Male and Female Genitalia

Male and Female Genitalia
Presentation Lecture by Jennifer Coleman, Assistant Professor of Nursing
Arkansas Tech University.

* Health Assessment

Common Chief Complaints
* Urethral discharge
* Palpable mass
* Erectile dysfunction
* Penile lesion
* Scrotal pain

Inspection

* Hair distribution
* Urethral meatus
o Location, discharge
* Inguinal area
o Bulges, masses
* Penis
o Size, shape, lesions, swelling, inflammation
* Scrotum
o Size, shape, lesions, inflammation, swelling, nodules
Inspect the Glans and Urethral Meatus
* Compress meatus
o Check for proper positioning of urethral opening
o Check for drainage – urethral culture
* Skin pink and smooth
Transillumination

* Light from behind scrotum
* Normal - Does not transilluminate
* Hernia – Pink or red glow
* Hydrospadias - Translucent

Palpation

* Penis
o Assess for tenderness, pulsations, masses
* Urethral meatus
o Assess for discharge
* Scrotum
o Assess for masses, tenderness, spermatic cord
* Inguinal area
o Assess for hernias

Inspect and palpate the scrotum

* Patient holds penis out of the way
* Note skin, lumps, nodes
* Testes: slide easily, oval, firm, movable
* Epididymis: feels discrete, softer than testis, smooth

Auscultation

* Not routinely done, but can add to assessment findings
* Scrotum
* Abnormal findings
o Presence of bowel sounds may indicate indirect inguinal hernia

Abnormal Finding Examples

* Hypospadias and Epispadias
* Penile lesions and Urethral discharge
* Hydrocele, Spermatocele, Empty scrotal half, Acute Orchitis, Scrotal Edema, Torsion of the cord, Acute epidymitis, Testis Tumor
* Hernias
* Alopecia, Lice or nits present

Hypospadias

* Urethral meatus open on ventral (under) side of glans, shaft or penoscrotal junction
* Do not circumcise until surgically corrected

Epispadias

* Meatus opens on dorsal (upper) side of glans or shaft
* Less common than hypospadias

Syphilitic Chancre

* Silver, small papule - erodes to red ulcer with yellow, serous discharge
* Nontender base
* Lymph nodes enlarged & nontender

Genital Herpes

* Clusters of small vesicles, surrounding erythema
* Often painful, erupt to superficial ulcers
* 1st infection lasts 7-10 days
* Virus remains dormant indefinitely
* Recurrent infection lasts 3-10 days

Genital Warts

* Warts
* Painless, grapelike clusters
* May look like skin tags
* One of the most common STD’s

Carcinoma of Penis

* Red, raised warty growth or an ulcer with watery discharge
* Necrose and slough
* Usually painless
* Usually on glans
* Lymph nodes commonly enlarged

Hydrocele

* Painless swelling
* Enlarged mass, transilluminates translucent
* Communicating vs. noncommunicating (intermittent or constant bulge)
* Common <2 y.o. - often disappears spontaneously

Spermatocele

* Cyst in epididymis (generally small)
* Painless
* Does transilluminate
* round, freely moveable (may feel like a third testis)

Empty scrotal half

* True cryptorchidism – testes never descended
* Physiologic cryptorchidism - absence of testis in scrotum, but can be milked down
* 3-4% at birth, most will descend in 1st mo. (much higher percentage with prematurity)
* Decrease spermatogenesis to infertile by 6 yrs.

Acute Orchitis

* Acute inflammation of testis – most commonly from the mumps
* Pain – sudden onset, swollen testis, fever
* Potential for infertility

Scrotal Edema

* Usually occurs with systemic edema (CHF, renal failure)
* Also with local inflammation
* Tenderness, reddened, taut with pitting

Torsion of the cord

* Sudden twisting of the spermatic cord
* Rare after 20 y.o.
* Usually on left side
* Blood supply is cut off – ischemia and engorgement - very painful
* Emergency – requires surgery
* Cremasteric reflex absent

Acute epidymitis

* Acute infection of epidiymis
* Severe pain of sudden onset, rapid swelling and fever
* Reddened scrotum
* WBCs and bacteria in urine

Testis Tumor

* Usually painless lump
* Increase in local nodes common

Hernia

* Internal anatomy of inguinal hernia
* Loop of bowel protruding through weak muscle
* Possible pain
* Swelling
* May be congenital or acquired

Palpate for hernia

* Inguinal canal
* Ask patient to “bear down”
* Nl: feel no change
* Abnl: feel mass bump into/push against side of your finger

Newborn

* Scrotum pink with rugae (preterm will have smooth scrotum)
* Cremastric reflex strong
* Check for undescended testes, hydrocele, inguinal bulge

Pediatric Considerations

* Circumcision is considered a personal/cultural/religious decision by parents (~70-80% in US)
* Start TSE at ~13-14 years of age
* Undescended testicles increase risk of cancer
* Do not retract foreskin 1st 3 months d/t risk of tearing membrane

Developmental Considerations

* Infants
o Prenatally – testis develop in abdomen then migrate down into scrotum beginning at week 30
* Adolescents
o Puberty ~ 9 ½ yrs- 13 ½ yrs.
o 1st sign of puberty are enlargement of testes, next is pubic hair then penis inc. in size
o Sexual Maturity Ratings – p. 717

Gerontological Variations

* Thinner, gray pubic hair
* Decreased testosterone levels
* Penile and testicular atrophy
* Scrotal rugae decreases
* Slightly decreased spermatogenesis
* Increased time to obtain erection
* Increased risk for impotence
* Benign prostatic hypertrophy - 1 in 10 the prostate gland will increase in size ~ 40 y.o.

Testicular Self Exam (TSE)

* Exam every month
* Exam with warm shower will relax scrotal sac
* Testicular cancer is rare but occurs most commonly in young men (15-35 y.o.)
* Caucasians 4 times more likely to develop testicular cancer
* ~100% cure rate with early detection

Anus

* Anal canal is outlet of GI tract
* Canal is surrounded by 2 layers of muscle
o internal sphincter - involuntary control
o external sphincter - voluntary control
* External inspection looks moist and hairless (check for skin breakdown with valsalva maneuver)
* “ Anal Wink test”

Rectum

* 12 cm long
* distal portion of large intestine

Pediatric Considerations

* 1st stool passed by newborn is dark green (meconium) - indicates anal patency - usually at 24-48 hours
* Infants pass stool by reflex (gastrocolic reflex) with each fdg. - nerves fully myelinated by 1.5 - 2 years old for voluntary control

Prostate

* Gland which surrounds the bladder neck and urethra
* Secretes milky fluid which helps sperm remain viable

Prostate Gland

* Puberty - rapid increase to > double size then stabilizes through adulthood
* Common to increase in size with older adults - gradually impede urine output - BPH
* Most common non-skin cancer in America, affecting 1 in 6 men
* African American men are 61% more likely to develop prostate cancer
* http://www.cancer.gov/cancertopics
* Prostatitis –
o infection in the prostate, most common cause of UTIs in men
o fever, chills, burning during urination, or difficulty urinating

Palpate Prostate Gland

* Size
* Shape
* Surface
* Consistency
* Mobility
* Sensitivity

Palpation of Anus & Rectum

* Gloves with water soluble lubrication
* Approach at an angle with finger
* Palpate muscular ring by rotating finger
* Use thumb to help check bulbourethral glands
* Inspect stool (brown and soft)

Abnormal Findings

* Pilonidal Cyst or Sinus
o Midline over coccyx
o Dimple opening with visible tuft of hair
o May be a palpable cyst – sinus develops when advanced
o Congenital – but often not diagnosed until 15-30 years old

Abnormal Findings

* Check for anorectal fistula (abnormal passage from GI tract, normally caused by an abcess)
* Rectal prolapse - rectal mucous membrane protrudes through anus
* Hemorrhoids (external & internal, thrombosed)
* Pruritus Ani - intense perianal itching
o children - pinworms
o adults - fungus

Abnormal Findings

* Polyps of rectum
o Relatively common growth
o Not easily palpated
o Proctoscopy and biopsy needed to screen for malignancy
* Carcinoma of the rectum
o Malignant neoplasm
o Asymptomatic

Female Genitalia

* Common chief complaints
o Uterine bleeding
o Vaginal discharge
o Urinary symptoms
o Pelvic pain

External Inspection

* Pubic hair distribution
* Skin color and condition
o Mons pubis and vulva
o Urethral meatus
o Vaginal introitus
o Perineum and anus

Palpation of External Genitalia

* Labia
* Urethral meatus
* Skene’s glands (normally unable to visualize)
* Bartholin’s glands (normally unable to visualize)
* Vaginal introitus
* Perineum

Bartholin’s Gland Infection

* Local pain (may be severe)
* Skin over abscess red and hot
* Can express purulent discharge
* Often complication of gonococcal infection

Internal Inspection

* Order of internal examination
o Speculum examination - obtain specimens
o Bimanual examination – water soluble lubrication
o Rectovaginal examination

Lithotomy Positioning

* Elevate head and shoulders slightly to improve comfort - also provides opportunity for patient to maintain eye contact
* Slide patient to very end of table
* Proper draping very important

Speculum Examination of the Cervix

* Use of speculum
* Characteristics of assessment
o Color
o Position
o Size
o Surface characteristics
o Discharge
o Shape of cervical os

Cervix

* Mucosa is pink and even
* 2nd mo. pregnancy is blue (Chadwick’s sign)
* After menopause is pale
* Note Os

Cervical Cancer and Nabothian Cysts
* HPV – main risk factor for cervical cancer
* Lack of regular Pap tests
* Weakened immune system
* Over the age of 40
* BC pills for 5 or more years with HPV
* http://www.cancer.gov/cancertopics

Cervix Specimen Collection
Collecting Specimens

* Pap smear/ Thin-layer preparation (liquid-based)
o Endocervical
o Cervical
o Vaginal
* Gonococcal/Chlamydia culture
* Saline mount (Wet Prep)
* Acetic Acid Wash (HPV – human papilloma virus – genital warts)
* Anal culture

Vaginal Discharge

* Normal – small amount, clear or cloudy, nonirritating
* Profuse, watery, gray-green & frothy - trichomoniasis
* Thick, white & curd-like - candidiasis

Uterine Positions

* Anteverted - usual position
* Anteflexed - usual position
* Midposition
* Retroflexed
* Retroverted
* See page 777.

Rectocele

* Rectum (under vaginal mucosa) is prolapsed into vagina
* Pressure felt in vagina
* Constipation possible

Cystocele

* Prolapse of bladder (under vaginal mucosa) into vagina
* Pressure felt in vagina
* Stress incontinence

Pediatric Considerations

* Newborn - engorged external genitalia d/t maternal estrogen
* Puberty - estrogen stimulate secondary sex characteristics
* 1st signs are breast and pubic hair development
* Begins 8.5 to 13 years
* Sexual Maturity rating – p. 411 & 760

Pregnancy

* Primagravida - pregnant for the 1st time
* Primipara - first delivery
* Multigravida - pregnant for >1 time
* Multipara - > 1 delivery
* Gravida - pregnancy
* Para - delivery
* AB - abortion (spontaneous/elective)

Pregnancy

* Chadwick’s sign – blue cervix
* Goodell’s sign – cervix softens
* Mucus plug – cervical canal
* Cervical & vaginal secretions – increase, thick, more acidic
* May increase risk of candidiasis (yeast) infection

Gerontological Variations

* Menopause - cells in the reproductive tract are estrogen dependent
o Low estrogen levels
o Cessation of menses
o Generalized atrophy of external and internal female organs
o Thinning of vaginal epithelium
+ Decrease in lubrication
+ Wall becomes drier and itchy
+ Increase risk for bleeding & vaginitis

Copyright 2002, Delmar, A division of Thomson Learning
Male and Female Genitalia.ppt