Male Reproductive System

 Physical Exam

 I. History: Sexual history, sexually transmitted disease, contraception, surgery, associated urinary problems

• External genitalia
• Hair distribution: varies; hair extends from base of penis over symphysis pubis; coarse and curly
• Penis shaft, corona, prepuce, glans
• Urethral meatus is slit like opening positioned on ventral surface, millimeters from tip of glans; opening should be glistening and pink
• Scrotum:

1. skin more darkly pigmented; more wrinkled; usually loose
2. symmetry - left testicle is lower than right
3. size - changes with temperature

• Inguinal canal: no finding - no bulging

II. Palpation

•  Penis:

1. foreskin should retract easily
2. small amount of thick white secretion between glans and foreskin is normal
3. testicle - ovoid; ranges from 2-4 cm in diameter, smooth and rubbery; nontender

• Inguinal canal: Normal finding - inguinal lymph nodes not palpable

III. Geriatric Alterations

• Increased bogginess of prostrate
• Testes softer

IV. Rectum and Anus

• Inspection of perianal areas

1. skin - smooth and uninterrupted
2. anal tissues - normally moist and hairless

• Digital palpation:

1. Anal sphincter - note tone
2. Rectal walls - smooth and even
3. Prostrate gland = Palpate through anterior rectal wall; Small walnut-sized, heart shaped structure; Ranges from 2.5 to 4 cm in diameter; Normal findings - firm, protrudes <1 cm into rectum

• Alterations:

1. fissures
2. fistulas
3. polyps
4. pain
5. hemorrhoids

 Gynecomastia

 Gynecomastia is a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast (see the image below). Gynecomastia is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Although the condition is usually bilateral, it can be unilateral. The condition known as pseudogynecomastia, or lipomastia, is characterized by fat deposition without glandular proliferation.

Reassure patients with physiologic gynecomastia regarding the benign nature of their condition, and inform them that most cases spontaneously resolve.
Counsel patients regarding the various treatment modalities available for gynecomastia, and highlight the risks, adverse effects, success rates, and benefits of each modality.

Prostate Diseases

The prostate is a gland. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from the bladder and out of the body. A young man's prostate is about the size of a walnut. It slowly grows larger with age. If it gets too large, it can cause problems. This is very common after age 50. The older men get, the more likely they are to have prostate trouble.

Some common problems are

    Prostatitis - an infection, usually caused by bacteria
    Benign prostatic hyperplasia, or BPH - an enlarged prostate, which may cause dribbling after urination or a need to go often, especially at night
    Prostate cancer - a common cancer that responds best to treatment when detected early

Prostate Cancer

The prostate is the gland below a man's bladder that produces fluid for semen. Prostate cancer is common among older men. It is rare in men younger than 40. Risk factors for developing prostate cancer include being over 65 years of age, family history, being African-American, and some genetic changes.

Symptoms of prostate cancer may include

    Problems passing urine, such as pain, difficulty starting or stopping the stream, or dribbling
    Low back pain
    Pain with ejaculation

Your doctor will diagnose prostate cancer by feeling the prostate through the wall of the rectum or doing a blood test for prostate-specific antigen (PSA). Other tests include ultrasound, x-rays, or a biopsy.

Treatment often depends on the stage of the cancer. How fast the cancer grows and how different it is from surrounding tissue helps determine the stage. Men with prostate cancer have many treatment options. The treatment that's best for one man may not be best for another. The options include watchful waiting, surgery, radiation therapy, hormone therapy, and chemotherapy. You may have a combination of treatments.