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Bates Chapter 13 (Revised)- Male genitalia
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May be from psychogenic causes, especially if early morning erection is preserved; may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation, or diabetes
What are some common causes of erectile dysfunction?
medications, surgery, neurologic deficits or lack of androgen
What are some common causes of reduced or absent ejaculation?
gonorrhea, gonococcal urethritis
What is profuse yellow penile discharge suggestive of?
What is scanty white or clear penile discharge suggestive of?
What are rash, tenosynovitis, monoarticular arthritis, meningitis, but not always with urogenital symptoms suggestive of?
syphilitic chancre, herpes
What can cause ulcers on the penis?
What can cause warts on the penis?
mumps orchitis, scrotal edema, testicular cancer
What can cause swelling of the male genitalia?
testicular torsion, epididymitis, orchitis
What are some common causes of pain in the male genitalia?
gonorrhea, chlamydia, syphilis, herpes
What are some infections a/w oral-penile transmission?
symptomatic or asymptomatic proctitis
What condition may follow anal intercourse?
What is tight prepuce that cannot be retracted over the glans?
What is a tight prepuce that, once retracted, cannot be returned; edema ensues?
What is inflammation of the glans?
What is inflammation of the glans and prepuce?
lice (crabs) or sometimes scabies
What are pubic or genital excoriations suggestive of?
What is a congenital, ventral displacement of the meatus on the penis?
Gram stain and culture
What is the procedure for definitive diagnosis of gonorrhea?
urethral strictures, possibly carcinoma
What is induration along the ventral surface of the penis suggestive of?
periurethral inflammation secondary to a urethral stricture
What does tenderness in an indurated area along the ventral surface of the penis suggest?
rashes, epidermoid cysts, skin cancer (rarely seen)
What skin conditions should you inspect for on the posterior surface of the scrotum?
cryptorchidism (undescended testicle)
What does a poorly developed scrotum on one or both sides suggest?
indirect inguinal hernias, hydroceles, scrotal edema, testicular carcinoma (rarely)
What are some common causes of scrotal swelling?
acute epididymitis, acute orchitis, torsion of the spermatic cord, strangulated inguinal hernia
What conditions present with tender, painful scrotal swelling?
What should a painless nodule in the testis raise your index of suspicion for?
15-34 years old
What are the peak incidence years for testicular cancer?
What are multiple tortuous veins in the area of the spermatic cord, from the epididymis to the superficial inguinal ring, suggestive of?
hydrocele of the cord
What does a cystic structure in the spermatic cord suggest?
may feel thickened or beaded
What occurs to the vas deferens if it is chronically infected?
Swellings containing serous fluid that light up with red glow or transilluminate are suggestive of what condition?
normal testes, tumors, most hernias
Swellings containing blood or tissue that do not transilluminate include what conditions?
What does a bulge that appears with straining suggest?
direct inguinal hernia
What does a bulge near the external inguinal ring suggest?
indirect inguinal hernia
What does a bulge near the internal inguinal ring suggest?
If you detect a hernia of any type, what does this warrant?
If you detect a large scrotal mass that does not return to the abdomen when the patient is supine but you are able to get your fingers above the mass in the scrotum, what does this suggest?
If you detect a large scrotal mass and upon auscultation of the mass you hear bowel sounds, what does this suggest?
If you detect a large scrotal mass and upon auscultation of the mass you do not hear bowel sounds, what does this suggest?
When the contents of a hernia cannot be returned to the abdominal cavity, what is this condition?
When the blood supply to the entrapped contents of a hernia is compromised, what is this condition?
What should you suspect if a hernia is accompanied by tenderness, nausea, and vomiting?
What should you consider with a strangulated hernia?
genital warts (condylomata acuminata)
What is the following presentation suggestive of: single or multiple papules or plaques of variable shapes; may be round, acuminate (or pointed), or thin and slender; may be raised, flat, or cauliflowerlike (verrucous); can arise on penis, scrotum, groin, thighs, or anus; usually asymptomatic, occasionally cause itching and pain; may disappear without treatment?
Human papillomavirus (HPV), usually subtypes 6, 11
What is the causative organism of genital warts?
weeks to months after exposure
What is the incubation period for genital warts?
genital herpes simplex -- *need to distinguish from genital herpes zoster (usually in older pts with dermatomal distribution) and candidiasis
What is the following presentation suggestive of: small scattered or grouped vesicles, 1 to 3 mm in size, on glans or shaft of penis; appear as erosions if vesicular membrane breaks; primary episode may be asymptomatic; recurrence usually less painful, of shorter duration; a/w fever, malaise, headache, arthralgias; local pain and edema, lymphadenopathy?
herpes simplex virus 2 (90%)
What is the causative organism of genital herpes simplex?
2-7 days after exposure
What is the incubation period for genital herpes simplex?
primary syphilis -- *need to distinguish from genital herpes simplex, chancroid, granuloma inguinale from Klebsiella granulomatis (rare in the US)
What is the following presentation suggestive of: small red papule that becomes a chancre, or painless erosion, up to 2 cm in diameter; base of chancre is clean, red, smooth, and glistening; borders are raised and indurated; chancre heals within 3-8 weeks; may develop inguinal lymphadenopathy within 7 days; lymph nodes are rubbery, nontender, mobile?
Treponema pallidum, a spirochete
What is the causative organism of primary syphilis?
9-90 days after exposure
What is the incubation period of primary syphilis?
chancroid -- *need to distinguish from primary syphilis, genital herpes simplex, lymphomogranuloma venereum, granuloma inguinale from Klebsiella granulomatous (both rare in the US)
What is the following presentation suggestive of: red papule or pustule initially, then forms a painful deep ulcer with ragged nonindurated margins; contains necrotic exudate, has a friable base; painful inguinal adenopathy; supperative buboes in 25% of pts?
What is the following presentation suggestive of: a congenital displacement of the urethral meatus to the inferior surface of the penis; a groove extends from the actual urethral meatus to its normal location on the tip of the glans?
What is the following presentation suggestive of: pitting edema may make the scrotal skin taut; seen in heart failure or nephrotic syndrome?
What is the following presentation suggestive of: palpable, nontender, hard plaques are found just beneath the skin, usually along the dorsum of the penis; the pt complains of crooked, painful erections?
What is the following presentations suggestive of: a nontender, fluid-filled mass within the tunica vaginalis; it transilluminates, and the examining fingers can get above the mass within the scrotum?
carcinoma of the penis
What is the following presentation suggestive of: an indurated nodule or ulcer that is usually nontender; limited almost completely to men who are not circumcised, it may be masked by the prepuce; any persistent penile sore is suspicious?
What is the following presentation suggestive of: usually an indirect inguinal hernia, that comes through the external inguinal ring, so the examining fingers cannot get above it within the scrotum?
What is the following presentation suggestive of: the testis is atrophied and may lie in the inguinal canal or the abdomen, resulting in an unfilled scrotum; there is no palpable left/right testis or epididymis; markedly raises the risk for testicular cancer?
What is a condition that may result in small, firm testes?
cirrhosis, myotonic dystrophy, use of estrogens, hypopituitarism; may also follow orchitis
What are conditions that may cause small, soft testes suggesting atrophy?
What is the following presentation suggestive of: testis is acutely inflamed, painful, tender, and swollen; it may be difficult to distinguish from the epididymis; seen in mumps and other viral infections; usually unilateral?
tumor of the testis
What is the following condition suggestive of: usually appears initially with a painless nodule in the testis; as it progresses and spreads, it may seem to replace the entire organ; characteristically feels heavier than normal
spermatocele (contains sperm) or epididymal cyst (does not contain sperm) -- clinically indistinguishable
What is the following presentation suggestive of: a painless, moveable cystic mass just above the testis that transilluminates; +/- sperm-containing?
What is the following presentation suggestive of: acutely inflamed structure that is tender and swollen and may be difficult to distinguish from the testis; scrotum may be reddened and vas deferens inflamed; occurs chiefly in adults, most commonly with Chlamydia infection; coexisting UTI or prostatitis supports the diagnosis
What is the following presentation suggestive of: chronic inflammation of TB produces a firm enlargement of this structure, which is sometimes tender, with thickening or beading of the vas deferens?
varicocele of the spermatic cord
What is the following presentation suggestive of: varicose veins of this structure, usually found on the left; feels like a soft "bag of worms" separate from the testis, and slowly collapses when the scrotum is elevated in the supine pt; infertility may be a/w this?
torsion of the spermatic cord
What is the following presentation suggestive of: acutely painful, tender and swollen organ that is retracted upward in the scrotum; scrotum becomes red and edematous; no associated urinary infection; most common in adolescents; surgical emergency due to obstructed circulation?
indirect inguinal hernia
What is the following presentation suggestive of: all ages, most common type, seen in both sexes; often in children, may be in adults; point of origin above the internal inguinal ligament, near its midpoint (internal inguinal ring); often into the scrotum; comes down and touches the inguinal canal and touches the fingertip?
direct inguinal hernia
What is the following presentation suggestive of: less common type, usually seen in men over 40, rare in women; point of origin above the inguinal ligament, close to the pubic tubercle (near the external inguinal ring); rarely into the scrotum; bulges anteriorly and pushes the side of the finger forward?
What is the following presentation suggestive of: least common type, more common in women than men; point of origin below the inguinal ligament; appears more lateral than an inguinal hernia; can be hard to differentiate from lymph nodes; never into the scrotum; inguinal canal is empty?
Psychogenic causes such as depression, endocrine dysfunction, or side effects of medications
What are causes of lack of libido?
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