External Male Genitalia

Nursing 330

Governors State University

Shirley Comer

Relevant History

Frequency, urgency, Nocturia dysuria Hesitancy or straining Urine color Penile pain, lesion, discharge Scrotal lumps, pain Sexual activity and contraceptive use STD

Inspection Penis

Skin- color, lesions, nodules Assess any discharge Retract uncircumcised foreskin- should move

easily– Phimosis= can not retract– Paraphimosis = cannot replace once retracted

Urinary meatus central– Can be displaced

Inspect and Palpate Scrotum

Scrotal size dependant on room temperature Asymmetry common – left lower than right Lift and Inspect posterior surface may be sebaceous

cyst (yellow nontender) Palpate testes, epididymis and spermatic cord between

thumb and forefinger– Oval and firm– Smooth and moveable– Should be sl tender– Epididymis non tender

Inspect and Palpate for Hernia

Inspect inguinal region for a bulge as pt is standing and as he strains down

Palpate inguinal canal- ask pt to shift wt to unexamined leg– Palpate up the spermatic cord invaginating the

scrotal skin as you go.– External inguinal ring will feel triangular– Insert finger and ask pt to bear down- should feel

nothing

Regional Lymph Nodes

Palpate Horizontal chain – Located inferior to inguinal ligament

Palpate Vertical chain– Located along upper inner thigh

May normally palpate isolated enlarged node

Testicular self Exam

Testicular cancer rate highest among men 15 to 34 yo

Perform monthly Shower is a good place to perform as scrotum

is warm Palpate testicle, epididymis and spermatic cord

for lumps between thumb and 2 forefingers

Age Specific Considerations

Infants – cryptorchidism – undescended testicles – should descend by 3 months – may migrate r/t immature inguinal rings

Aging male – thinner hair – testicles smaller and less firm – scrotum more pendulous – may sit on scrotum and cause lesions

Practice Exam Question

Your 25 year old male patient becomes sexually aroused during your genital assessment. He is extremely embarrassed. What should you do?

A. Set limits about sexual behavior B. Continue the exam as if nothing has occurred C. Tell him it happens and excuse yourself for 10

minutes D. Have the PHCP perform the exam

Rationale

C is the correct answer. This is a physiological response that is not sexually motivated. Allow the pt to relax and then continue the exam.

B is incorrect because you cannot adequately exam the genitalia in this state

D is an option if the pt is too embarrassed to have you continue the exam