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Male

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Glandular structures accessory to genital organs are: Prostate, ... also due to muscle tone, subcutaneous fat & cellular ... hang lower due to tone of muscle ... – PowerPoint PPT presentation

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Title: Male


1
Male Female Genitalia Assessment
  • Week 9

2
Male Genitalia Assessment
3
Male Genitalia Assessment
  • Physical structures for assessment in male
    genitalia include
  • Externally penis scrotum
  • Internally testis, epididymis vas deferens
  • Glandular structures accessory to genital organs
    are Prostate, seminal vesicles and
    bulbourethral glands (which we just discussed in
    anal, rectal prostate assessment).

4
Figure 24-1. p. 722
5
Figure 24-2. p. 723.
6
Figure 24-3. p. 723.
7
Developmental Considerations
  • Prenatally testes develop in abdomen near kidneys
    late in gestation the testes migrate, pushing
    abdominal wall in front of them dragging vas
    deferens, blood vessels nerves behind
  • They descend inguinal canal into scotum before
    birth
  • At birth each testis measures 1.5 2.0 cm long
    1 cm wide same till adolescence.

8
Developmental Considerations
  • At puberty (ages 9½ to 13½) first sign is
    enlargement of the testes next pubic hair
    then penis size increases takes about 3 years
    (2 5) for complete maturation
  • Tanners sexual maturity ratings (see Table 24-1
    on pg. 725) consistent across socio-economic
    status culture although timing can be different.

9
Developmental Considerations
  • 40 yrs ? production sperm starts ? 80s or 90s
  • gt 55-60 yrs testosterone production gradually ?
  • Changes also due to ? muscle tone, subcutaneous
    fat cellular metabolism
  • Pubic hair ?, remaining hair turns grey penis
    size ?
  • Scrotal contents hang lower due to ? tone of
    muscle
  • Testes ? in size are less firm to palpation ?
    connective tissue in the tubules so they become
    thickened produce less sperm.

10
Normal Sexual changes r/t Aging in Male
  • Slower less intense sexual response although
    wide range of variation exists
  • Erection takes longer is not as full or firm
  • May hold erection longer without ejaculation
  • May be shorter or less forceful ejaculation
  • Volume of seminal fluid is less than when younger
  • After ejaculation rapid detumenscence after 60
    yrs
  • Refractory period lasts longer from 12 24 hours
    as compared with 2 minutes in younger male.

11
Transcultural Considerations
  • Circumcision
  • Tends to be done for more cultural or religious
    reasons than for health
  • In US 70 80 of newborn males are circumcised,
    in Canada, Great Britain, Australia Sweden only
    20 of newborn males are circumcised
  • Jews Muslims practice circumcision as part of
    their religious value system.

12
Subjective Data Collection
  • Frequency, urgency, nocturia /or dysuria?
  • Hesitancy /or straining?
  • Urine colour amount?
  • Past genitourinary history?
  • Penis pain, lesion, discharge?
  • Scrotum - self-care behaviours, lesions?
  • Sexual activity contraceptive use, STD contact?.

13
Objective Data Collection
  • Penis should look wrinkled, hairless without
    lesions, dorsal vein may be apparent
  • Glans looks smooth, compress to detect d/c
  • Urethral meatus is positioned centrally
  • Scotal size varies with room temperature
    asymmetry is normal, free of lesions, contents
    should slide easily, testes feel oval, slightly
    tender, each epididymis feels discrete, softer
    than the testes, smooth nontender.

14
Testicular Self-Examination
  • Encourage every male age 13 14 to adulthood to
    examine testicles every month
  • T timing once a month
  • S shower, warm water relaxes scrotal sac
  • E examine, check for changes, report changes
    immediately.

15
Female Genitalia Assessment
16
Figure 24-1. p. 798.
17
Figure 24-2. p. 799.
18
Dev. Considerations
  • At birth, external genitalia engorged due to
    maternal estrogen, structures recede in few weeks
  • Ovaries located in abdomen during childhood,
    uterus is small with straight axis
  • Puberty estrogens stimulate growth of cells
    dev. of secondary sex characteristics 8 ½ 13
    yrs - takes about 3 years to complete
  • Irregularity of menstrual cycle is common during
    adolescence
  • With menarche uterus flexes on cervix ovaries
    are now in pelvic cavity.

19
Developmental Considerations
  • Menopause occurs around 48 to 51 yrs, ovaries
    stop producing progesterone estrogen
  • Uterus shrinks in size, ovaries atrophy
  • Sacral ligaments relax - pelvic musculature
    weakens uterus droops
  • Cervix shrinks, looks paler
  • Vagina shorter, narrower, less elastic, drier, pH
    more alkaline - ? risk for vaginitis
  • Mons pubis fat pad atrophies
  • Labia clitoris decrease in size, hair becomes
    thin sparse.

20
Subjective Data Collection
  • Past hx
  • Sexual activity
  • Contraceptive use
  • Sexually transmitted disease contact
  • STD risk reduction
  • Medications.
  • Menstrual hx (LMP)
  • Obstetric hx
  • Menopause
  • Self-care behaviours
  • Urinary symptoms
  • Vaginal discharge

21
Objective Data Collection external inspection
  • Note skin colour, hair distribution
  • Labia majora normally symmetric, plump, well
    formed
  • Nulliparous woman labia meet in midline,
    following vaginal delivery labia gaping
    slightly shrivelled
  • No lesions, except for occasional sebaceous cysts
    yellowish, 1-cm nodules firm, nontender
    multiple
  • Examine clitoris, labia minora, urethral opening
    vaginal opening for inflammation, lesions or
    foul-smelling discharge.

22
Developmental Considerations of Exam
  • In adolescent take more time, assess independent
    of mother, provide health education discussion
    of pubertal progress
  • Pelvic exam is indicated when contraception is
    desired, when sexual activity included
    intercourse or at age 18.
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