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Male Genitalia and Rectal Assessment — Transcript

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0:01Hello again. So today we're going to
0:04discuss assessment of the male genitalia
0:06and rectum and so many students feel
0:09uncomfortable performing these exams
0:11initially and patients may feel
0:14vulnerable or embarrassed as well. But
0:17knowing our role as nurses is to
0:18maintain professionalism, protect
0:20privacy and explain each step clearly
0:23and obtain information um and informed
0:26consent before beginning this type of
0:29exam. Um and then remembering that a
0:32focused genital or rectal assessment is
0:35not performed on every patient. These
0:37assessments are really guided by the
0:39patients history, symptoms, risk
0:41factors, and their reason for seeking
0:44care.
0:46our learning objectives here for this
0:49lecture.
0:51And so before we can perform a
0:53meaningful assessment of the male
0:54genitalia, it's important to review and
0:57understand the anatomy. So understanding
0:58normal anatomy is going to help us
1:00recognize any abnormal findings and
1:02explain conditions to our patients. So
1:05the male reproductive and urinary
1:07systems share really common structures
1:09particularly their urethra which serves
1:11as a passageway for both urine and semen
1:14and there are external structures. So
1:16the penis is composed of erectile tissue
1:19and contains the urethra and it
1:21functions in both urination and
1:23reproduction. So some key structures
1:25here include the glands penis which is
1:28the rounded tip of the penis and this is
1:30highly ba vascular and sensitive and
1:33then we have the prepuse which um also
1:36known as the foreskin. This covers the
1:38glands in uncircumcised individuals.
1:42Then we have the urethral miatus. This
1:45is the external opening through which
1:47urine and semen exit the body. So during
1:50assessment, we're inspecting these
1:52structures for any lesions, discharge,
1:55inflammation, swelling, and any skin
1:57abnormalities.
2:00And then we also have erectile tissue.
2:02So the penis contains erectile tissues
2:04that fills with blood during sexual
2:07arousal. Um the corpus cavernosum, this
2:11is one of the primary erectile bodies.
2:14So understanding erectile anatomy is
2:16important because conditions affecting
2:18blood flow, nerve function or tissue
2:21integrity can contribute to erectile
2:23dysfunction which is a pretty common
2:25concern for males.
2:29Um scrotum and testes. So the scrotum is
2:32a loose pouch of skin that contains the
2:34testes and the the scrotum helps
2:37regulate testicular temperature. It
2:39maintains an environment slightly cooler
2:41than the body um which is necessary for
2:43sperm production. And the testes have
2:46two primary functions. So the production
2:48of sperm and the production of
2:49testosterone.
2:51So during our assessment the testes
2:53should be smooth, firm, ovalshaped, non-
2:56tender. And know that the left testicle
2:59commonly hangs slightly lower than the
3:02right. And this is considered a normal
3:03finding. And then we have the vast
3:06deference. This is a muscular tube that
3:08transports sperm from the epidmus
3:10towards the ejaculatory ducts. Um you
3:14may recognize this structure because
3:15it's surgically interrupted during a
3:17vasectomy. Um when we palpate this the
3:19vaspherence normally feel smooth and
3:22cordlike.
3:24And then we also have internal
3:25reproductive structures. So several of
3:27these internal structures contribute
3:29fluids that support sperm function. We
3:33have the seinal vesicles which produce
3:35most of the fluid found in semen and
3:38they provide nutrients to help sperm
3:40survive and move. Then the ejaculatory
3:43ducts which transport semen toward their
3:46urethra during ejaculation.
3:48Then we also have the kalpers glands
3:51which produce a lubricating alkaline
3:53secretion before ejaculation and help
3:56neutralize residual acidity in the
3:58urethra.
4:00We also have the prostate gland which
4:01surrounds the proximal urethra just
4:03below the bladder and it functions as um
4:07producing prostatic fluid. It supports
4:09sperm motility and viability and it also
4:12tends to enlarge with age which can
4:14contribute to urinary frequency
4:17hesitancy, weak urinary stream, nocturia
4:21and this is why we assess the prostate
4:24particularly in older male adults
4:26because it does get enlarged.
4:31So notice the close relationship between
4:33the bladder, prostate and urethra. Um
4:35the prostate surrounds the urethra and
4:38enlargement can partially obstruct urine
4:40flow. Um so that is worrisome. Um,
4:46and it explains why many urinary
4:49symptoms are associated with that
4:51enlargement, also known as benign
4:53prosthetic hyperlasia,
4:56which we'll talk more about in adult
4:57health, too.
5:01So, as men age, we have normal
5:03physiologic changes that occur within
5:05the reproductive, urinary, and
5:07gastrointestinal systems. Um, not we
5:10because I am a female, but um, men. So,
5:13it's important for us as nurses to
5:16understand which changes are expected
5:18with aging and which findings warrant
5:20further evaluation. So, while some
5:23changes are considered normal, um
5:25symptoms that significantly affect
5:27quality of life or indicate disease,
5:29they should never be dismissed as simply
5:32getting older, right? Um we've talked
5:34about this throughout the semester.
5:37We have stool retention and
5:38incontinence. Um so older adults may
5:41experience changes in bowel function.
5:43This is due to decreased GI motility,
5:46reduced physical activity, medication
5:48side effects, neurologic disorders, also
5:52reduced anal sphincter tone and these
5:54changes may contribute to constipation,
5:57stool retention, fecal impaction, fecal
5:59incontinence. And so during our
6:02assessment, we want to ask about the
6:03frequency of bowel movements, stool
6:05consist consistency, use of laxatives,
6:09any episodes of leakage or accidents.
6:12Um, and many adults, older adults are
6:15embarrassed to discuss these bowel
6:16habits. So asking direct but respectful
6:19questions is going to be important.
6:22Declining testosterone levels. So
6:24beginning around middle adulthood,
6:26testosterone production gradually
6:28declines. So potential effects of this
6:31may include reduced libido, decreased
6:34muscle mass, increased body fat, reduced
6:36energy levels, mood changes. Um, and so
6:40understanding that testosterone decline
6:42is typically gradual and it varies
6:45considerably among individuals and not
6:47all older men experience symptoms and
6:49low testosterone alone doesn't explain
6:52every complaint of fatigue or sexual sex
6:54sexual dysfunction. So having that in
6:56the back of your mind is going to be
6:57important when you're um asking their
6:59history or doing these assessments.
7:03And then the testes drop lower in the
7:05scrotum. So as connective tissues lose
7:08elasticity with age, the testes often
7:10hang lower within the scrotum. And this
7:13is considered normal. But during
7:15assessment, we want to remember that
7:16mild asymmetry is normal. The left being
7:20lower than the right. And then lower
7:22positioning of the testes is expected.
7:24Any new masses, swelling or pain, these
7:28aren't normal. Um, so we should kind of
7:32uh explore a little bit more there, but
7:35our goal is to distinguish expected
7:37versus unexpected findings.
7:41And then benign prosthetic hyperplasia.
7:43This is one of the most common
7:45conditions affecting older men. Um so
7:48enlargement of that prostate gland
7:50because the prostate surrounds the
7:52urethra. Enlargement can again interfere
7:54with urine flow and common symptoms
7:56include hesitancy, weak stream,
7:59dribbling, urinary frequency, urgency,
8:02nocturia. Um so if an older male reports
8:06getting up multiple times at night to
8:08urinate, we should be thinking as BPH as
8:12one of our considerations.
8:15But these can also occur with things
8:16like urinary tract infections or
8:18neurologic disorders, even prostate
8:21cancer. So further assessment is going
8:23to be necessary. And then we talked
8:25about erectile dysfunction, but this
8:26becomes more common with age um but
8:29should not automatically be considered
8:31as normal. Um so factors contributing to
8:34erectile dysfunction include vas
8:36vascular disease, diabetes,
8:38hypertension, sometimes medication side
8:41effects, depression, hormonal changes.
8:44And because erection depends on adequate
8:46blood flow, erectile dysfunction may
8:48sometimes be an early indicator of
8:50cardiovascular disease.
8:55So when performing um a male genitalia
8:58or rectal assessment uh cultural
9:00humility and patient centered
9:02communication are going to be important.
9:04Um so these examinations involve highly
9:07personal and sensitive areas of the
9:09body. So a patients cultural beliefs,
9:11religious practices, gender identity,
9:14sexual orientation, any previous
9:16experiences with health care and their
9:18personal values may influence their
9:20comfort level and their willingness to
9:21participate in the assessment. So, as
9:23nurses, our goal is to create a safe,
9:25respectful environment where patients
9:27feel heard and respected.
9:30So, we want to avoid making assumptions
9:32about a patient's gender identity, their
9:34sexual orientation, any sexual
9:36practices, their relationships, or
9:39reproductive goals. Instead, we want to
9:41use open-ended and inclusive language.
9:44And we also want to maintain respect and
9:45privacy. Um again because patients may
9:48have cultural or religious beliefs that
9:50affect their comfort with their genital
9:52exams. Um preference for same-sex exam
9:56uh same gender examiner willingness to
9:59discuss sexual health topics and use of
10:02touch during assessments. So explaining
10:04the purpose of the examination when
10:06possible, obtaining their consent of
10:08course before beginning, offering a
10:10chaperone, even using appropriate
10:13draping and allowing time for questions.
10:16piercings and tattoos. So, body
10:18modifications may be present on the
10:20genitalia, paranneeium or surrounding
10:22areas. So, during assessment, we want to
10:24document the location and appearance.
10:27Assess for any signs of infection,
10:29irritation, or trauma. We want to avoid
10:31judgmental comments. Um, some piercings
10:34may be cultural, spiritual, aesthetic,
10:36or related to personal identity. So,
10:38remember that body modifications are not
10:40necessarily indicators of risk-taking
10:42behavior or even disease.
10:45And then caring for transgender
10:47patients. Some patients may identify as
10:49transgender transgender. So um a
10:53transgender female is a person who is
10:55assigned male at birth but identifies as
10:57a female as we know. And these patients
10:59may have native male genitalia. They may
11:03be on hormonal therapy um where they
11:06have hormone therapy related changes um
11:08even gender affirming surgeries or
11:10unique unique healthcare needs. So, our
11:14assessment should always be based on the
11:16patients anatomy, symptoms, and health
11:18care concerns rather than our own
11:20assumptions or biases.
11:24And when we're obtaining a health
11:26history, we're focusing on anatomy and
11:29behaviors that influence health risk
11:31rather than labels alone. So, we want to
11:33include current anatomy present, sexual
11:36practices, any STI risk factors, urinary
11:39symptoms, hormone use, and previous
11:42surgeries. This is going to help guide
11:43um appropriate screenings, assessment,
11:45and patient education.
11:50So, while many findings um identified
11:53during a genital or rectal assessment
11:56are non-urgent, there's several
11:57conditions that require immediate
11:58recognition and intervention. So, we're
12:01playing that role in identifying any red
12:04flags and we're escalating care when
12:05necessary.
12:08Testicular torsion versus epidmmititis.
12:11Um this is one of the most important
12:13assessments involving the male genitalia
12:15is differentiating the two here. Um so
12:18testicular torsion occurs when the
12:20spermatic cord twists which cuts off
12:23blood flow to the testicle. Um some
12:26common findings include sudden onset of
12:28severe unilateral testicular pain, high
12:32riding testicle, so you'll see it a
12:34little bit higher than what it normally
12:36was. Um sweat swelling for sure. uh
12:40nausea, vomiting, absent um cremaster
12:45reflex, which um not too sure about what
12:48that means, but um I'm actually going to
12:50go look that up after this. Um but
12:53knowing that this is a surgical
12:55emergency um because we have permanent
12:58tissue damage that can occur within
13:01hours if we don't restore that blood
13:03flow. So they could lose their testicle.
13:06Um so any patient with sudden severe
13:08testicular pain should be treated as
13:10having testicular torsion until proven
13:13otherwise.
13:15Epidimmitis this is inflammation or
13:18infection of the epidmus. Um common
13:21findings include gradual onset pain,
13:24swelling, tenderness, fever, urinary
13:26symptoms. So unlike torsion, this
13:28usually develops over hours to days
13:30rather than minutes. Um so getting a
13:32clinical history is going to help us
13:34distinguish between these two
13:36conditions.
13:38And then 40 years gang green this is a
13:39rapidly um progressive necroizing
13:42infection of the paranneeium and genital
13:45tissues. Risk factors include diabetes,
13:47amunosuppression, alcohol use disorder,
13:50any recent trauma or surgery. And our
13:52assessment findings may include severe
13:54pain out of proportion to the findings,
13:57swelling, iththemma, crerepidus, tissue
14:00discoloration, and a foul odor and also
14:03signs of sepsis. So this condition can
14:05be life-threatening very quickly. Um
14:08immediate medical and surgical
14:09intervention is going to be required.
14:13Cotti, catheter associated urinary tract
14:15infection. These are this is among the
14:19most common healthcare associated
14:20infections. Um, assessment findings may
14:23include fever, super pubic discomfort,
14:26cloudy urine, any new confusion in older
14:28adults, malaise, and we can help prevent
14:31codies by avoiding any unnecessary
14:34catheter use, maintaining a closed
14:36drainage system, performing catheter
14:39care, removing catheters as soon as
14:41possible. Um, so good clinical judgment
14:44here is does this patient still need
14:46this catheter today?
14:51anorerectyl difficulties. So patients
14:54may report rectile pain, hemorrhoids,
14:56fissures, constipation, fecal impaction,
14:58incontinence and some conditions are
15:01again uncomfortable but not emergencies
15:03while others require urgent
15:05intervention. So red flags would include
15:08severe pain, inability to pass stool,
15:10significant rectal bleeding, signs of
15:13bowel obstruction, and our assessment
15:15finding should always be considered in
15:16the context of the patient's overall
15:18condition.
15:21And finally, colurectal cancer. This
15:23remains one of the most common cancers
15:25affecting adults. Symptoms may include
15:27rectal bleeding, occult blood in the
15:29stool, any changes in bowel habits,
15:32unexplained weight loss, iron
15:34deficiency, anemia, persistent abdominal
15:36discomfort. Um, and many patients
15:38initially dismiss these symptoms as
15:40hemorrhoids or age relating changes. But
15:42we need to recognize these warning signs
15:45and encourage um timely evaluation.
15:51So before we perform a physical exam of
15:53the male genitalia or rectum, we begin
15:55with a thorough health history as we
15:57know and in many cases the subjective
15:59history provides us with more diagnostic
16:02information than the physical exam
16:04itself. And because these topics can be
16:06sensitive, we're going to use a calm,
16:08professional, and non-judgmental
16:10approach. We want to establish trust
16:12trust with our patient.
16:15Um assessment of risk factors. So when
16:17collecting subjective data, we want to
16:19identify any risk factors that may
16:21increase the patient's risk for
16:23reproductive, urinary, sexually
16:25transmitted or colurectal disorders.
16:28Um, and our assessment is going to be
16:31individualized based on the patients
16:32age, symptoms, health history, and risk
16:34factors. And then we want to ask about
16:37conditions that may affect urinary,
16:39reproductive or colarctal health in
16:41their past medical history. Examples
16:43here would include diabetes,
16:46hypertension,
16:47uh peripheral vascular disease,
16:49neurologic disorders, chronic kidney
16:51disease, inflammatory bowel disease, any
16:55previous urinary tract infections,
16:57sexually transmitted infections,
17:00for example, diabetes can contribute to
17:02erectile dysfunction, urinary retention,
17:05and increased infection risk.
17:09Um, medical and surgical history. So, we
17:11should ask about any previous genital
17:13surgeries, if they've had a vasectomy,
17:16circumcision, any hernia hernia repairs,
17:19prostate procedures, um if they've had a
17:22colonoscopy, any findings, uh colarctal
17:26surgery, any pelvic trauma,
17:30um because these may explain current
17:32symptoms or alter our assessment
17:34findings,
17:36lifestyle and personal habits, these can
17:39significantly influence ments
17:40reproductive and gastrointestinal
17:43health. So important topics to talk
17:45about would be tobacco use, alcohol
17:48consumption, any substance use, exercise
17:51habits, their diet, occupational
17:54exposures. Um these can affect
17:56fertility, any erectile function, cancer
17:59risk and bowel health.
18:02And then sexual health assessment. So,
18:04the five Ps when we're discussing health
18:07um sexual health, your book recommends a
18:09structured approach. This is known as
18:11the five Ps. And these questions help
18:13assess risk uh while maintaining a
18:16respectful and standardized interview
18:18process. So, partners we want to ask, do
18:21you currently have sexual partners?
18:24This is going to help us determine their
18:26exposure risk and provide us context for
18:29further assessment. practices. What
18:31types of sexual activity do you engage
18:33in? This is going to help us identify
18:35specific risk factors and appropriate
18:37screening needs. Um,
18:41protection. Do you use protection
18:42yourself from sexually transmitted
18:44infections?
18:46Um, past history of STI. We want to ask
18:50about gorrhea, gorrhea, chlamydia,
18:53syphilis, HPV, HIV, herpes. because a
18:58previous STI increases the risk of
19:00future infections and it may explain
19:03current symptoms.
19:05Prevention of pregnancy. So, we want to
19:07ask what methods do you and your partner
19:09use to prevent pregnancy? Um, and this
19:12is this discussion provides insight into
19:14reproductive goals and sexual health
19:16practices.
19:19After the five Ps, we can talk about
19:21medications. Many medications can affect
19:24urinary, bowel, and sexual function. So
19:27things like anti-hypertensives,
19:28anti-depressants, opioids,
19:31antiolinergics,
19:33hormonal therapies. Um so a patient may
19:35report erectile dysfunction,
19:37constipation or urinary retention, but
19:39it may actually be the experience that
19:42they're getting the side effects from a
19:44medication.
19:45So we al always want to review both
19:48prescription and over-the-counter
19:50medications.
19:52And then family history. We want to ask
19:54about family history of prostate cancer,
19:56testicular cancer, any colctal cancer,
19:59if they've had polops on their
20:01colonoscopy in the past, inflammatory
20:04bowel disease. Um, because a positive
20:07family history may increase screening
20:09needs and influence clinical decision-m.
20:16So one of the most important roles of
20:19our job is health promotion as we've
20:22talked about and during genital urinary
20:26and rectal assessments we have
20:27opportunities to provide education that
20:29support early detection of disease
20:32prevention of sexually transmitted
20:33infections and healthy reproductive and
20:36bowel function. So we should always
20:38individualize based on the patients age
20:40risk factors family history lifestyle
20:42and their personal health goals. So when
20:45we're discussing their health promotion,
20:47we want to consider their priorities and
20:49the risk factors. Um some common topics
20:52would include prevention and early
20:54detection of testicular cancer, prostate
20:57health, any family planning, prevention
21:00of sexually transmitted infections,
21:02healthy sexual function, colctal cancer
21:05screening. Um, this is one of the most
21:08effective um, ways that we can have our
21:11patients understand not only what to do
21:13for these situations, but why it
21:15matters.
21:17Um, testicular cancer awareness.
21:20Um, testicular cancer is relatively
21:22uncommon overall, but it's one of the
21:25most common cancers affecting young
21:27adult males, particular particularly
21:29between ages 15 and 35. Um, the good
21:33news is that when it's detected, early
21:34treatment outcomes are really excellent,
21:37but patients should be taught to
21:38recognize any new lumps or masses,
21:41testicular enlargement, feelings of any
21:44heaviness in the scrotum, persistent
21:46discomfort, and changes from their
21:48normal normal baseline. Um, definitely a
21:51painless lump should never be ignored.
21:55Testicular self-examination.
21:57Um, we can teach our patients how to
22:01routinely um, self-examine. Um,
22:05and current recommendations vary, but a
22:08routine screening is not universally
22:10recommended for all asymptomatic men.
22:13Many um, clinicians though still
22:15encourage familiarity with normal
22:17anatomy so patients can recognize any
22:20changes early.
22:23So the key message here is going to be
22:25knowing what is normal for your body. So
22:28telling our patients that and reporting
22:29any new changes promptly.
22:32So if teaching self-exam um we want to
22:35explain that it's easiest after a warm
22:37shower or bath when the scral tissue are
22:40relaxed. The patient should examine one
22:43testicle at a time. They should roll the
22:44testicle gently between the thumb and
22:46fingers. And we're assessing for lumps,
22:48firm nodules, enlargement, any changes
22:51in consistency. And patients should
22:53understand that the epidmus normally
22:55feels like a soft cord-like structure
22:58behind the testicle and should not be
23:00mistaken for a mass.
23:03Any warning signs that require
23:04evaluation. So, a new lump, any
23:07persistent swelling, heaviness in the
23:09scrotum, any unexplained testicular
23:11enlargement, persistent pain, sudden
23:13severe pain. And we want to remind um
23:17ourselves that sudden severe pain raises
23:20the concern for the testicular torsion
23:22and that's going to require immediate
23:24evaluation.
23:29And then when talking about family
23:30planning, we're discussing options about
23:32contraceptive
23:34uh reproductive goals, condom use, STI
23:36prevention, vaccination recommendations,
23:39including the HPV vaccine when
23:41appropriate.
23:43um we can play a major role actually in
23:46reducing STI transmission through our
23:48patient education and risk reduction
23:50counseling
23:52and then screening for prostate cancer.
23:55Um this is a topic that often generates
23:57questions from patients. So current
23:58recommendations emphasize um a shared
24:01decision- making between the patient and
24:03healthcare provider. Um screening may
24:06involve prostate specific antigen, so
24:09PSA testing, digital rectal examination
24:12in some settings. Um but factors
24:15influencing screening decisions include
24:17the patients age, family history, race
24:20and ethnicity, personal preferences, and
24:22overall health status.
24:25So screening recommendations differ
24:28among organizations and may change as
24:31evidence evolves.
24:35Most patients do not say um or present
24:40saying I think I have a problem with my
24:42prostate or I need a genital assessment
24:46um and said they present with symptoms.
24:48So as nurses were recognizing common
24:50complaints and understanding the
24:52possible underlying causes. Um so this
24:54slide is just reviewing some of the most
24:56common symptoms associated with
24:58disorders of the male genitalia,
24:59prostate and rectum. So pain, pain is
25:02often the symptom that prompts patients
25:04to seek care. We want to ask where it's
25:06located. Um we want to ask what's the
25:10onset, what makes it better or worse,
25:14any difficulties with urination, um
25:17which are extremely common especially in
25:18older adults.
25:23Erectile dysfunction. Um
25:26so inability to achieve or maintain an
25:29erection for sufficient sexual activity.
25:31Um and again many patients are hesitant
25:33to discuss ED. So nurses should approach
25:36the topic professionally and without
25:38judgment. Um potential causes we've
25:40talked about cardiovascular disease,
25:42diabetes, hypertension, medication side
25:44effects, depression, anxiety, hormonal
25:47disorders. Um and erectile dysfunction
25:50again may be an early sign of vascular
25:52disease.
25:56any penile lesions, discharge or rash.
25:59Patients may report ulcers, vesicles,
26:02warts, rashes, penile discharge, and
26:05potential causes for this may be
26:07sexually transmitted infections, fungal
26:09infections, contact dermatitis, skin
26:12disorders, malignancy, and our
26:14assessment should include the
26:15appearance, color, location, drainage,
26:18any pain or itching. Um and remembering
26:21that any painless lesions can sometimes
26:23be more concerning than the painful
26:25ones.
26:27Scrotal enlargement. Um scrotal swelling
26:29may occur for many reasons. Um I've seen
26:32it very commonly in the hospital
26:34setting. Um some common causes include
26:37hydroil
26:39hernia, epidmmititis, um testicular
26:42tumor. And so our questions of our
26:45assessment may include is the swelling
26:46painful? Did it develop suddenly or
26:49gradually? Is one side larger than the
26:51other? Are there associated redness or
26:53fever? And any new scrotal mass should
26:56be evaluated very carefully.
27:01So after collecting the health history,
27:03we move into the objective assessment.
27:05So the goal here is to gather physical
27:07findings that either support or rule out
27:09potential causes of the patient's
27:10symptoms. And because genital and rectal
27:13exams can feel invasive or embarrassing,
27:16preparation and communication are going
27:18to be especially important. Always
27:20explaining what you're doing before you
27:21do it. We're obtaining consent um and
27:24maintaining privacy throughout the
27:26examination. So for equipment, um we
27:28have disposable gloves. Um makes sense
27:31when we're inspecting, palpating, if
27:33we're doing a digital rectal exam,
27:36gloves are going to protect both the
27:37patient and ourselves.
27:40water- soluble lubricant. Um it's
27:43primarily used during the digital rectal
27:45exam. Um benefits would include
27:48increasing the patients comfort,
27:49reducing tissue trauma. Um these are
27:53preferred because they're safe for
27:54tissue contact and easy to remove. Um a
27:58flashlight or pen light can help us
28:00visualize any lesions, discharge,
28:02inflammation, skin color changes,
28:04scrotal abnormalities. Um, good lighting
28:07is essential because subtle findings may
28:09otherwise be missed.
28:12Stethoscope,
28:13um, although it's not routinely used for
28:15every genital assessment, it may be
28:17helpful when we're eval evaluating any
28:19large inguinal hernas,
28:22suspected vascular abnormalities. Um,
28:25most routine male genital exams rely
28:27primarily on inspection and palpation,
28:29so potentially might not even need the
28:32stethoscope.
28:34measurements of your index finger. This
28:36is unique but a practical point from
28:38your book. So during a digital rectal
28:40exam, the examiner often estimates the
28:42prostate size using their index finger
28:44as a reference. So knowing the width of
28:47your fingertip, the length of your
28:48distal fangi, um it can help estimate
28:52prostate enlargement and document
28:54findings more accur accurately. Um
28:59preparation. This is often most
29:01important um because before beginning
29:04any exam we want to wash our hands,
29:06gather our equipment, ensure privacy,
29:08explain the procedure, obtain um consent
29:11and permission to proceed. Uh offer a
29:14chaperon according to institutional
29:17policy. Position the patient and drape
29:20the patient appropriately. Um patients
29:22should never feel rushed or surprised
29:24during um this kind of exam.
29:28Patient positioning. Um, so common
29:31positions include standing, often used
29:34for genital inspection and hernia
29:36assessment. Supine, this allows
29:38inspection and palpation of the penis
29:40and scrotum. Left lateral positioning or
29:43also known as SIMS position. Um, this is
29:46commonly used for rectal exams. the P um
29:50the physician is going to be chosen to
29:54um perform the procedure but also for
29:57patients comfort.
30:00And again, we're using therapeutic
30:01communication throughout um remembering
30:04that patients may be experiencing
30:06embarrassment, fear or vulnerability.
30:11So after completing the health history
30:13and preparing the patient, we move into
30:14the physical assessment. So the exam of
30:17the male genitalia is going to focus
30:18again like I said primarily on
30:20inspection and palpation. Um
30:24remember that not every patient is going
30:26to require a complete genital or rectal
30:28exam.
30:30The exam itself is going to depend on
30:32the patient's symptoms, history, risk
30:34factors and the clinical setting.
30:38So the primary techniques um we start
30:41with inspection. We're observing the
30:42skin color, symmetry, swelling, lesions,
30:45rashes, any discharge or deformities,
30:48and then we're going in and palpating.
30:49We're assessing for tenderness, masses,
30:52consistency, temperature, swelling.
30:54We're always comparing findings
30:56bilaterally when appropriate.
30:58We can begin by observing the groin
31:00region, assessing for skin integrity,
31:03rashes, lesions, swelling,
31:05lymphatinopathy,
31:06any surgical scars. Um, some common
31:09findings may include fungal infections,
31:11any enlarged lymph nodes, hernas, skin
31:14irritation for moisture.
31:19Then we're doing a um assessment of the
31:21penis. We're inspecting for skin color,
31:23lesions, ulcers, nodules, inflammation,
31:26discharge. If they're uncircumcised,
31:28we're gently retracting the foreskin.
31:30We're inspecting the glands. We're
31:32returning the foreskin to its normal
31:34position after. Um so normal findings
31:36include intact skin, no no lesions, no
31:39tenderness, no discharge. Um and
31:41abnormal findings may suggest
31:43infections, sexually transmitted
31:45infection. Um trauma and malignancy. And
31:50then we're going going ahead and
31:51inspecting the scrotum for that
31:53symmetry, color, swelling, lesions,
31:56masses. Um the scrertal skin should
31:58appear uh rugated, intact, free from
32:02lesions and we're palpating the testes
32:04individually to assess the size, shape,
32:06consistency, any tenderness. Um
32:11normally they are smooth, firm, uh
32:15ovalshaped, non- tender. Um and again
32:19the left testicle is commonly hanging
32:20slightly lower than the right.
32:29the paranal area. So the paranium is the
32:31area between the scrotum and anus. We're
32:34inspecting there for skin breakdown, any
32:35irrima, swelling, lesions and drainage.
32:39Um this is important for that for gang
32:41green or any trauma, infection, any
32:44surgical complications potentially from
32:47vasectomy. Um any severe pain,
32:49discoloration or necrotic tissue is
32:51going to require immediate evaluation.
32:54ingal and femoral regions. So, we're
32:56inspecting and palpating for hernas,
32:58enlarged lymph nodes, masses, any
33:00tenderness. Um, we're going to ask the
33:03patient if they're able to stand and
33:05inspect the area while the patient
33:07coughs or bears down. So, a bulge that
33:10becomes more prominent during coughing.
33:12That may indicate an inguinal hernia.
33:15So, understanding that hernas may be
33:18visible, palpable, or both.
33:23So once the initial inspection and
33:25palpation are completed, um there are
33:27additional assessment techniques that
33:29may be used to further evaluate
33:31abnormalities or gather more diagnostic
33:33information. And this is going to help
33:35us distinguish normal findings from
33:36conditions requiring treatment,
33:38referral, or urgent intervention.
33:42So when palpating the testes, we'll want
33:44to examine each testicle separately.
33:46Again, um size, size, shape, symmetry,
33:49tenderness, masses. We've talked about
33:51all of this. Um
33:56the vast deference this can be palpated
33:59as part of the spermatic cord. Um normal
34:02findings that it would be smooth, firm,
34:04mobile and have cord-like structure.
34:08Um we might feel some thickening um
34:11nodules or even absence of the vast
34:14deference tenderness. Um and so that
34:17would require um further evaluation
34:22translumination of the scrotum. So
34:24sometimes we can place a light um behind
34:26the scrotum in a darkened room and this
34:28helps us differentiate fluid fil masses
34:30from solid masses if we do feel that. Um
34:34examples of this would be hydroal or
34:36sperm spermatosal.
34:39um
34:43hernia assessment. Again, we've already
34:45talked about
34:48um
34:50peranal and rectal exam. Um we're
34:53inspecting. We're maybe performing a
34:55digital rectal exam. Assessing for
34:58hemorrhoids, fistulas, fissures, any
35:00skin tags, inflammation, bleeding,
35:02lesions.
35:04Um prostate exam. This is assessed
35:07through that anterior rectal wall during
35:10a digital rectal exam. So normally the
35:12prostate would be smooth, firm, non-
35:14tender and symmetrical.
35:16Um if it is enlarged um might be
35:19suggestive of BPH. Um finding suggestive
35:23cancer on a prostate exam would be hard
35:25nodules, an irregular surface and
35:28asymmetry.
35:32And then stool assessment. Um we're
35:34assessing stool
35:36um to evaluate color consistency, any
35:39presence of blood, any presence of
35:40mucus.
35:48And then our uh clinical decisions,
35:51we're analyzing their lab data and
35:53diagnostic testing um if applicable.
35:59We are prioritizing what we think the
36:01patient has and we are doing our
36:04interventions as necessary. Um analyzing
36:08any changing findings, writing that in
36:11their chart. Um maybe collaborating with
36:14urology
36:16and updating the plan of care and
36:18evaluating the outcomes of our
36:20interventions.
36:23And that is it for today. Um, I hope you
36:27enjoyed and I will see you in class.

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