Transcript Exanimation of the Male Reproductive Anatomy

Exanimation of the
Male Reproductive
Anatomy
By
Donald G. Hudson,
D.O.,FACEP/ACOEP
Examination
• While most of the male examination is
pretty straight forward the anatomy and
some of the embryology is definitely
important to both know and consider.
• Therefore, this slide show will include a lot
of details concerning anatomy and
physiology that I think is important to
consider in any male examination.
Genital Variations
• As you already recognize humans come in
all sizes and shapes therefore you should
not be surprised to find huge variations in
male genitals and breasts.
• Do a good history and record your findings
• Much of what you want to know has to do
with recent changes and how that effects
the patient
History
• As with most things in medicine a good
history is important.
• Sexual history, # of partners, their
medical Hx, condom use, sexual
preference, etc.
• Do they get up at night to urinate, how
many times, is there difficulty starting or
stopping the urine flow.
• Is there any problems with ejaculation
History
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Have they had any recent weight loss
Do they use alcohol & how much
Medications, any recent changes in meds?
Family Hx of problems with reproductive
system
• Surgical History or trauma to genitals or
testes
• Do they do self examinations?
More Anatomy
Blood Supply to the Testes
Testes Surgically Removed
Internal Views of a normal Testes &
one injured with loss of Blood Supply
Normal Prostate
Penis & Testes Come in all
Sizes & Shapes
And sometimes multiple
Almost all men masturbate some time,
ask how often and how, do they use
restrictive bands, vibrators, etc, & how
much do you ejaculate; penis size
does not relate to amount of ejaculate
Why is this Important
• Restrictive bands (cock rings) can
cause severe ischemia & major
damage to the penis.
• Others put rings around both penis &
Scrotum to prevent ejaculation. This
also causes ischemia & atrophy to
the testes. The hormone production
can then be inappropriate
Why Important
• The amount of ejaculate in both
volume & force can give some good
indication of nerve and prostate
function.
• The important fact is “is it different”?
• Some men cannot ejaculate with
intercourse and masturbation is their
only option; is this new or an old
occurrence?
What Else is Important
• There is a large number of males who are
not satisfied with their genitals, size,
having testicules, & you will see some self
mutilation being preformed.
• These range from attempts to castrate
them selves with Bizzardo Clamps (for
animals) to a variety of surgical attempts,
& methods to cut off blood supply for 24+
hours.
• For some this is erogenous event, for
others it is a mental illness.
Emasculatome
• These are placed over the scrotum
after identifying the Vas deferens. It
is clamped down, left for 1 min.
Emasculatome (#2)
• This is repeated by moving the tool about
½ inch distal on the vas. Clamp again for
1 min. Repeat on the other side.
• The skin remains intact, the testes
atrophy, initially the scrotum bruises & the
vas swells up.
• The men are now scared they did
something bad & it will take some good Hx
taking to get the whole truth
Another Reason to Ask- Remember a
lot of men cannot ejaculate without
stimulation of the prostate
What about the Prostate?
• What does the Prostate do?
• The prostate is the analog structure to the
uterus in the female
• It produces most of the ejaculate, it plus
the Cowper's glands produce over 98% of
what the male ejaculates
• It will eventually, in the majority of men
have a cancer within the organ
The Prostate (#2)
• The PSA test is important to do. It
was previously thought to be a
screening test for over 60 y/o males.
Now it is used on much younger
men.
• The exact numbers of the PSA test is
not as important as the changes and
progressive increases
Prostate (#3)
• The actual exam of the prostate involves
doing a rectal exam.
• This is easiest done with the man laying
on his back. Using an exam table have
him pull his knees up and across his abd.
• The prostate is now up toward the penis.
• Lubricate your gloved finger, enter the
rectum & sweep your finger forward & side
to side.
Prostate (#4)
• You are looking for lumps, soft areas,
too large to feel sides, and pain.
• While you are doing this also collect
a stool sample for guiac testing.
Penis Examination
• The penis extends behind the scrotum to
an area about ½ inch from the anterior
portion of the rectum, it is longer than
what you actually see.
• Look at the urethra, examine for sores,
redness, narrowing, inability to see into
the opening.
• If they are not circumcised make sure you
can slide the foreskin back off of the glans
looking for too tight & signs of infection.
Penis Examination (#2)
• The entire length of the shaft must be
palpated, looking for painful areas,
deviation to the side, soft areas, or
masses.
• The proximal ½ of the penis is essentially
under the scrotum.
• Be sure you look & fell the entire length.
• Many men will get an erection during this
examination, do not be embarassed, it is
pretty normal behavior for most men.
The Testicular Examination
Testes Exam
• The preceding picture is to refresh what
you are to feel
• The Vas Deferens is a hard tube feeling
like a piece of spegitti, & not tender.
• The Epiditmus is in the back of the testes
& is softer bigger and separated from the
testes & moderately tender.
• The testes are frequently of different
sizes.
Testes Exam (#2)
• The blood supply for the left testes
comes from the renal artery. Men
may have a varicose vein, usually on
the left & it feels like a “bag of
worms” & may be slightly tender.
These are the layers you are feeling
through.
Testes Exam (#3)
• The Testes should feel smooth. Look
at the attached picture.
Testes Examine (#4)
• Note where the blood supply & nerves all
run. While you are here examine the
inguinal canal looking for pain, loose
tissue, hernia. Pull down gently on the
testes while feeling that area.
Self Exam
The development of the male
& female
• While we all think our genitals are
special we are so similar during
gestation.
• Just so you can appreciate how
similar the parts are I have included
a comparison chart so you can relate
to the various analogous parts.
To Summarize
• While you thought the examination
of the male was easy & simple I
hope this makes you realize how
complicated it can be.
• Also there are so many components
to the male that in many ways they
are as complicated as the female.
• Do not forget to do a breast exam on
any male with sexual dysfunction.
Summary (#2)
• There is a lot of gynecomastia, swollen
breasts as well as breast cancer.
• Just because they are male does not
remove the possibility of cancer.
• See the next pictures. The male breast
has the same internal anatomy & with
hormone added they look the same. The
exam is the same.
Before & After Surgery
Before & After Surgery
Believe it or not this is a male
with breast augmentation
What’s Important?
• Bloody discharge
• Painful swelling is better than painless
swelling
• Milk production
• Skin looking like the cover of a football
• New dimples
• Ulcers
• Any of these are REALLY important.
• And remember every thing may not be as
it seems so ask questions if you have any
doubts.
The documentation
• Make sure you do a good
examination & keep an open mind.
• Like all examinations it is important
to remove the clothes & look, touch,
smell & understand what you are
seeing.
• Document your findings well.
• Notify you collaboration physician to
help make a plan of correction.