Male Reproductive Disorders & STD’s

1. Male Reproductive Disorders& STD’s Chapters 39, 41 & 42 By Angie Lawson RN, BSN

2. Male A&P Review • External Structures • Penis • Scrotum • Internal Structures • Testes • Epididymidis • Vas deferens • Seminal vesicles • Prostate gland • Bulbourethral glands

3. Assessment • History • Risk for STD’s • Contraceptive use • Ability to achieve & sustain an erection • Pain during intercourse • Premature ejaculation • Infertility • Prior surgeries or treatments

4. Assessment cont: • Physical Examination • Transillumination • Testicular self – exam • Breast self -exam • Diagnostic Tests • Ultrasound • Cystourethroscopy • Fertility tests

5. Prostatitis • Inflammation of the prostate gland • Pain/discomfort • Low back pain • Fever • Chills • Dysuria • Urethral discharge

6. Benign Prostatic Hyperplasia • An increased number of noncancerous cells in the prostate bland • Symptom onset is gradual • Inability to void • Medications & Treatments • TURP • Terazosin (Hytrin) • Finasteride (Proscar)

7. Prostate Cancer • Prostatic cancer grows slowly and has a high survival rate if detected early. • No symptoms at first, later – urinary frequency, nocturia and dysuria

8. Penile Disorders • Peyronies’s Disease • Priapism • Phimosis & Paraphimosis

9. Priapism • Persistent Engorgement of the penis without sexual stimulation • Causes – drug side effects or vascular problem

10. Pain with erection and intercourse Unable to retract the foreskin Painful swelling of the glans, severe edema and urinary retention. Strangulation of the glans penis by the foreskin Phimosis Paraphimosis

11. Penile Cancer • Rare, possibly cause by chronic skin irritations • Lesion on the penis, that may become infected over time.

12. Testicular Disorders • Cryptorchidism • Hydrocele • Varicocele

13. Cryptorchidism • No signs and symptoms noted • Scrotum feels empty

14. Hydrocele, Spermatocele & Varicocele • All present as swelling of the scrotum • Hydrocele • fluid around testicles-no teatment • Spermatocele • cystic mass on epididymis - no teatment • Varicoceles • dilated veins – untreated causes infertility

15. Epididymitis Orchitis • Inflammation of the epididymis • Pain, swelling, fever, chills, scrotal skin red and tense • Inflammation of the testis

16. Testicle Cancer • Cancer in the testicle, that is a highly metastasizing cancer • Swelling of the scrotum, a noticeable lump, abdominal pain, weakness & aching in the testes.

17. Sexual Functioning • Vasectomy • Erectile dysfunction • Impotence • Inability to achieve or maintain an erection • Causes – aging, testosterone insufficiency, drug side effects, atherosclerosis, hypertension, diabetes, anxiety or depression • Infertility

18. Vasectomy • Done in a Dr. Office, ligation of the vas deferens • Vasovasostomy – a surgical attempt to reverse a vasectomy

19. Sexually Transmitted Diseases(STD’s)

20. Common STD’s • Chlamydia • Gonorrhea • Herpes Infection • Venereal Warts

21. Chlamydia • Most common, fastest spreading, caused by chlamydia trachomatis • Most are asymptomatic, if they occur, clear urethral discharge, redness, irritation, dysuria, lower abd pain, or testicular pain

22. Gonorrhea • High incidence in 15-24 yr olds, caused by Neisseria Gonorrhoeae • Many women are asymptomatic, but may have white/yellow discharge, cervicitis, dysuria, men have urethritis

23. Syphilis • Curable, transmitted from blood, caused by the spirochete, Treponema pallidum • Early-painless papule, later-papule ulcerates, fever, malaise, rash, headache, sore throat, lymph node enlargement

24. Trichomonas • May also be transmitted through nonsexual contact • Redness, swelling, itching, and burning

25. Herpes Infection • Highly contagious, not curable, caused by herpes simplex virus type 2 • Vesicles on the penis, prepuce, buttocks, thighs, introitus, or cervix, burning itching, ulcerations, flu symptoms, headache

26. Genital Warts • Called condylomas, reoccuring, more susceptible in immunodeficient people • Painless, single or in a cluster, soft, fleshy growths, turn white when vinegar is applied

27. Hepatitis B • Early signs - loss of appetite, rashes, malaise, pain, headaches, nausea, vomiting • Hepatitis B & liver cancer • Late signs – dark urine, light stool, jaundice, spleen enlargement, liver tenderness cirrhosis, coma, death

28. Genital Parasites • Not a true STD, but can be transmitted through close body contact • Lice Scabies

29. Pharmacology • Penecillin • Uses : syphilis, gonorrhea • Adverse reactions: glossitis, stomatitis, gastritis, furry tongue, nausea & vomiting • Norfloxacin • Uses: uncomplicated gonorrhea, prostatitis • Adverse reactions: diarrhea, headache, abdominal discomfort, superinfections

30. Pharmacology Cont: • Metronidazole (flagyl) • Uses – trichomonas • Adverse reactions- nausea, anorexia, seizures, numbness • Spectinomycin (trobicin) • Uses – gonorrhea • Adverse reacions – soreness at inj. site. urticaria, sudden decrease in blood pressure.

31. Pharmacology Cont: • Acyclovir (Zovirax) • Uses: herpes simplex, herpes zoster • Adverse Reactions: N & V, diarrhea, headache, dizziness, lethargy, rashes • Docosanol (Abreva) • Uses: HSV types 1&2 • Adverse reactions: headache, skin rash

32. Pharmacology Cont: • Imiquimod – • Uses: external genitalia and perianal warts • Adverse reactions: local skin irritations, itching, excoriation • Indinavir • Uses: HIV infections • Adverse reactions: headache, N&V, diarrhea, cough, dysuria, acne

33. Pharmacology Cont: • Valacyclovir (valtrex) • Uses: HSV type 2: herpes zoster • Adverse reactions: N&V, headache, dizziness, anorexia, diarrhea • Zidovudine AZT (retrovir) • Uses: HIV infection • Adverse reactions: asthenia, malaise, weakness, headache, anorexia, diarrhea, N&V, dizziness, insomnia, anemia, agranulocytosis

34. Pharmacology Cont: • Fluconazole (diflucan) • Uses: vaginal candidiasis • Adverse reactions: headache, N&V, diarrhea, skin rash • Ibuprofen (motrin, advil) • Uses: painful dysmenorrhea • Adverse reactions: nausea, dizziness, dyspepsia, gastric/duodenal ulcer formation, GI bleeding, headache

35. Pharmacology Cont: • Naproxen (aleve, anaprox) • Uses: dysmenorrhea • Adverse reactions: dizziness, visual disturbances, headache, N&V, gastric/duodenal ulcers • Rofecoxib (vioxx) • Uses: primary dysmenorrhea • Adverse reactions: headache, dizziness, insomnia, rash, dyspepsia, fatigue

36. Pharmacology Cont: • Urofollitropin (Fertinex) • Uses: induction of ovulation • Adverse reactions: ovarian enlargement, N&V, breast tenderness, ectopic pregnancy, abdominal discomfort • Methyltestosterone (Android) • Uses: hypogonadism, impotence, postpubertal cryptochidism, female breast cancer • Adverse reactions: gynecomastia, testicular atrophy, impotence, enlargement of penis, nausea, male pattern baldness, amenorrhea

37. Pharmacology Cont: • Finasteride (Proscar) • Uses: BPH, prevention of male pattern baldness • Adverse reactions: impotence, decreased libido, decreased volume of ejaculate • Conjugated estrogens (Premarin) • Uses: problems assoc. with menopause • Adverse reactions: headache, migraine, dizziness, depression, insomnia, cramps, spotting, edema, breast pain, HTN, gallbladder disease

38. Pharmacology Cont: • Medroxyprogesterone (Provera) • Uses: amenorrhea, endometrial hypoplasia • Adverse reactions: spotting, amenorrhea, breast tenderness, weight gain, depression • Estrogens & Progestins Combo (Prempro) • Uses: treament of moderate to severe symptoms of menopause • Adverse reactions: same as premarin and provera

39. Pharmacology Cont: • Contraceptives (oral) • Ortho novum’s, Desogen, Triphasil, Ortho Tri-Cyclen, • Contraceptives (implantable and injectable • Norplant – surgical incision with implantation of 6 hormone capsules • Depo-provera – given IM every 3 months • Ortho evra - patch applied each week times 3 then off for 1 week.

40. Pharmacology Cont: • Hepatitis B Vaccine (Engerix – B) • Uses: immunity against hepatitis b infections • Adverse reactions: headache, vertigo, dizziness, paresthesia, insomnia, pruritus, nausea, dyspepsia, diarrhea, local pain at site, flu like symptoms, fatigue and earache