Start with a permission statement. “Often boys your age experience…”
Try the ubiquity approach, “When did you…” rather than “Do you…”
Sometimes all you do is “open the door” to later conversation
Additional Hx for preadolexcents and adolescents
Around age 12 to 13 years…
Who can you talk to…
Boys around age 12 to 13 years have a normal experience…
Teenage boys have other normal experiences and wonder if they are the only ones who ever had them…
Often boys your age have questions about sexual activity.…
Has a nurse or doctor ever taught you…
Has anyone ever touched your genitals…
Objective data during PE male reproductive organ
Penis – Inspect and Palpate
phimosis--unable to retract foreskin
paraphimosis--retracted foreskin which is unable to return over head of penis.
Epispadias--meatus is on dorsal side
Hypospadias--meatus is on ventral side. Needs surgery to correct or poor dude will be peeing in his own face.
Shaft of penis (should not hurt)
Sometimes men will have an errection. What then?
Apprehension regarding exam, feeling uncomfortable, developmental level of patient, adolescents. Just reassure that it's normal and move on.
Glass slide for urethral specimen
Materials for cytology, flashlight (can transiluminate)
More objective findings of the male reproductive organ during PE
Scrotum – Inspect and Palpate
Any mass: note location, size, tenderness, mobility, texture
how do you Teach testicular self exam?
T = Timing (pick a date and stick to it each month)
S = Shower (easy, convenient time to do it)
E = Examination points (See lovely diagram above. Don't forget posterior)
Understanding your prostate
Discussion of prostate health and examination of prostate gland is a unique aspect of male health assessment
Prostate cancer typically detected by testing blood for prostate-specific antigen (PSA) and/or on digital rectal examination (DRE). Needs to be done during the correct age/developemental stage (until after age 50) and needs to be pair with a digital rectal exam (start at age 40). Blood must be drawn before exam. If done afterward blood levels will be artificially elevated.
Saw Palmetto supplement can help increase protate health.
Male genital lesions
Genital herpes, HSV-2 Infection
Genital warts, HPV (16-18 would not be visible to naked eye. Will not generally display symptoms with 16-18 until cancer. GET IMMUNIZATION!)
Urinary problems with men
Urethritis (Urethral discharge and Dysuria)
Renal calculi (kidney stones): Terrible flank (low back) pain. Do not do CVA tenderness. Dehydration is #1 contributing factor.
Acute urinary retention due to renal calculi, enlarged prostate.
Urethral stricture: scarring, stone, in urethra causing blockage.
Testicular torsion: twisting. Hurst a lot. Often requires surgery.
Varicocele: vericose veins of spermatic cord.
Spermatocele: retension cyst in epidimis found higher up in the scrotum.
Early testicular tumor
Hydrocele: Cystic mass in scrotum. Transilluminates.
Scrotal hernia: Due to indirect inguinal hernia that has extended down into scrotum.
Orchitis: Enlarged, swollen testies.
What is Priopism?
SE of ED drugs. Englarged glands. Will need to puncture to release some blood.
Abnormal Testicular findings.
Identify hydrocele, orchitis, scrotal edema and scrotal hernia
Types of hernias...
Femoral: because of femoral artery, when repaired can only sew one side.