sexual libido. Causes / Risk Factors Malfunctioning bladder sphincter Common side effect of medications. Avoid strong soaps or chemicals. Decongestants like Ephedrine and Phenylephrine. surgery of the colon. which increases the risk for impotence. mental disorders (clinical depression.Lecture Notes on Male Reproductive System System Prepared By: Mark Fredderick R Abejo R. psychological problems. but not during sexual intercourse. especially those known to cause a skin reaction. PREMATURE EJACULATION is a condition where a man ejaculates earlier than he or his partner would like him to. Antihistamines like Chlorphenamine. Other condition such as: Dermatitis Allergy Yeast infection Clinical Manifestation First signs – small red erosions on the glans Redness of the foreskin Redness of the penis Other rashes on the head of the penis Foul smelling discharge Painful foreskin and penis Collaborative Management If there is an infection. Aging. stress. or rectum may damage the nerves and blood vessels involved in erection. Overtraining Collaborative Management Testosterone supplements may be used for cases due to hormonal deficiency Medical and Surgical Nursing RETROGRADE EJACULATION Occurs when semen. particularly aerobic exercise is an effective cheap treatment for erectile dysfunction Counseling A purpose-designed external vacuum pump can be used to attain erection.) Neurogenic Disorders (spinal cord and brain injuries. Normally. retrograde ejaculation may occur. bladder. which would normally be ejaculated via the urethra. is redirected to the urinary bladder.N. When the bladder sphincter does not function properly. hypertension. whereas a man with delayed ejaculation either does not have orgasms at all or can't have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more. treatment will include an appropriate antibiotic or antifungal medication.) Psychological causes: performance anxiety. and stroke.