male reproductive system assessment
male reproductive system assessment
an evaluation of the condition of the patient's genitalia, reproductive history, and past and present genitourinary infections and disorders.
method In a relaxed professional interview the procedures to be conducted are explained and the patient is reassured that his privacy will be scrupulously maintained. He is questioned about his offspring; sexual activity; the existence of nocturia, urgency, frequency, dysuria, urethral discharge, hernia, or genital sores; discomfort or pain in the groin, lower back, or legs; and past treatment for epididymitis, gonorrhea, herpes genitalis, hydrocele, nonspecific urethritis, orchitis, prostatitis, syphilis, and varicocele. The examiner, while inspecting the genitalia, observes universal precautions as indicated by the condition. The penis is examined for swelling, inflammation, and lesions such as herpes vesicles or syphilitic sores, chancres, or scars. Anomalies that may be noted include hypospadias or epispadias, resulting from failed closure of the urethra; elongation of the foreskin constricting the urinary meatus; or swelling of the glans caused by a retracted, tight foreskin. The urethral orifice is inspected for a purulent or bloody discharge, and the scrotum is observed for symmetry and shape; in elderly or debilitated men the scrotum may be elongated and flat. The normally smooth testes, epididymis, and spermatic cords are palpated for the presence of beading and varicosities and the size, location, and consistency of any scrotal mass. Fluid felt around the testes may be seen by darkening the room and illuminating the scrotum with a flashlight. Wrapping the flashlight with clear plastic wrap, which is changed between patients, decreases the risk of bacteria transfer. The patient is asked to cough or bear down to reveal a hernia, and the abdomen is palpated above the symphysis pubis to determine whether the bladder is distended. The inguinal lymph nodes are palpated, and the amount and distribution of pubic hair are observed. The prostate may be examined with the patient in the Sims' knee-chest position or lithotomy position, but, when possible, the patient should stand bent at a right angle over a table as the examiner's well-lubricated gloved forefinger sweeps the rectal circumference and palpates the lobes and medial sulcus of the gland. The size, consistency, and any localized nodule suggesting a neoplasm of the normally smooth, firm prostate are carefully noted, and the findings are recorded as on a clock dial with the symphysis pubis representing 12 o'clock. When additional studies are indicated, a smear is prepared from the first urine voided after massage of the prostate. Primary screening for prostatic cancer includes the digital rectal examination and a blood test for PSA. Prostatic acid phosphatase is also assessed if prostatic cancer is suspected. Diagnosis is usually established by a biopsy. The assessment includes laboratory studies of any discharge from the penis. A Gram-stained smear usually confirms or rules out a diagnosis of gonorrhea. A fluorescent-tagged antibody method may be required if the result is equivocal. Cultures may be needed to determine whether nonspecific urethritis is caused by Escherichia coli, Pseudomonas, Staphylococcus, Streptococcus, or organisms of other pathogenic genera. Syphilis may be diagnosed by the Venereal Disease Research Laboratories serological test, but the fluorescent treponemal antibody-absorption test is the most sensitive and specific diagnostic measure. If infertility is a problem, examinations of multiple semen samples are conducted. Each specimen collected after 3 days of abstinence is inspected in the laboratory to determine whether the volume of the ejaculate approximates the normal 2 to 5 mL average and whether the semen has a pH of 7.7 and a sperm count of 60 to 150 million per milliliter.
interventions The health care provider conducts the interview and examination, assembles the results of laboratory studies, and urges the patient to inform his sex partner, or partners, if an infectious disease is diagnosed. Throughout the assessment the health care provider recognizes that the patient may be reluctant to discuss his symptoms and activities and may be sensitive about the necessary procedures.
outcome criteria A careful, understanding evaluation of the male patient's reproductive system helps to establish the diagnosis and plan the treatment and aids in allaying the patient's anxiety. The assessment also serves as a public health measure by encouraging the reporting of a sexually transmitted disease to the patient's contacts and proper authorities.