Male rep syst.

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Anatomy and Physiology Review
The male reproductive system is divided anatomically into external and internal
genital organs. The penis and scrotum are easily inspected and palpated, but many
internal structures are not palpable.

Figure 23.1
Male reproductive organs serve dual roles as part of the reproductive system and the
urinary system. They manufacture and protect sperm for fertilization, transport sperm
to the female vagina, and provide sexual pleasure.
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The scrotum is a loosely hanging, pliable, pear-shaped pouch of darkly pigmented
skin that houses the testes, which produce sperm. It maintains a surface
temperature of 34 °C (93.2 °F), which is approximately 3 °C cooler than core body
temperature.
Pubic hair scantily covers the scrotum, which is visibly asymmetric, with the left side
extending lower than the right. Two muscles, the cremaster muscle and the dartos
muscle, play a protective role in sperm production and viability.
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Testes
The testes are two firm, rubbery, olive-shaped structures that measure 4 to 5 cm
(1.57 to 1.96 in.) long and 2 to 2.5 cm (0.78 to 0.98 in.) wide. They manufacture
sperm and secrete testosterone.
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Epididymis
The epididymis is a long, coiled tube located on top of and just posterior to each
testicle. It contains immature sperm and transports them to the ductus deferens
where they mature and become mobile.
Ductus Deferens
The ductus deferens is a tubular structure that runs from the end of the epididymis to
the ejaculatory duct. It serves as an excretory duct and a reservoir for mature sperm.
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Seminal Vesicles
The seminal vesicles are a pair of saclike glands located between the bladder and
rectum. They produce 60% of the semen, which is secreted into the ejaculatory duct,
where it mixes with sperm, enhancing its motility.
Prostate Gland
The prostate gland borders the urethra near the lower part of the bladder and
produces milky, alkaline secretions that aid sperm transport.
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Bulbourethral Glands
The bulbourethral glands are located below the prostate within the urethral sphincter
and secrete a clear mucus just before ejaculation.

Penis
The penis is a cone-shaped organ located between the left and right groin areas. It is
filled with blood during sexual arousal and contracts and elongates to become firm
and erect so that it can deposit sperm into the female vagina.

Inguinal Areas
Inguinal hernias are caused by a separation of the abdominal muscles, and occur in
the inguinal canals, which are associated with the abdominal muscles.
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Perianal Area
The anus is the terminal end of the gastrointestinal system, and opens onto the
perineum at the midpoint of the gluteal folds. It has internal and external muscles,
and is moist, darkly pigmented, and hairless.
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Special Considerations
The nurse uses effective communication, critical thinking, the nursing process, and
appropriate assessment techniques to determine the patient's health status.

Health Promotion Considerations

Healthy People 2020 aims to improve reproductive health among individuals in the
United States by reducing the incidence and prevalence of sexually transmitted
diseases, and by preventing the development of acquired immunodeficiency
syndrome (AIDS) and HIV-related deaths.
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Infants and Children
The male newborn's genitals should be clearly evident and not ambiguous, and the
urethral meatus should be in the center of the glans. If the opening is on the
underside of the glans, hypospadias exists, and if the opening is on the superior
aspect of the glans, epispadias exists.
ALERT!
The male infant's scrotum should be consistent in color with other body parts and
seem oversized in comparison with the penis. The testes should be palpable and
about 2 cm (0.78 in.) in diameter at birth.
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Male children begin to develop adult sexual characteristics at 10 to 15 years of age,
and may experience unexpected erections and nocturnal emissions. Open,
supportive communication is essential at this time.
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Precocious puberty is an endocrine disorder characterized by the development of
adult male characteristics in males under age 10. It may be idiopathic or caused by a
genetic trait, lesions in the pituitary gland or hypothalamus, or testicular tumors.
Male children should be assessed for sexual molestation, infection, tumors, and
hernias. Adolescents may be concerned about or confused by an attraction to
individuals of the same sex, and should be counseled on relationship issues, birth
control, protection against sexually transmitted diseases, and delaying sexual
activity.
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The older male patient experiences changes to the external genitals, including pubic
hair thinning and graying, the prostate gland enlargement, the size of the penis and
testes diminishing, the scrotum hanging lower, and the testes being softer to
palpation. Sexual function and ability also change as well.
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Psychosocial Considerations
Fatigue, depression, stress, grief over the loss of a relationship, feelings of betrayal,
and past or recent trauma can all affect a patient's ability to enjoy a sexual
relationship.
Some males fear that their penis is too small to satisfy a female sexually. Caring and
sensitive teaching are needed to help them understand this.

Considerations
Religious and cultural beliefs may influence a patient's preference for a same-gender
examiner. The nurse should be careful to avoid making assumptions about the
patient's cultural background.
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Some cultures have specific beliefs or encourage specific behaviors related to
circumcision and sexual practices, such as testicular self-examination. Testicular
cancer is most common among White males.
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23.1 Testicular Self-Examination
In the shower or bath, feel each testicle by applying gentle pressure with your thumb,
index, and middle fingers. If your testicle hurts while you are feeling it, you are
pressing too hard.
Prostate cancer is most common in African American males and Carribean males of
African ancestry. The signs are not usually noticeable until the cancer is advanced.
Risk factors for prostate cancer include a family history of the disease and smoking.
Annual prostate examinations are recommended after the age of 50 for males who
are at average risk of developing the disease, and at age 45 for men who have a
first-degree relative diagnosed with prostate cancer.
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Family reactions to an individual's sexual orientation can have a negative impact on
an individual's ability to find and maintain a satisfying sexual relationship.
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Gathering the Data
Health assessment of the male reproductive system includes gathering subjective
and objective data. The nurse uses a variety of communication techniques to elicit
general and specific information about the patient's state of health or illness.
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Focused Interview
The focused interview for the male reproductive system involves observing the
patient and listening for cues related to the function of this body system. Open-ended
and closed questions are used to obtain information.
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Nurses need to understand their own feelings and comfort about sexuality to gather
data about the health status of the male patient.
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Analysis