Assessment of Male Genitalia This tubule produce sperm via

NCM 101 - H.A. spermatogenesis.

- An image of a seminiferous tubules
with sperm in the middle.
Functional Anatomy of the Male
Reproductive System
- Structures that are important in the
male reproductive system include:
Vas Deferens (Ductus Deferens),
Penis, Testes, Scrotum,
Bulbourethral gland, Prostate
Gland, and the Seminal Vesicle.

- The LUMEN of a seminiferous

tubules is lined by cells called
“Sertoli Cells”, connected by a tight
junctions. Lining inside of the cell is a
layer of Smooth Muscle, outside is a
layer of Leydig Cells.
Testes - Basal and Lumenal Compartment,
The male “Gonad”. are regions of cross sections.

- Longitudinal section through 1

testicle.
- The majority of the testes is
composed of seminiferous tubules.
Sertoli Cells produced the Sperm. ●
●
●
●
●
●
●
●

● Sperm is mix with the fluid

When ejaculation occurs, sperm is
forcefully expelled from the tail of
the epididymis into the deferent
duct. Sperm then travels through
the deferent duct through up the
spermatic cord into the pelvic
cavity, over the ureter to the
prostate behind the bladder. Here,
the vas deferens joins with the
seminal vesicle to form the
ejaculatory duct, which passes
through the prostate and empties
into the urethra. When ejaculation
occurs, rhythmic muscle
movements propel the sperm
forward.
that came from the seminal
● Ejaculatory duct penetrates
through the prostate gland
to join the Urethra.
● Urethra
● Does both urine and sperm
are in the urethra.
●
What propel the sperm through all this
structure? PERISTALSIS

Pathway of the Sperm

● Seminiferous Tubules
The FRUCTOSE provide energy to the
● Rete Testis
sperm because they also need it to
● Efferent Ductules (The
“Swing”.
point in which the sperm
exit the Testes)
MUCUS serve as a Lubricant.

● Epididymis
● Vas Deferens (Pathway
to get out of the testes)
● Vas deferens joins with
the seminal vesicle to
form the ejaculatory duct
 Stages of Maturation

Tanner Staging of Development

Drugs that cause Dysfunction in Male

Erectile becomes more dependent on

tactile simulation and less responsive
to erotic use.
Erectile dysfunction (impotence) is the
inability to get and keep an erection firm
enough for sex. Having erection trouble
from time to time isn't necessarily a
cause for concern. Lack of Desire.
Inability to ejaculate. Causes can be
Neurological, Vascular, Physiological,
Psychological, and Doctrinal.

As a dedicated nurse you can develop an

awareness about beliefs and values
through education, listening, and self-
awareness.

Subjective Data
 Men are at higher risk for many
serious diseases, including heart
disease, lung cancer, and HIV. Men also
face unique health problems that don’t
affect women, like prostate cancer.
To improve men’s health, it’s
important to raise awareness about
preventive screenings and regular health
care for men of all ages. Interventions to
reduce smoking and drinking and
promote healthy behaviors also can help
prevent diseases and improve men’s
health.

Risk Reduction and Health Promotion

- It is important to male, to screen
themselves to identify testicular
cancer by performing Self-
Examination.

- Both Testicular and Prostate

Cancer have better outcomes if
detected early.
Men die an average of 5 years
earlier than women.1 Healthy People
2030 focuses on improving men’s health.
 testicle, and then roll it between
your fingers.

Testicular Self-Examination
1. By performing monthly self-
examination men and
adolescents older become
familiar with what is normal
for them. After this, normal
has been established
changes are easier to
identify thus, testicular
cancer can be detected at
an early stage.
● Best perform during and after
shower because wheat relaxes
the scrotum which makes the
TSE easier.
● Examine one testicle at a time.
Use both hands to gently roll each
testicle (with slight pressure)
between your fingers. Place your
thumbs over the top of your
testicle, with the index and middle
fingers of each hand behind the

● You should be able to feel the

epididymis (the sperm-carrying
tube), which feels soft, rope-like,
and slightly tender to pressure,
and is located at the top of the
 back part of each testicle. This is
a normal lump. EQUIPMENTS:
● Remember that one testicle
(usually the right one) is slightly
larger than the other for most
guys — this is also normal.
● When examining each testicle,

PS. If performing a complete history

and physical assessment, conduct the
genital examination last. Doing so
allows the patient to become more
comfortable interaction
feel for any lumps or bumps along
the front or sides. Lumps may be
as small as a piece of rice or a
pea. 1. Examine the patient in supine
● If you notice any swelling, lumps, position, on his side, and
or changes in the size or color of a standing. While the patient is
testicle, or if you have any pain or standing you should be seated in
achy areas in your groin, let your front of him.
doctor know right away.

Signs and symptoms of

testicular cancer include:
● A lump or enlargement in either
testicle.
● A feeling of heaviness in the
scrotum.
● A dull ache in the abdomen or
groin.
● A sudden collection of fluid in the
scrotum.
● Pain or discomfort in a testicle or
the scrotum.
● Enlargement or tenderness of the
breasts.
● Back pain.
Anus and Rectum
INSPECTION
Assessment Technique
Inspect the base of the penis and
pubic hair.
Sit on a stool with the client facing
you and standing.
Ask the client to raise his gown or
drape. Note pubic hair Growth
pattern and any excoriation,
erythema, or infestation at the
base of the penis and within the
pubic hair.
Normal Findings Abnormal Findings
Pubic hair is coarser than scalp Absence or scarcity of pubic hair
hair. The normal pubic hair pattern may be seen in clients receiving
in adults is hair covering the entire
chemotherapy. Lice or nit (eggs)
groin area, extending to the medial infestation at the base of the
thighs and up the abdomen toward penis or pubic hair is known as
the umbilicus. pediculosispubis. This is
commonly referred to
The base of the penis and the pubic as“crabs.”
hair are free of excoriation,
erythema, and infestation.

Inspect the skin of the shaft. Genital piercing is becoming Rashes, lesions, or lumps may
Observe for rashes, lesions, or more common, and nurses may indicate STI or cancer. Drainage
lumps. see male clients with one or around piercings Indicates
more piercings of the penis. infection.
The skin of the penis is wrinkled
and hairless and is normally free
of rashes, lesions, or lumps.
Palpate the shaft. The penis in a nonerect state is Tenderness may indicate
usually soft, flaccid, and inflammation or infection.
Palpate any abnormalities noted nontender.
during inspection. Also note any
hardened or tender areas.
Inspect the foreskin. The foreskin, which covers the Discoloration of the foreskin
glans in an uncircumcised male may Indicatescarring or
Observe for color, location, and client, is intact and uniform in infection.
integrity of the foreskin in color with the penis.
uncircumcised men.
Inspect the glans. The glans size and shape vary, Chancres (red, oval ulcerations)
Observe for size, shape, and Appearing rounded, broad, or even from syphilis and genital warts
lesions or redness. pointed. The surface f the glans is are sometimes detected on
normally smooth, free glans.
If the client is not circumcised, of lesions and redness.
ask him to retract his foreskin (if The foreskin retracts easily. A A tight foreskin that cannot be
the client is unable to do so, the small amount of whitish material, retractedis called phimosis. A
nurse may retract it) to allow called smegma, foreskin that, once retracted,
observation of the glans. normally accumulates under the cannot be returned to cover
This may be painful. foreskin. the glans is called paraphimosis.
Hypospadias is displacement of
Note the location of the urinary The urinary meatus is slit-like the urinary meatus to the
meatus on the glans. and normally found in the center ventral surface of the penis.
of the glans.
Palpate for urethral discharge. The urinary meatus is normally A yellow discharge is usually
Gently squeeze the glans between
your index finger and thumb.
Scrotum
INSPECTION
Assessment Technique
Inspect the size, shape, position
of the scrotum.
Ask the client to hold his penis
out of the way. Observe for
swelling, lumps, or bulges.
Inspect the scrotal skin.
Observe color, integrity, and
lesions or rashes.
To perform an accurate
inspection, you must spread
out the scrotal folds (rugae) of
skin.
Lift the scrotal sac to inspect
the posterior skin.
PALPATION
Palpate the scrotal contents.
Palpate each testis and epididymis
between your thumb and first two
fingers. Note size, shape,
consistency, nodules, masses and
tenderness.
CLINICAL TIP:
Do not apply too much pressure
to the testes because this will
cause pain. The spermatic cord and vas
deferens should feel uniform on
Palpate each spermatic cord and both sides. The cord is smooth,
vas deferens from the epididymis nontender, and rope-like.
free of discharge.
Normal Findings
The scrotum varies in size
(according to temperature) and
shape. The leftside of the
scrotal sac usually hangs lower
than the right side.
Scrotal skin is thin and rugated Rashes, lesions, and inflammation
(crinkled) with little hair
dispersion. Its color is Slightly
darker than that of the penis.
Lesions and rashes are not
normally present. However,
sebaceous cysts (small, yellowish,
firm, nontender, benign nodules)
are a normal finding.
Testes are ovoid, approximately
3.5-5 cm long, 2.5 cm wide, and 2.5
cm deep, and equal bilaterally in
size and shape. They are smooth,
firm, rubbery, mobile, free of
nodules and rather tender to
pressure. The epididymis is
nontender, smooth, and softer
than the testes.
associated with gonorrhea. A
clear or white discharge is
usually associated with
urethritis.
Any discharge should be
cultured.
Abnormal Findings
An enlarged scrotal sac may
result from
fluid(hydrocele),blood
(hematocele), bowel (hernia),or
tumor (cancer).
Absence of testes may suggests
cryptorchidism(an undescended
testicle), Painless nodules may
indicate cancer. Tenderness and
swelling
may indicate acute orchitis,
torsion of the spermatic cord, a
strangulated hernia, or
epididymitis. If the client has
epididymitis, passive elevation of
the testes may relieve the
scrotal pain (Prehn’s sign).
Palpable, tortuous veins suggest
to the inguinal ring. The spermatic
cord will lie between your thumb
and finger. Note any nodules,
swelling, or tenderness.
Assessment of scrotal mass
Found during examination.
If an abnormal mass or swelling
Was noted during inspection and
Palpation of the scrotum, perform
Transillumination.
Darken the room and shine a
light from the back of the scrotum
through the mass.
Look for a red glow.
If during inspection and
palpation of the scrotal contents,
you palpated a scrotal mass, ask
the client to lie down.
Note whether the mass
disappears. If it remains,
auscultate it for bowel sounds.
Finally, gently palpate the mass
and try to push it upward into the
abdomen.
CLINICAL TIP:
If the client complains of
extreme tenderness or nausea, do
not try to push the mass up into the
abdomen.
Normally scrotal contents do not
transilluminate.
Normal findings are not expected.
varicocele. A beaded or thickened
cord indicates infection or cysts. A
cyst suggests hydrocele of the
spermatic cord.
Swellings or masses that contain
Serous fluid—hydrocele,
spermatocele—light up with a red
glow. Swellings or massesthat
are solid or filled with blood—
tumor,hernias, or varicocele—do
not light up with a red glow.
If the bulge disappears, no scrotal
hernia is present, but the mass
may result from something else.
Refer the client for further
evaluation. A mass on or ,
around the scrotum should be
considered malignant until testing
proves otherwise.
If the mass remains, place your
Fingers above the scrotal mass. If
you can get your fingers above
the mass, suspect hydrocele.
Bowel sounds auscultated over
the mass indicate the presence of
bowel and thus a scrotal hernia.
Bowel sounds will not be heard
Over a hydrocele. If you cannot
push the mass into the abdomen,
suspect an incarcerated hernia.
A hernia is strangulated when its
blood supply is cut off. The client
typically complains of extreme
tenderness and nausea. If you
suspect that the client has a
strangulated hernia, refer the
client immediately to the
physician and prepare him for
surgery.
Inguinal Area
INSPECTION
Inspect for inguinal and The inguinal and femoral areas are Bulges that appear at the
femoral hernia. normally free from bulges. external Inguinal ring or at the
femoral canal when the client
Inspect the inguinal and femoral bears down may signal a hernia.
areas for bulges.

Ask the client to turn head and

coughor to bear down as if
having a bowel movement,
and continue to inspect the areas.
PALPATION
Bulging or masses are not A bulge or mass may indicate a
Palpate for inguinal hernia and normally palpated. hernia.
inguinal nodes.

Ask the client to shift his weight

To the left for palpation of the
right inguinal canal and vice
versa.

Place your right index finger into

the client’s right scrotum
and press upward, invaginating
the loose folds of skin.

Palpate up the spermatic cord

until you reach the triangular-
shaped,slit-like opening of the
external inguinal ring.

Try to push your finger through

the opening and, if possible,
continue palpating up the inguinal
canal.

When your finger is in the canal

or at the external inguinal ring,
ask the client to bear down or
cough.

Feel for any bulges against your

finger. Then, repeat the
procedure on the opposite side.
Palpate inguinal lymph nodes.
If nodes are palpable, note size,
No enlargement or tenderness is Enlarged or tender lymph nodes
Normal. may indicate an inflammatory
process or infection of the penis
consistency, mobility
tenderness.
Palpate for femoral hernia.
Palpate on the front of the thigh in normally palpated.
the femoral canal area.
Ask the client to bear down
or cough, Feel for bulges. Repeat
on the opposite thigh.
Anus and Rectum
INSPECTION
Inspect the perianal area.
Spread the client’s buttocks and
inspect the anal opening
and surrounding area for the
following:
* Lumps
* Ulcers
* Lesions
* Rashes
* Redness
* Fissures
* Thickening of the epithelium
Ask the client to perform
Valsalva’s maneuver by
straining or bearing down.
Inspect the anal opening for any
bulges or lesions.
CLINICAL TIP
Document any abnormalities by
noting position in relation to a face
of a clock.
Inspect the sacrococcygeal
area.
Inspect this area for any signs of
swelling, redness, dimpling, or
or
Bulges or masses are not
The anal opening should appear
hairless, moist, and tightly closed.
The skin around the anal opening
is more coarse and more darkly
pigmented. The surrounding
perianal area should be free of
redness, lumps, ulcers, lesions,
and rashes.
No bulging or lesions appear.
Area is normally smooth, and
free of rednessand hair.
or scrotum.
Bulge or mass palpated as client
bears down or coughs.
Lesions may indicate STIs,
cancer, or hemorrhoids.
A thrombosed external
hemorrhoid appears swollen. It is
itchy, painful, and bleeds when
the client passes stool. A
previously thrombosed
hemorrhoid appears as a skin tag
that protrudes from the anus.
A painful mass that is hardened
and reddened suggests a perianal
abscess. A swollen skin tag on the
anal margin may indicate a fissure
in the anal canal. Redness and
excoriation may be from
scratching anal Aarea infected by
fungi or pinworms. A small
opening in the skin that
surrounds the anal opening may
be an anorectal fistula.
Thickening of the epithelium
Suggests repeated trauma from
anal intercourse.
Bulges of red mucous membrane
May indicate a rectal prolapse.
Hemorrhoids or an anal fissure
may also be seen.
hair. A reddened, swollen, or dimpled
area covered by a small tuft of
hair located midlineon the lower
sacrum suggests a pilonidalcyst.
PALPATION
Client’s sphincter relaxes, Sphincter tightens, making further
Palpate the anus. permitting entry. examinationunrealistic.

Inform the client that you are

going to perform the internal
examinationat this point.

Explain that it may feel like his

bowels are going to move but
that this will not happen.

Lubricate your gloved index

finger; ask the client to bear
down.

As the client bears down, place

the pad of your index finger on
the anal opening and apply slight
pressure; this will cause
relaxation of the sphincter.

CLINICAL TIP

Never use your fingertip—this

causes the sphincter to tighten
and, if forced into the rectum, may
cause pain.

When you feel the sphincter Examination finger enters anus. Examination finger cannot enter
relax, insert your finger gently the anus.
with the pad facing down.

CLINICAL TIP

If severe pain prevents your

entrance to the anus, do not force
the examination.

If the sphincter does not relax
and the client reports severe pain,
spread the gluteal folds
with your hands in close
The client can normally close the
Sphincter around the gloved
finger.
Poor sphincter tone may be the
result of a spinal cord injury,
previous surgery, trauma, or a
prolapsed rectum. Tightened
sphincter tone may indicate
approximation to the anus and
attempt to visualize a lesion
that may be causing the pain.
If tension is maintained on the
gluteal folds for 60seconds, the
anus will dilate normally.
Ask the client to tighten the
external sphincter; note the tone.
Rotate finger to examine the
muscular anal ring. Palpate for
tenderness, nodules, and
hardness.
Palpate the rectum.
Insert your finger further into the smooth, nontender, and free of
rectum as far as possible. Next, nodules.
turn your hand clockwise then
counterclockwise. This
allows palpation of as much rectal
surface as possible. Note
tenderness, irregularities,
nodules, and hardness.
Palpate the peritoneal cavity.
This area may be palpated in men
above the prostate gland in the
area of the seminal vesicleson the
anterior surface of the rectum.
Note tenderness or nodules.
Prostate Gland
PALPATION
The prostate can be palpated on
the anterior surface of the rectum
by turning the hand
fully counterclockwise so that the
pad of your index finger faces
toward the client’s
umbilicus.
CLINICAL TIP
You may need to move your body
The anus is normally smooth,
nontender, and free of nodules
and hardness.
The rectal mucosa is normally soft,
This area is normally smooth and
nontender.
The prostate is normally
nontender and rubbery.
It has two lateral lobes that are
Divided by a median sulcus. The
lobes are normally
smooth, 2.5 cm long, and heart-
shaped.
anxiety, scarring, or inflammation.
Tenderness may indicate
hemorrhoids, fistula,
or fissure. Nodules may indicate
polyps or cancer. Hardness may
indicate scarring or cancer.
Hardness and irregularities may
be from scarring or cancer.
Nodules may indicate polyps or
cancer.
A peritoneal protrusion into the
rectum, called a rectal shelf may
indicate a cancerous lesion or
peritoneal metastasis.
Tenderness may indicate
peritoneal inflammation.
A swollen, tender prostate may
Indicate acute prostatitis. An
enlarged smooth, firm, slightly
elastic prostate that may
not havea median sulcus suggests
benign prostatic hypertrophy
(BPH).
A hard area on the prostate
or hard, fixed, irregular nodules
on the prostate suggest cancer.
away fromthe client to achieve the
proper angle for examination.

Tell the client that he may feel an

urge to urinate but that he will
not.

Move the pad of your index finger

over the prostate gland, trying to
feel the sulcus between the lateral
lobes. Note the size, shape, and
consistency of the prostate, and
identify any nodulesor tenderness.
CHECK STOOL
Inspect the stool.
Withdraw your gloved finger.
Inspect any fecal matter on
Your glove. Assess the color, and
test the feces foroccult blood.
Provide the client with a towe lto
wipe the anorectal area
Stool is normally semi-solid,
brown, and free of blood.
Black stool may indicate upper
Gastrointestinal bleeding, gray or
tan stool results from the lack of
bile pigment, and yellow stool
suggests steatorrhea (increased
fatcontent). Blood detected in the
stool may indicate cancer of the
rectum or colon. Refer the client
for an endoscopic examination of
the colon.