Male Health

Jarvis Chapter 23 & 26

S. Morrell 2023

1
Objectives
1. Review subjective/objective male assessment
2. Discuss development considerations
3. Discuss cultural and social concerns
4. Discuss screening
5. Discuss abnormal findings

2
The nurse is reviewing the importance of testicular self-
examination (TSE) with a 17-year-old male patient. Which of the
following statements by the patient confirms his understanding
of TSE?

A. “I will check my testicles for lumps when I’m 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.”

Copyright © 2019 Elsevier, Inc.

Soft, pointed, fleshy papules that occur on the genitalia caused by the
human papillomavirus (HPV) are known as:

A. chancres.
B. genital warts.
C. urethritis.
D. varicoceles.
_____________ is an emergency requiring
surgery.

A. A scrotal hernia
B. Epididymitis
C. Testicular torsion
D. Cryptorchidism
Subjective assessment

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Patient History

Surgeries - cryptorchidism (undescended testicle)/ fistulas

Injuries - trauma (testicular torsion)
Urinary - kidney disease, kidney stones, flank pain, UTIs, prostate trouble?
Genital - Testicular, prostate or penile cancer, Sexually transmitted infections
(STI’s)
Diabetes, Hypertension, Neurological impairment, respiratory conditions or
cardiovascular (increased risk for erectile dysfunction)
Family History

Cancer - testicular, prostate, colon, or penile cancer,

Infertility
Hernia
Inflammatory bowel disease
 Lifestyle behaviours-DADSPIES

• D diet - high fat/low fiber (prostate cancer), red/processed meat/ low fiber (colon cancer)
water
• A alcohol - colon ca
• D drugs-
• S smoking - colon cancer
• P physical exam - Fit screening, testicular exam, prostate
• I immunizations - Gardasil (HPV)
• E exercise - in active/obese (colon/prostate cancer)
• S stress/Sex – safe sex (condoms

pt
Questions about urine

• Urinating more often than usual?

• average adult- 5-6/day- varies with fluid intake
• Polyuria: excessive quantity
• Oliguria: diminished quantity <400 mL/24 hr.
• Feel as if you cannot wait?
• Urgency may be indicative of infection or obstruction.
• Awaken during the night to urinate?
• Nocturia -with frequency and urgency in urinary tract disorders
• other origins: cardiovascular, diabetes, habitual, diuretic medication.
• Pain or burning sensation with urinating?
• Dysuria- with acute cystitis, prostatitis, and urethritis.
bladder infection
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Questions about urine

• What colour is your urine

• Dark yellow, strong-smelling urine is a sign of dehydration
• Urine is cloudy in UTI
• Hematuria (blood in the urine)
• symptoms of cancer (bladder/ kidney)
• associated with disease, inflammation, infection, or trauma urinary tract

Colour change lasting more than 1 day, seek health care

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 12

Urine
UTIs
 Urine
colour

dehydrated: concentrated urine

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Incontinence

incontinence:

urine comes out unconsicously

true incontinence: loss of urinw without warning

urge incontinence; urine loss from overactive detrusor muscle in bladder

stress incontinence: loss of urine with physical strain, sneezyng, or coughing

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problem in bladder muscle; where they cannot hold
( frequent urination; leaking urine before you can make it to the bathroom)
Questions regarding penis

• Problem-pain, lesions
• Discharge
• how much
• increased or decreased since onset
• colour
• odour
• associated with pain or with urination

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Questions regarding sexual activity

• sexual activity in the last 6 months

• Do you have a regular sexual partner
• How many partners in the past 6 months
• Sexual preference: woman, man, both
• Do you use protection?
• Difficulty having an erection when aroused-medications/natural therapies for erectile
dysfunction
• Erectile dysfunction (ED)-inability to get and keep an erection firm enough for sex
• may be a warning sign of current or future heart disease or type 2 diabetes

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 • Change from preadolescent to adult take approx 3
years
• Beginning and end age ranges vary

Developmental
Considerations
Puberty
 changes with aging
• Thinner, greying pubic hair
• Penis size changes (smaller) (decreased
blood flow and testosterone)
• Prostate – enlarges (benign prostatic
hypertrophy (BPH))
• 10% of men by 40
Developmental • Lemon size by age 60
Considerations • risk of prostate cancer increases with age
• Relaxation of perianal musculature
Ageing & decreased sphincter control
• Sperm production decreases - 40 years
• Testosterone declines gradually after 55
years
• Slower and less intense sexual response but
no change with libido
 • Circumcision of male infants—religious and
cultural values
Cultural and • No medical indication for male neonatal
circumcision (Canadian Paediatric Society, 2002)
Social • Not covered by provincial health insurance
• Reduces infection by human
Considerations immunodeficiency virus (HIV), herpes
simplex virus type 2 (HSV-2), prevalence of
human papilloma virus (HPV); decreases risk
for sexually transmitted infections (STIs)
• Parental knowledge of care of uncircumcised
penis
Prevention

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 Human Papillomavirus (HPV)

HPV vaccine approved

for boys and men

(Public Health Agency

of Canada, 2011)

HPV: cervical cancer for female

Screening-
Testicular cancer

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 • Most common cancer in males 15 to 35 yrs
• Most diagnosed between 20 and 35 yrs
Testicular •
•
Most common in white males
Increased Risk
Cancer undescended testicle (Cryptorchidism)
family hx of testicular cancer
personal hx of testicular cancer
non link with vasectomy, injury; or diet

• Finding early-knowing your testicles

https://cancer.ca/en/cancer-information/cancer-types/testicular/risks
 • May not see symptoms in early stages
• Signs appear as tumour grow
- painless lump in the testicle
Testicular - swelling so the testicle is larger than usual
- pain or dull ache in the testicle or scrotum

Cancer:
appear once tumour causes bleeding or blocks the bowel
- feeling of heaviness in the scrotum or abdomen
- buildup of fluid in the scrotum
- pain in the back or abdomen
symptoms
change in bowel habits: diarrhea or constipation
general abdominal discomort: bloating, sensation of fullness, cramps
body stools: =

• Other symptoms https://cancer.ca/en/cancer-

information/cancer-types/testicular/signs-and-
symptoms
when pts present with testicular complaints:

• Any problem with the scrotum or testicles?

• Do you perform testicular self-examination
(TSE)?
• Have you noticed any lump/swelling/mass on
Scrotum:
your testes? Testicular
• Have you noted any change in size of the
scrotum? questions
• Have you noted any bulge or swelling in the
scrotum?

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purpose: 14 yrs and over to be fmailiar with what is usual for them

know your testicles

T: timing; S: shower; E examination

• Purpose- by performing monthly self-

examinations, men older than 14 years become
familiar with what is usual for them Testicular
• T = Timing; S = Shower; E = Examination Self-
• Once this baseline is established, changes are
easier to identify Examination

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• Egg-shaped and movable
• Rubbery with smooth surface (peeled hard-
boiled egg) Testicular
• Compare two sides-note any differences
(normal for one testicle to be larger) Self-
• Epididymis- tube on top & behind testicle (soft
cord or small bump)
Examination

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 • after a warm shower or bath (relaxes and distends)
• Examine each testicle one at a time-roll the testicle gently from side
to side
• Cancerous lumps usually on the sides of the testicle but can
show up on the front

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findings:
- egg-shaped and movable
- rubbery with smooth surface (peeled ) hard-boiled egg
- compare two side-note any differences ( normal for one testicle to be larger )
epididymis: tube on top and behind testicle ( soft cord or small bump)
 Objective
examination:
Variations
 hypospadias
• Urethral meatus opens on the
ventral aspect (underside) of
glans or shaft or at the
penoscrotal junction
Epispadias
• Meatus opens on the dorsal
(upper) side of glans or shaft
(less common)
Circumcision

• Uncircumcised - Ask him to retract the

prepuce. Should retract easily
• Smegma (a thin, white, cheesy substance)
may be present around the corona

• Circumcised penis - the glans and corona

are visible, lighter in colour than the shaft,
and free of smegma.

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Abnormal
findings
 foreskin swelling:

Phimosis & Paraphimosis pull back the skin and clean

Genital Herpes: HSV-2 Infection
can transfer from oral sex

• Clusters of small vesicles

• surrounding erythema
• often painful
• erupt on the glans or foreskin
• rupture to form superficial ulcers
• initial manifestation lasts 7–10 days
• virus remains dormant indefinitely
• recurrent manifestations last 3–10
days -milder symptoms.
Syphilitic Chancre

• 2–4 weeks after infection

• small, solitary, silvery papule
• erodes to a red, round or oval, superficial
ulcer with a yellowish serous discharge
• nontender, indurated base that can be
lifted like a button between thumb and
finger
• Lymph nodes enlarge early nontender
• treated with penicillin G
• untreated, leads to cardiac problems,
neurological problems, and blindness
Genital Warts

• Soft, pointed, moist, fleshy, painless papules

• single or multiple- cauliflowerlike patch
• may be grey, pale yellow, or pink in Euro-
Canadian men
• black or translucent grey-black in men of
African descent
• occur on the shaft of the penis, behind the
corona, or around the anus
• caused by the human papillomavirus (HPV)
• HPV infection is correlated early onset of
sexual activity, infrequent use of
contraception, multiple sexual partners
Carcinoma

• red, raised warty growth or as

an ulcer, with watery discharge
• As it grows, it may necrose and
slough
• usually painless
• on glans, inner lip of the
foreskin and after chronic
inflammation
• enlarged lymph nodes
Testicular Torsion
 often due to STIs

Epididymitis

elevated.
Testicular Torsion Epididymitis
Pain is excruciating in testicle Pain is gradual
Nausea & vomiting in 50% of Nausea & vomiting rare
patients
Fever is rare Fever in 50% of patients
Voiding symptoms, urethral Voiding symptoms, urethral irritation,
irritation, urethral discharge rare urethral discharge in 50% patients
appear once tumour causes bleeding or blocks the bowel
change in bowel habits: diarrhea or constipation
general abdominal discomort: bloating, sensation of fullness, cramps
0-30% have altered urinalysis
body stoolright
Urinalysis diagnostic in 20-95% patients
results
Elevation of affected testicle does Elevation of affected testicle usually
not lessen pain lessons pain

Surgical intervention immediately Antibiotic therapy indicated

required
Varicocele
Hydrocele
• Inspect the inguinal region for a bulge as the
patient stands and as the patient strains down
• Normally, none is present Hernia
• A hernia may be present but should be easily
reduced
Structures of the Inguinal Area
Indirect Inguinal hernia
Direct Inguinal hernia
Femoral hernia

why do we care about hernia?

- bowel
abdominal pain (bump)
-
 Anus Rectum
Subjective Assessment
and Prostate
appear once tumour causes bleeding or blocks the bowel
change in bowel habits: diarrhea or constipation
general abdominal discomort: bloating, sensation of fullness, cramps
body stools:
Questions about bowel habits-bleeding

See Abdominal PPTS week 8

Rectal bleeding/blood in the stool
• How long,
• How much blood: spotting on the toilet paper or outright passing of blood with the stool
• What is the colour
• Black - tarry as a result of occult blood (melena) or nontarry as a result of ingestion of iron medications
• Red - GI bleeding/localized bleeding around the anus/colon or rectal cancer
• Clay-coloured stool- absence of bile
• Mucus or pus in stool - infection, inflammatory bowel disease, or cancer
• Frothy - (Steatorrhea)excessive fat in the stool- malabsorption of fat
• Do you need to pass gas frequently-food or intestinal conditions (ie; IBS, Crohns, colitis)

appear once tumour causes bleeding or blocks the bowel

change in bowel habits: diarrhea or constipation
general abdominal discomort: bloating, sensation of fullness, cramps
body stools: bright
Questions about prostate

• Trouble starting the urine stream

• Strain to start/maintain the stream
• Change in force of stream- narrowing/weaker
• Dribbling?
• Afterwards, do you still feel you need to urinate
• Urinary tract infections (UTIs)
All of above suggest prostate obstruction

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Prostate

• 2.5 cm long by 4 cm wide; should not

protrude more than 1 cm into the
rectum
• Shape: heart shape, with palpable
central groove
• Surface: smooth
• Consistency: elastic, rubbery
• Mobility: slightly movable
• Sensitivity: nontender to palpation
 Benign Prostatic Hypertrophy
• S: Urinary frequency, urgency,
hesitancy, straining to urinate, weak
stream, intermittent stream,
sensation of incomplete emptying,
nocturia.
• O: symmetrical, nontender
enlargement-occurs in middle age
• surface feels smooth, rubbery, or
firm (like the consistency of the
nose)
• median sulcus obliterated
Prostatitis
• S: Fever, chills, malaise, urinary
frequency and urgency, dysuria,
urethral discharge; dull, aching
pain in perineal and rectal area

• O: Acute inflammation: extremely

tender, slightly asymmetric,
swollen gland
• Chronic inflammation: vary from
tender enlargement & boggy
texture-to isolated firm areas -or
the gland may feel normal
 Prostate carcinoma
S: Frequency, nocturia, hematuria, weak
stream, hesitancy, pain or burning
sensation on urination, continuous pain in
lower back, pelvis, thighs.

O: A malignant neoplasm - starts as a single

hard nodule on the posterior surface (see
diagram A)
producing asymmetry and a change in
consistency
multiple hard nodules appear, or the entire
gland feels stone hard and fixed (see
diagram B)
median sulcus obliterated.
 Rectum & Anus
Rectum
• 12 cm long
• distal portion of the large intestine
• sigmoid colon (third sacral vertebra) to
anal canal
• above the anal canal, the rectum dilates
and turns posteriorly
anal canal
• outlet of the gastro-intestinal tract
• 3.8 cm long in adults
• lined with modified skin (which has no
hair or sebaceous glands)
• merges with rectal mucosa at the
anorectal junction
• canal slants forward toward the umbilicus
Fissure
• painful longitudinal tear in
the superficial mucosa at the
anal margin
• (>90%) occur in the posterior
midline area
• Fissures often result from
trauma: for example, from
passing a large, hard stool or
from irritant diarrheal stools.
• itching, bleeding, and pain
Hemorrhoids
• varicose vein
• external hemorrhoid- below anorectal
junction
• Thrombosed - contains clotted blood and
becomes a painful, swollen, shiny blue
mass that itches and bleeds with
defecation
• internal hemorrhoid - above the
anorectal junction
• Hemorrhoids result from increased portal
venous pressure- straining at stool,
chronic constipation, pregnancy, obesity,
chronic liver disease, low-fibre diet
 Screening
Cancer care Ontario
guidelines
appear once tumour causes bleeding or blocks the bowel
change in bowel habits: diarrhea or constipation
general abdominal discomort: bloating, sensation of fullness, cramps
body stools:eright
 Colon Cancer
• fecal immunochemical test (FIT)
Average risk
• 50 to 74 years old with no first-degree relative (parent,
brother, sister or child)
• Age 50- FIT every 2 years
Increased risk
• Family history of colorectal cancer - 1 or more first-
degree relatives (parent, brother, sister or child)
• Age 50 or 10 yrs before relative diagnosed- relative before
60- Colonoscopy every 5 years
• Age 50 or 10 yrs before relative diagnosed- relative after
60 years- Colonoscopy every 10 years

https://www.cancercareontario.ca/en/types-of-cancer/colorectal/screening
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Colorectal Cancer- Symptoms

- appear once tumour causes bleeding or blocks the bowel

- change in bowel habits: diarrhea or constipation
- general abdominal discomort: bloating, sensation of fullness, cramps

- bloody stools: bright red or very dark

- stools that are narrower than usual
- a strong urge to defecate
- feeling that the bowel has not completely emptied
- nausea and vomiting
- fatigue
- weight loss
Colorectal cancer-lower risks

• Limit alcohol - 2 standard drinks

• Smoking
• Limit red/processed mead
• Eat high fibre diet
• Health weight
• Stay active
Prostate- screening

• Cancer Care Ontario does not support an organized, population-based screening program for
prostate cancer
Diagnosis
• do a digital rectal exam (DRE) to check the size and shape of the prostate and feel for any
lumps or abnormal areas
• Prostate-specific antigen (PSA) test
• Transrectal ultrasound (TRUS) /biopsy

• Read more: http://www.cancer.ca/en/cancer-information/cancer-

type/prostate/diagnosis/?region=on#ixzz6GLTHMraD
Prostate- risk

Lower your Risk

• Your risk increases after age 50 and peaks around 70 to 74.
• Your risk decreases slightly after age 75, but still remains high
• Your risk is higher if you have a father or brother who had prostate cancer.
• Prostate cancer rates are highest in African men and lowest in Asian men.