The male genitalia

Chapter 9 The male genitalia



SYMPTOMS OF GENITAL TRACT DISEASE



Urethral discharge


A discharge of smegma from a normal prepuce is very different from a discharge caused by urethritis. In urethritis, the patient may complain of urinary symptoms such as burning or stinging when passing urine. Ask about a recent episode of gastroenteritis, for urethritis may follow a few weeks later. Reiter’s syndrome is the most florid manifestation of this association and is characterised by a urethral discharge, balanitis, painful joints (arthritis and tendinitis) and bilateral conjunctivitis.




imageQuestions to ask: Urethral discharge



• Is there a possibility of recent exposure to a sexually transmitted disease?

• How long ago might you have had such a contact (incubation period)?

• Does your partner complain of a vaginal discharge?

• Have you experienced joint pains or gritty, red eyes?

• Have you recently suffered from gastroenteritis?


imageDifferential diagnosis: Urethral discharge



Physiological



• Sexual arousal


Pathological



• Gonococcal urethritis (incubation 2–6 days)

• Non-gonococcal urethritis

• Idiopathic non-specific urethritis

• Chlamydia trachomatis

• Trichomonas vaginalis

• Candida albicans

• Post urinary catheter

• Reiter’s syndrome (may follow gastroenteritis) includes arthritis and conjunctivitis


Genital ulcers


Enquire about possible contact with sexually transmitted disease or casual sexual encounters. Ask whether the ulcer is painful and try to assess a possible incubation period. Herpetic ulcers tend to recur and may be preceded by a prodrome of a prickly sensation or pain in the loins. Sexual transmission may affect the mouth or anus as well as the penis. Exotic ulcerating venereal infections occur in the tropics and it is important to obtain a history of foreign travel and possible sexual contact.



Testicular pain


Inflammation or trauma to the testes causes an intense visceral pain that may radiate towards the groin and abdomen. The pain may be accompanied by swelling and be aggravated by movement or even light palpation. Painless swelling of a testis should alert you to the possibility of a cystic lesion or malignancy.




imageDifferential diagnosis: Testicular pain



• Trauma

• Infection (mumps orchitis)

• Epididymitis

• Testicular torsion

• Torsion of epididymal cyst


Impotence


The term refers to a spectrum of sexual dysfunction ranging from loss of libido, failure to obtain or to maintain an erection, to inability to achieve orgasm. Impotence is often a manifestation of emotional disturbance. Take a careful drug and alcohol history; alcoholism is an important cause of impotence and many widely prescribed drugs are associated with impotence. An obvious association with organic disease may be apparent in patients presenting with concomitant cardiovascular, respiratory or neurological symptoms.



Infertility


Primary infertility refers to a failure to achieve conception, whereas secondary infertility refers to a difficulty or a failure to conceive, although there has been at least one successful conception in the past. Male infertility accounts for approximately one-third of childless relationships.




imageQuestions to ask: Infertility



• Have you or your partner ever conceived?

• Do you have difficulty obtaining or maintaining an erection?

• Do you ejaculate?

• Do you understand the timing of ovulation in your partner?

• Are you on any medication that may cause impotence or sperm malfunction (e.g. sulfasalazine)?

• Have you noticed any change in facial hair growth?

• Have you ever had cancer treatment?


EXAMINATION OF THE MALE GENITALIA


The genitalia are usually examined with the patient lying but remember that varicoceles and scrotal hernias may only be apparent when the patient stands.



GENERAL EXAMINATION


In testicular malfunction (hypogonadism), there may be loss of axillary hair, the pubic hair distribution may start to resemble the distinctive female pattern and there is a typical facial appearance with wrinkling around the mouth. You will have also checked the breast and noted whether or not gynaecomastia was evident.




image Differential diagnosis: Male gynaecomastia



Physiological



• Puberty

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Apr 20, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on The male genitalia

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