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Male Genitourinary System

Health Assessment
by

Dana Brackney

on 4 November 2013

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Transcript of Male Genitourinary System

Genitourinary System Health Assessment of the Male Patient
Assessment
Penis
Glans
Corona
Urethra
Foreskin
Frenulum
Scrotum
Rugae
Cremaster Muscle
Testes
Epididymis
vas deferens
Spermaticc cord
ejaculatory duct
lymphatics
Inguinal Area (groin)
Inguinal ligament
inguinal canal
femoral canal
Development
Anatomy
Subjective
Objective
Talking with patients
Questions about sexual activity
Communicates acceptance
Prompts interest and possibly relief that you introduced the topic.
Inguinal area or groin (cont.)
Inguinal canal is 4 to 6 cm long in adult
Openings are:
Internal ring: 1 to 2 cm above midpoint of inguinal ligament
External ring: above and lateral to pubis
Femoral canal is inferior to inguinal ligament
Potential space located 3 cm medial to and parallel with femoral artery
You can use artery as landmark to find this space
Structure and Function
Inguinal area or groin
Juncture of lower abdominal wall and thigh
Knowledge of these anatomic areas is useful because they are potential sites for a hernia, which is a loop of bowel protruding through a weak spot in musculature
Borders are the anterior superior iliac spine and symphysis pubis
Between these landmarks lies inguinal ligament
Inguinal canal lies superior to ligament formed by narrow tunnel passing obliquely between layers of abdominal muscle
Structure and Function
Lymphatics of penis and scrotal surface drain into inguinal lymph nodes
Lymphatics of testes drain into abdomen
Abdominal lymph nodes are not accessible to clinical examination
Structure and Function
Spermatic cord
Ascends along posterior border of testis and runs through tunnel of inguinal canal into abdomen
Here, vas deferens continues back and down behind bladder, where it joins duct of seminal vesicle to form ejaculatory duct, which empties into urethra
Structure and Function
Sperm
Transported along series of ducts
Epididymis: markedly coiled duct system and main storage site of sperm; comma-shaped structure, curved over top and posterior surface of testis
Vas deferens: a muscular duct continuous with lower part of epididymis and with other vessels (arteries and veins, lymphatics, nerves) that forms spermatic cord
Structure and Function
Testes
Have a solid oval shape, suspended vertically by spermatic cord
Left testis is lower because left spermatic cord is longer
Tunica vaginalis: double-layered membrane covers each testis and separates it from scrotal wall
Layers are lubricated by fluid so that testis can slide within scrotum which helps prevent injury
Structure and Function
Scrotum
Cremaster muscle
controls size of scrotum by responding to ambient temperature
Keep testes at 3° C below abdominal temperature; best temperature for producing sperm
When it is cold, muscle contracts, raising sac bringing testes closer to body to absorb heat for sperm viability
As a result, scrotal skin looks corrugated
When it is warmer, the muscle relaxes, scrotum lowers, and skin looks smoother
Septum inside separates sac into halves; in each is a testis, which produces sperm
Structure and Function
Scrotum
Scrotum
Loose protective sac; continuation of abdominal wall
After adolescence, scrotal skin deeply pigmented and has large sebaceous follicles
Scrotal wall consists of thin skin lying in folds, or rugae, and underlying cremaster muscle
Structure and Function
Penis
Glans: at distal end of shaft corpus spongiosum expands
into cone of erectile tissue
Corona: shoulder where glans joins shaft
Urethra transverses corpus spongiosum, and its meatus forms slit at tip of glans
Foreskin or prepuce forms hood or flap over glans
Often removed shortly after birth by circumcision
Frenulum: fold of foreskin extending from urethral
meatus ventrally
Structure and Function
Penis
Penis
Composed of three cylindrical columns of erectile tissue:
Two corpora cavernosa on dorsal side
Corpus spongiosum ventrally
Structure and Function
Male genital structures include:
External
Penis and scrotum
Internal
Testis, epididymis, and vas deferens
Glandular structures accessory to genital organs:
Prostate, seminal vesicles, and bulbourethral glands
Male Genitourinary System
Inguinal Area
Renal calculi
Acute urinary retention
Urethral stricture
Abnormal Findings:
Urinary Problems
Carcinoma
Begins as red, raised warty growth or as an ulcer, with watery discharge
As it grows, may necrose and slough
Usually painless; almost always on glans or inner lip of foreskin and following chronic inflammation; enlarged lymph nodes are common
Genital warts, human papillomavirus (HPV)
Syphilitic chancre
Genital herpes, HSV-2 infection
Abnormal Findings:
Male Genital Lesions
Understanding prostate changes
PSA made by normal prostate gland
When prostate cancer develops, PSA levels increase
But, benign or noncancerous enlargement of prostate (BPH), age, and prostatitis can cause PSA to increase
The DRE involves a gloved, lubricated finger being inserted into rectum
Prostate gland located just in from opening of rectum making it possible to palpate surface of gland manually for bumps or hard areas that may be a developing cancer
Less effective than PSA blood test in finding prostate cancer, but it can sometimes find cancers in men who have normal PSA levels; thus both PSA and DRE are recommended
Promoting a Healthy Lifestyle: Screening for Prostate Cancer
Understanding prostate changes
Prostate cancer typically detected by testing blood for prostate-specific antigen (PSA) and/or on digital rectal examination (DRE)
Recommended that both PSA and DRE should be offered to men yearly, beginning at age 50
Men at higher risk for developing prostate cancer, such as African Americans and/or men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than 65) should be offered testing earlier
Promoting a Healthy Lifestyle: Screening for Prostate Cancer
Understanding prostate changes
Discussion of prostate health and examination of prostate gland is a unique aspect of male health assessment
Gradual enlargement of prostate gland considered to be normal part of aging
Enlargement termed benign prostatic hypertrophy, or BPH; it does not raise an individual’s risk for prostate cancer, yet symptoms for BPH and prostate cancer can be very similar
Promoting a Healthy Lifestyle: Screening for Prostate Cancer
Direct inguinal hernia
Directly behind and through external inguinal ring, above inguinal ligament; rarely enters scrotum
Usually painless; round swelling close to pubis in area of internal inguinal ring; easily reduced when supine
Less common, occurs most often in men over 40 age, rare in women
Acquired weakness; brought on by heavy lifting, muscle atrophy, obesity, chronic cough, or ascites
Abnormal Findings:
Inguinal and Femoral Hernias (cont.)
Indirect inguinal hernia
Sac herniates through internal inguinal ring; can remain in canal or pass into scrotum
Pain with straining; soft swelling that increases with increased intraabdominal pressure; may decrease when lying down
Most common; 60% of all hernias; more common in infants less than 1 year old and in males 16 to 20 years old
Congenital or acquired
Abnormal Findings:
Inguinal and Femoral Hernias
Urethritis, urethral discharge, and dysuria
Infection of urethra, painful burning urination
Meatus edges are reddened, everted, and swollen; purulent urethral discharge is present; urine cloudy with discharge and mucous shreds
Cause determined by culture
Gonococcal urethritis has thick, profuse, yellow or gray-brown discharge
Nonspecific urethritis (NSU) may have similar discharge but often has scanty, mucoid discharge
About 50% are caused by chlamydia infection
Important to differentiate as antibiotic treatment differs
Abnormal Findings:
Male Genital Lesions
Femoral hernia
Pain may be severe, may become strangulated
Least common, 4% of all hernias; but more common in women
Acquired; due to increased abdominal pressure, muscle weakness, or frequent stooping
Abnormal Findings:
Inguinal and Femoral Hernias (cont.)
a. Phimosis
b. Hypospadias
c. Epispadias
d. Peyronie’s disease
Priapism
Abnormal Findings:
Abnormalities of the Penis
A. Absent testis, cryptorchidism
B. Small testis


C. Testicular torsion
D. Epididymitis
E. Spermatic cord varicocele
Abnormal Findings:
Abnormalities in the Scrotum
A. Early testicular tumor
B. Diffuse tumor


C. Scrotal hernia
D. Orchitis
E.Scrotal edema
Abnormal Findings:
Abnormalities in the Scrotum
Slide 3
A. Often young men your age…
B. I worry that you might…
C. Do you…
D. You don’t…do you?
2. The nurse is obtaining a sexual history from an adolescent male. Which of the following
would be the best way to begin the sexual history interview?
Slide 2
A. “I will check my testicles for lumps in the shower.”
B. “I will bear down and check my groin area while seated.”
C. “I will check my testicles while lying on my right side.”
D. “I will have my testicles examined by my health care
provider every year.”
1. The nurse is reviewing the importance of testicular self-examination (TSE) with a 17-year-old male. Which statement by the patient confirms the patient’s understanding of TSE?
Audience Response System Questions
Chapter 24: Male Genitourinary System
Jarvis: Physical Examination & Health Assessment, 6th Edition
Aging men
In older male, you may note thinner, graying pubic hair and decreased size of penis
Size of testes may be decreased and may feel less firm
Scrotal sac pendulous with less rugae
Scrotal skin may become excoriated if man continually sits on it
Objective Data:
Developmental Competence
Infant or toddler (cont.)
Inspect penis and scrotum (cont.)
If a hernia is suspected, palpate inguinal area
Use your little finger to reach external inguinal ring
Objective Data:
Developmental Competence
Infant or toddler (cont.)
Inspect penis and scrotum (cont.)
Common scrotal finding in boy under 2 is a hydrocele, or fluid in scrotum; appears as a large scrotum and transilluminates as faint pink glow
Usually disappears spontaneously
Inspect inguinal area for a bulge
If parent gives a positive history of one, try to elicit it by increasing intraabdominal pressure
Ask boy to hold his breath and strain down or have him blow up a balloon
Objective Data:
Developmental Competence
Infant or toddler (cont.)
Inspect penis and scrotum (cont.)
Normally, testes are descended and are equal in size bilaterally
Important to document that you have palpated testes
Once palpated, they are considered descended, even if they have retracted momentarily at next visit
If scrotal half feels empty, search for testes along inguinal canal and try to milk them down
Ask toddler or child to squat with knees flexed up; this pressure may force the testes down; or have child sit cross-legged to relax reflex
Objective Data:
Developmental Competence
Infant or toddler (cont.)
Inspect penis and scrotum (cont.)
Scrotum size varies with ambient temperature, but overall, infant’s scrotum looks large in relation to penis
No bulges, either constant or intermittent, are present
Palpate scrotum and testes
Cremasteric reflex is strong in infant, pulling testes up into inguinal canal and abdomen from exposure to cold, touch, exercise, or emotion; take care not to elicit reflex
Keep your hands warm and palpate from external inguinal ring down
Block inguinal canals with thumb and forefinger of your other hand to prevent testes from retracting
Objective Data:
Developmental Competence
Infant or toddler (cont.)
Inspect penis and scrotum
Penis size usually small in infants and in young boys until puberty
In obese boy, penis looks even smaller because of folds of skin covering base
In circumcised infant, glans looks smooth with meatus centered at tip
While child wears diapers, meatus may be ulcerated from ammonia irritation; more common in circumcised infants
If possible, observe newborn’s first voiding to assess strength and direction of stream
Objective Data:
Developmental Competence
Self-care: TSE (cont.)
Phrase your teaching something like this:
A good time to examine testicles is during shower or bath, when your hands are warm and soapy and scrotum is warm; cold hands retract scrotal contents
Procedure is simple; hold scrotum in palm of your hand and gently feel testicles using thumb and first two fingers
Testicle is egg-shaped and movable; it feels rubbery with a smooth surface
Abnormal lumps are very rare and usually not worrisome, but if you ever notice a firm, painless lump, a hard area, or an overall enlarged testicle, call your physician for further check
Objective Data
Self-care: TSE (cont.)
Early detection of cancer enhanced if male is familiar with his normal consistency
Points to include during health teaching are:
T - timing, once a month
S - shower, warm water relaxes scrotal sac
E - examine, check for and report changes immediately
Objective Data
Self-care: testicular self-examination (TSE)
Encourage self-care by teaching every male from 13 to 14 years old through adulthood how to examine his own testicles
Overall incidence of testicular cancer is still rare, but testicular cancer most commonly occurs in young men age 15 to 40
Males with undescended testicles are at greatest risk, and white males are four times more likely to contract testicular cancer than nonwhites
This tumor has no early symptoms; if detected early by palpation and treated, cure rate is almost 100%
Objective Data
Inspect and palpate for hernia
Inspect and palpate for hernia
Palpate femoral area for a bulge
Normally you feel none
Objective Data
Inspect and palpate for hernia
Inspect inguinal region for bulge as person stands and strains down; normally none is present
Palpate inguinal canal
For right side, ask male to shift his weight onto left leg
Place your right index finger low on right scrotal half
Palpate up length of spermatic cord, invaginating scrotal skin as you go, to the external inguinal ring
It feels like a triangular slitlike opening, if it will admit your finger, gently insert it into canal and ask person to “bear down;” normally you feel no change
Repeat procedure on the left side
Objective Data
Inspect and palpate scrotum (cont.)
Normally, no other scrotal contents are present; if you find a mass, note:
Is there any tenderness?
Is the mass distal or proximal to testis?
Can you place your fingers over it?
Does it reduce when person lies down?
Can you auscultate bowel sounds over it?
Transillumination
Perform this maneuver only if you note swelling or mass
Darken room; shine flashlight from behind scrotal contents
Normal scrotal contents do not transilluminate
Objective Data
Inspect and palpate scrotum (cont.)
Palpate gently each scrotal half between your thumb and first two fingers
Scrotal contents should slide easily; testes normally feel oval, firm and rubbery, smooth, and equal bilaterally, and are freely movable and tender to moderate pressure
Each epididymis normally feels discrete, softer than testis, smooth, and nontender
Palpate each spermatic cord between your thumb and forefinger, along its length from epididymis up to external inguinal ring
You should feel a smooth, nontender cord
Objective Data
Inspect and palpate scrotum
Inspect scrotum as male holds penis out of the way; alternatively, you hold penis out of the way with back of your hand
Scrotal size varies with ambient room temperature; asymmetry is normal, with left scrotal half usually lower than right
Spread rugae out between your fingers; lift sac to inspect posterior surface; normally, no scrotal lesions are present, except commonly found sebaceous cysts; these are yellowish, 1-cm nodules that are firm, nontender,
and often multiple
Objective Data
Inspect and palpate penis (cont.)
Compress glans anteroposteriorly between your thumb and forefinger; meatus edge should appear pink, smooth, and without discharge
If you note urethral discharge, collect smear for microscopic examination and culture
If no discharge shows but person gives history of it, ask him to milk shaft of penis; this should produce a drop of discharge
Palpate shaft of penis between your thumb and first two fingers
Normally, penis feels smooth, semifirm, and nontender
Objective Data
Inspect and palpate penis
Skin normally looks wrinkled, hairless, and without lesions; dorsal vein may be apparent
Glans looks smooth and without lesions; ask uncircumcised male to retract foreskin, or you retract it; it should move easily
Some cheesy smegma may have collected under foreskin; after inspection, slide foreskin back to original position
Urethral meatus positioned just about centrally
Objective Data

Your demeanor should be confident and relaxed
Do not discuss genitourinary history or sexual practices while you are performing examination as it may be perceived as judgmental
Use a firm deliberate touch, not soft, stroking one
If erection does occur, do not stop the examination or leave the room; this only focuses more attention on the erection and increases embarrassment
Reassure the male that this is only a normal physiologic response to touch
Proceed with the rest of examination
Objective Data
Concerns are similar to those experienced by female during examination of genitalia
Modesty, fear of pain, cold hands, negative judgment, or memory of previously uncomfortable examinations
Additionally, he may fear comparison to others, or fear having an erection during examination that would be misinterpreted by examiner
Apprehension becomes manifested in different behaviors
Many act resigned or embarrassed and may avoid eye contact
Occasional man will laugh and make jokes to cover embarrassment; also man may refuse examination by
female and may insist on male examiner
Objective Data
Equipment needed
Gloves: wear gloves during every male genitalia examination
Occasionally may require glass slide for urethral specimen
Materials for cytology
Flashlight
Objective Data
Preparation
Position male standing with underwear down and appropriate draping
Examiner should be sitting; alternatively, male may be supine for first part of examination and stand for hernia check
It is normal for a male to feel apprehensive about having his genitalia examined, especially by a female examiner
Younger adolescents usually have more anxiety than older adolescents
But any male may have difficulty dissociating a necessary, matter-of-fact step in physical examination from feeling this is an invasion of his privacy
Objective Data
Adolescent
Adolescents show wide variation in normal development of genitals
Using SMR charts, note:
Enlargement of testes and scrotum
Pubic hair growth
Darkening of scrotal color
Roughening of scrotal skin
Increase in penis length and width
Axillary hair growth
Be familiar with normal sequence of growth
Objective Data:
Developmental Competence
Infant or toddler (cont.)
Inspect penis and scrotum (cont.)
Migratory testes, physiologic cryptorchidism, is common because of strength of cremasteric reflex and small mass of prepubertal testes
Note that affected side has normally developed scrotum; these testes descend at puberty and are normal
With true cryptorchidism, the scrotum is atrophic
Palpate epididymis and spermatic cord as described in adult section
Objective Data:
Developmental Competence
Infant or toddler (cont.)
Inspect penis and scrotum (cont.)
If uncircumcised, foreskin normally tight during first 3 months and should not be retracted because of risk of tearing membrane attaching foreskin to shaft
This leads to scarring and possibly to adhesions later in life
In infants older than 3 months of age, retract foreskin gently to check glans and meatus; it should return to its original position easily
Scrotum looks pink in white infants and dark brown in dark-skinned infants
Rugae well formed in full-term infant
Objective Data:
Developmental Competence
Infant or toddler
Perform this procedure right after abdominal examination
In preschool-age to young school-age child, 3 to 8 years of age, leave underpants on until just before examination
In an older school-age child or adolescent, offer an extra drape, as with adult; reassure child and parents of normal findings
Objective Data:
Developmental Competence
Take time to consider these feelings, as well as to explore your own
You may feel embarrassed and apprehensive too
You may worry about your age, lack of clinical experience, causing pain, or even that your movements might “cause” an erection
Some examiners feel guilty when this occurs; you need to accept these feelings and work through them so that you can examine the male in a professional way
Discuss these concerns with an experienced examiner
Your demeanor is important; your unresolved discomfort magnifies any discomfort the man may have
Objective Data
Additional history for
aging man
Any difficulty urinating?
Have you experienced any hesitancy or straining, a weakened force of stream, dribbling, or incomplete emptying?
Do you ever
leak water
or urine when you don’t want to?
Do you use pads/tissue to catch urine in your underwear?
Do you need to
get up at night
to urinate?
What medications are you taking? What fluids do you drink in the evening?
Subjective Data
Additional history for preadolescents and adolescents (cont.)
Has anyone ever touched your genitals and you did not want them to?
Another boy, or an adult, even a relative?
Sometimes that happens to teenagers
You should remember it is not your fault and you should tell another adult about it
Subjective Data
Additional history for preadolescents and adolescents (cont.)
Often boys your age have questions about sexual activity
What questions do you have? How about things like birth control, or STIs such as gonorrhea or herpes? Do you have any questions about these?
Are you dating? Someone steady? Have you had intercourse? Are you using birth control?
What kind of birth control do you use?
Has a nurse or doctor ever taught you how to examine your own testicles to make sure they are healthy?
Subjective Data
Additional history for preadolescents and adolescents (cont.)
Boys around age 12 to 13 have normal experience of fluid coming out of penis at night, called nocturnal emissions, or “wet dreams”
Have you had this?
Teenage boys wonder if they are only ones who ever had them, like having an erection at embarrassing times, having sexual fantasies, or masturbating
Boys might have thoughts about touching another boy’s genitals and wonder if he might be homosexual
Would you like to talk about any of these things?
Subjective Data
Additional history for preadolescents and adolescents (cont.)
Around age
12 to 13
, but sometimes earlier, boys start to change and grow around penis and scrotum; what changes have you noticed?
Have you ever seen charts and pictures of normal growth patterns for boys? Let’s go over these now.
Who can you talk to about your body changes and about sex information? How do these talks go? What about sex education classes at school? How about your parents? Is there a favorite teacher, nurse, doctor, minister, or counselor to whom you can talk?
Subjective Data
Additional history for preadolescents and adolescents (cont.)
Start with a permission statement: “Often boys your age experience... ” This conveys that it is normal and all right to think or feel a certain way
Try the ubiquity approach, “When did you . . . ” rather than “Do you . . . ” This method is less threatening because it implies that topic is normal and unexceptional
Do not be concerned if a boy will not discuss sexuality with you or respond to offers for information
You do well to “open the door;” adolescents may come back at a future time
Subjective Data
Additional history for infants and children (cont.)
Ask directly to preschooler or young school-age child: Has anyone ever touched your penis or in between your legs and you did not want them to?
Tell him that sometimes that happens to children and it’s not okay
They should remember that they have not been bad
They should try to tell a big person about it
Can you tell me three different big people you trust who you could talk to?
Subjective Data
Additional history for infants and children (cont.)
Any problem with child’s penis or scrotum, such as sores, swelling, or discoloration?
Have you been told if his testes are descended?
Has he ever had a hernia or hydrocele?
Does he have any swelling in his scrotum during crying or coughing?
Subjective Data
Additional history for infants and children
Does your child have any problem urinating? Does his urine stream look straight?
Any pain with urinating, crying, or holding the genitals?
Any urinary tract infections?
If child older than 2 to 2½ years of age
Has toilet training started? How is it progressing?
If child is 5 years old or older, does he wet bed at night? Is this a problem for child or for parents? What have you done? How does the child feel about it?
Subjective Data
STI contact
Any sexual contact with a partner having an STI, such as gonorrhea, herpes, AIDS, chlamydia, venereal warts, or syphilis?
When was this contact? Did you get the disease?
How was it treated? Were there any complications?
Do you use condoms to help prevent STIs?
Do you have any questions or concerns about any of these diseases?
Subjective Data
Sexual activity and contraceptive use
Are you in a relationship involving sexual intercourse?
At times, phrase your questions so that all is right for person to acknowledge a problem
How many sexual partners have you had in the last 6 months?
What is your sexual preference? Do you prefer a relationship with a woman, a man, or both?
Subjective Data
Sexual activity and contraceptive use
Are you in a relationship involving sexual intercourse?
Are aspects of sex satisfactory to you and your partner?
Are you satisfied with the way you and your partner communicate about sex?
Occasionally a man notices a change in ability to have an erection when aroused. Have you noticed any changes?
Do you and your partner use a contraceptive? Which method? Is this satisfactory? Do you have any questions about this method?
Subjective Data
Penis
Have you had any problem with your penis, such as pain or lesions?
Any discharge? How much? Increased or decreased since start? Color? Odor? Discharge associated with pain or urination?
Scrotum, self-care behaviors
Any problem with scrotum or testicles?
Any lumps or swelling on testes? Change in size of scrotum? History of undescended testicle as infant? Any bulge or swelling in scrotum?
Have you ever been told you have a hernia? Have you had any dragging, heavy feeling in scrotum?
Subjective Data
Genitourinary history
Have you had any difficulty controlling your urine?
True incontinence: loss of urine without warning
Urgency incontinence: sudden loss, as in acute cystitis
Do you accidentally urinate when you sneeze, laugh, cough, or bear down?
Do you have any history of kidney disease, kidney stones, flank pain, urinary tract infections, or prostate
trouble?
Subjective Data
Hesitancy and straining
Do you have any trouble starting urine stream?
Do you need to strain to start or maintain stream?
Has there been any change in force of stream?
Have you experienced dribbling, so that you must stand closer to toilet?
Afterward, do you still feel you need to urinate?
Have you ever had any urinary tract infections?
Urine color
Is usual urine clear or discolored, cloudy, foul-smelling, or bloody?
Subjective Data
Frequency, urgency, and nocturia
Are you urinating more often than usual?
Do you feel as if you cannot wait to urinate?
Do you awaken during the night because you need to urinate? How often? Is this a recent change?
Nocturia occurs with frequency and urgency in urinary tract disorders; other origins include cardiovascular, habitual, diuretic medication
Dysuria
Any pain or burning with urinating?
Burning common with acute cystitis, prostatitis, and
urethritis
Subjective Data
Additional history for preadolescents and adolescents (cont.)
Use the following questions regarding sexual growth and development and sexual behavior
First ask questions that seem appropriate for boy’s age, but be aware that norms vary widely
When you are in doubt, it is better to ask too many questions than to omit something
Children obtain information, often misinformation, from media, internet, and from peers at surprisingly early ages
Ask direct, matter-of-fact questions; avoid sounding judgmental
Subjective Data
Additional history for aging man (cont.)
A man in his 70s, 80s, or 90s may notice changes in his sexual relationship or in his sexual response and wonder if it is normal
For example, it is normal for an erection to develop slowly at this age
This is not sign of impotence, but a man might wonder if it is
Subjective Data
Circumcision (cont.)
Circumcision lowers risk of certain STIs, specifically syphilis, chancroid, and somewhat reduced risk of genital herpes
Circumcised men have a significantly lowered risk of acquiring genital HPV infection, and their partners have a lower risk of cervical cancer
Finally, epidemiological studies now suggest a potential reduction in acquisition of HIV in circumcised men
Structure and Function:
Cultural Competence (cont.)
Circumcision
During pregnancy or immediate neonatal period, parents may ask whether or not to circumcise male infant
There are religious and cultural indications for circumcision, also prevention of phimosis and inflammation of glans penis and foreskin, decreasing incidence of cancer of penis, and slightly decreasing incidence of urinary tract infections in infancy
Structure and Function:
Cultural Competence
Sexual expression in later life
Chronologic age by itself should not mean a halt in sexual activity; physical changes need not interfere with libido and sexual pleasure
Older male is capable of sexual function as long as he is in reasonably good health and has an interested, willing partner
Danger is in male misinterpreting normal age changes as a sexual failure; once this idea occurs, it may demoralize man and place undue emphasis on performance rather than on pleasure
Structure and Function: Developmental Competence
Adult and aging men (cont.)
Testosterone production declines after age 55 to 60 years
Decline proceeds gradually
Aging changes also are due to decreased muscle tone, subcutaneous fat, and cellular metabolism
Pubic hair decreases and penis size decreases
Due to decreased tone of dartos muscle, scrotal contents hang lower, rugae decrease, and scrotum becomes pendulous
Testes decrease in size and are less firm to palpation
Increased connective tissue is present in tubules, so these become thickened and produce less sperm
Structure and Function: Developmental Competence
Adult and aging men
Male does not experience a definite end to fertility as female does
Around age 40 years, production of sperm begins to decrease, although it continues into 80s and 90s
After age 55 to 60 years, testosterone production declines
Structure and Function: Developmental Competence
Adolescents
Puberty begins between ages of 9½ and 13½
First sign is enlargement of testes
Next, pubic hair appears, then penis size increases
Stages of development are documented in Tanner’s sexual maturity ratings
Complete change in development from preadolescent to adult takes around 3 years, although normal range is 2 to 5 years
Structure and Function: Developmental Competence
Infants
Prenatally, testes develop in abdominal cavity near kidneys
During later months of gestation testes migrate, pushing abdominal wall in front of them and dragging the vas deferens, blood vessels, and nerves behind
Descend along inguinal canal into scrotum before birth
At birth, testis measure 1.5 to 2 cm long and 1 cm wide
Only a slight increase in size occurs during prepubertal years
Structure and Function: Developmental Competence
Loss of spouse
Depression
Preoccupation with work
Marital or family conflict
Side effects of medications
Heavy use of alcohol
Lack of privacy, living with adult children or in a nursing home
Economic or emotional stress
Poor nutrition or fatigue
Sexual expression in later life (cont.)
In the absence of disease, withdrawal from sexual activity may be due to:
Structure and Function: Developmental Competence

Are you urinating more often than usual?
Do you feel as if you cannot wait to urinate?
Do you awaken during the night because you need to urinate? How often? Is this a recent change?
Nocturia occurs with frequency and urgency in urinary tract disorders; other origins include cardiovascular, habitual, diuretic medication
Dysuria
Any pain or burning with urinating?
Burning common with acute cystitis, prostatitis, and urethritis
Frequency, Urgency, Nocturia
Subjective Data
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