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The man with heart disease who hoped to see his son graduate, but didnt live long enough to do so. The prevalence of current cigarette smoking among adults has declined from 42% in 1965 to 18% in 2012. Tobacco has killed more than 20 million people prematurely since the frst Surgeon Generals report in 1964. The fndings in this report show that the decline in the prevalence of smoking has slowed in recent years and that burden of smoking- attributable mortality is expected to remain at high and unacceptable levels for decades to come unless urgent action is taken. Recent surveys monitoring trends in tobacco use indicate that more people are using multiple tobacco products, particularly youth and young adults. We need to monitor patterns of use of an increasingly wide array of tobacco products across all of the diverse seg- ments of our society, particularly because the tobacco industry continues to introduce and market new products that establish and maintain nicotine addiction. Tobacco control efforts need to not only address the general population, but also to focus on populations with a higher prevalence of tobacco use and lower rates of quitting. These populations include people from some racial/ethnic minority groups, people with mental illness, lower educational levels and socioeconomic status, and certain regions of the country. We now have proven interventions and policies to reduce tobacco initiation and use among youth and adults. With intense use of proven interventions, we can save lives and reduce health care costs. It pulled back the curtain in a way that numbers alone cannot, and showed the tobacco-caused tragedies that we as health care professionals see and are saddened by every day. Addition- ally, millions of nonsmokers talked with friends and family about the dangers of smoking and referred smokers to quit services. Most Americans who have ever smoked have already quit, and most smokers who still smoke want to quit. If we continue to implement tobacco prevention and cessation strategies that have proven effective in reducing tobacco use, people throughout our country will live longer, healthier, more productive lives. Director Centers for Disease Control and Prevention ii Preface from the Acting Surgeon General, U. That report marked a major step to reduce the adverse impact of tobacco use on health worldwide. Over the past 50 years, 31 Surgeon Generals reports have utilized the best available evidence to expand our understanding of the health consequences of smoking and involuntary exposure to tobacco smoke. The conclusions from these reports have evolved from a few causal associations in 1964 to a robust body of evidence documenting the health consequences from both active smoking and exposure to secondhand smoke across a range of diseases and organ systems. The 2004 report concluded that smoking affects nearly every organ of the body, and the evidence in this report provides even more support for that fnding. A half century after the release of the frst report, we continue to add to the long list of diseases caused by tobacco use and exposure to tobacco smoke. This report fnds that active smoking is now causally associated with age-related macular degeneration, diabetes, colorectal cancer, liver cancer, adverse health outcomes in cancer patients and survivors, tuberculosis, erectile dysfunction, orofacial clefts in infants, ectopic pregnancy, rheumatoid arthritis, infammation, and impaired immune function. In addition, exposure to secondhand smoke has now been causally associated with an increased risk for stroke. Smoking remains the leading preventable cause of premature disease and death in the United States. The science contained in this and prior Surgeon Generals reports provide all the information we need to save future generations from the burden of premature disease caused by tobacco use. How- ever, evidence-based interventions that encourage quitting and prevent youth smoking continue to be underutilized. At the same time, we will explore end game strategies that support the goal of eliminating tobacco smoking, including greater restrictions on sales. It is my sincere hope that 50 years from now we wont need another Surgeon Generals report on smoking and health, because tobacco-related disease and death will be a thing of the past. Department of Health and Human Services iii the Health Consequences of Smoking50 Years of Progress Overview For the United States, the epidemic of smoking- other conditions caused by parental smoking, particularly caused disease in the twentieth century ranks among the smoking by the mother. More than ever, the current rate of progress in tobacco control is not 10 times as many U. Study after study attributable disease and death, and the associated costs, has confrmed the magnitude of the harm caused to the will persist for decades without changes in our approach human body by exposure to toxicants and carcinogens to slowing and even ending the epidemic. Since 1964, the 31 previous Sur- persists at the current rate among young adults in this geon Generals reports have chronicled a still growing country, 5. Health statistics show that all populations More than 20 million Americans have died as a are affected. Most were adults with a history of smoking, neered, addictive, and deadly products containing thou- but nearly 2. Although the prevalence of smoking has declined signifcantly over the past one-half century, the risks for smoking-related disease and mortality have not. The new evi- Residential fres 86,000 dence in this report provides still more support for these Lung cancers caused by exposure to 263,000 conclusions. Fifty years after the frst report in 1964, it is secondhand smoke striking that the scientifc evidence in this report expands the list of diseases and other adverse health effects caused Coronary heart disease caused by exposure to 2,194,000 secondhand smoke by smoking and exposure of nonsmokers to tobacco smoke. These new fndings include: Center for Chronic Disease Prevention and Health Promotion, Offce on Smoking and Health, unpublished data. Nonetheless, between 20052009, smoking was Smoking causes general adverse effects on the body responsible for more than 480,000 premature deaths including infammation and it impairs immune annually among Americans 35 years of age and older function. Additionally, if cur- the 50 years since the 1964 report, approaches have moved rent trends continue 5. Note: the condition in red is a new disease that has been causally linked to smoking in this report. Many of the fndings in this report have particular This comprehensive report chronicles the dev- relevance to women who are current smokers. For the astating consequences of 50 years of tobacco use in the frst time ever, they are as likely as men to die from many United States. The relative risk effects resulting from smoking and exposure to second- for dying from coronary heart disease among women 35 hand smoke, and details public health trends, both favor- years of age and older is now higher than for men. This report marks the risks for women have increased so much in the last the steady progress achieved in reducing the prevalence of decades, women who smoke now have about the same smoking and validates tobacco control strategies that have high risk of death from lung cancer as men. It also examines strate- In addition to the impact that smoking has on health gies with the potential to eradicate the death and disease and well-being, the nation pays enormous fnancial costs caused by the tobacco epidemic at long last, and identi- because of smoking. Productivity losses from premature fes specifc measures that should be taken immediately to death alone now exceed $150 billion per year (Chapter 12). The annual costs ments that effective interventions are available and calls of direct medical care of adults attributable to smoking are for their full implementation. Executive Summary 3 Surgeon Generals Report Major Conclusions from the Report 1. In addition to causing multiple diseases, cigarette caused an enormous avoidable public health tragedy. The tobacco epidemic was initiated and has been cantly since 1964, very large disparities in tobacco use sustained by the aggressive strategies of the tobacco remain across groups defned by race, ethnicity, edu- industry, which has deliberately misled the public on cational level, and socioeconomic status and across the risks of smoking cigarettes. Since the 1964 Surgeon Generals report, compre- smoking has been causally linked to diseases of nearly hensive tobacco control programs and policies have all organs of the body, to diminished health status, been proven effective for controlling tobacco use. Even 50 years after the Further gains can be made with the full, forceful, and frst Surgeon Generals report, research continues to sustained use of these measures. The burden of death and disease from tobacco use in toid arthritis, and colorectal cancer. Exposure to secondhand tobacco smoke has been elimination of their use will dramatically reduce this causally linked to cancer, respiratory, and cardiovas- burden. For 50 years the Surgeon Generals reports on smok- ing and health have provided a critical scientifc foun- 5. The disease risks from smoking by women have risen dation for public health action directed at reducing sharply over the last 50 years and are now equal to tobacco use and preventing tobacco-related disease those for men for lung cancer, chronic obstructive and premature death. The 2014 Surgeon Generals report is presented in three sections: Section 1: Historical Perspective, Overview, and Conclusions; Section 2: the Health Consequences of Active and Passive Smoking: the Evidence in 2014; and Section 3: Tracking and Ending the Epidemic. In fact, rates of smoking among women actu- Generals report on smoking and health in January 1964, ally increased in the years following the frst Surgeon few could have anticipated the long-term impact it would Generals report. The report reviewed more During the decades that followed, however, a num- than 7,000 research articles related to smoking and dis- ber of local, state, and federal laws and policies addressed easethe evidence considered dated to the early twenti- tobacco product marketing and advertising, labeling and eth century but most came from the wave of research that packaging, youth access, and exposure to secondhand started at mid-century.
Age of irst sexual intercourse and [37] Alvarado-Zaldivar G erectile dysfunction protocol program order 100mg zudena with amex, Salvador-Moysen J erectile dysfunction forum discussion cheap zudena 100mg free shipping, Estrada- acculturation: effects on adult sexual responding xenadrine erectile dysfunction purchase zudena 100mg amex. Womens sexual function improves when partners sexual coercion in South Africa: An overview erectile dysfunction help order zudena now. Social are administered vardenail for erectile dysfunction; A Science and Medicine. Sexual esteem, sexual depression, are administered sildenail citrate (Viagra) for erectile and sexual preoccupation in the exchange approach to dysfunction: a multicentre, randomised, double-blind, sexuality. Sildenail differentiating young at-risk urban children showing citrate (Viagra) is effective and well tolerated for treating resilient versus stress-affected outcomes: A replication erectile dysfunction of psychogenic or mixed aetiology. Relationship between of sexual functions in women with male partners traumatic events in childhood and chronic pain. Disability complaining of erectile dysfunction: does treatment of and Rehabilitation. Cognitive and partner-related factors in rapid ejaculation: differences [47] Faith M, Schare M. The interplay of nature, nurture and [64] Revicki D, Howard K, Hanlon J, Mannix S, Greene A, developmental inluences: The challenge ahead for mental Rothman M. Improving the sexual dysfunction, sexual distress, and compatibility with partner. Psychosexual functioning [53] Chevret-Measson M, Lavallee E, Troy S, Arnould B, oudin of partners of men with presumed non-organic erectile S, Cuzin B. Improvement in quality of sexual life in female dysfunction: cause or consequence of the disorder? Psychosocial adjustment of female partners depression: common indings in partners of men with of men with prostate cancer: a review of the literature. Sexual anxiety and female bei heterosexuellen Mannern mit einer Erektionssorung sexual arousal: A comparison of arousal during sexual (Control beliefs and anxiety in heterosexual men with anxiety stimuli and sexual pleasure stimuli. Anxiety and self-concept correlates arousal in sexually dysfunctional and functional women. Differential patterns of arousal in [88] Leiblum S, Seehuus M, Goldmeir D, Brown C. The treatment of sexual phobias: The activation following acute exercise on physiological and combined use of antipanic medication and sex therapy. Niveles de ansiedad y depresion en mujeres con y sin disfunction sexual: Estudio comparativo. The mutually reinforcing triad of depressive from clomipramine in obsessive-compulsive disorder: A symptoms, cardiovascular disease and erectile dysfunction. Sexual history and dysfunction before antidepressant therapy in major quality of current relationships in patients with obsessive- depresson. Lifetime psychopathology in in to the sexuality of women with borderline personality individuals with low sexual desire. Philadelphia: Sanders; the general population: Exploring factors associated with 1953. Sexual functioning and self-reported Research: New Developments New york: Holt Rhinehart; depressive symtpoms among college women. Joint Conference of the American Association [122] Araujo A, Durante R, Feldman H. The relationship betweeen of Sex Educators, Counsellors and Therapists and depressive symptoms and male erectile dysfunction: the Society for the Scientiic Study of Sex. Journal of and current factors discriminating sexually functional from Sex and Reproductive Medicine. Resuls of a placebo-controlled relationship functioning in men with chronic prostatitis/ trial with sildenail citrate. A combined-constructionist sexual dysfunction: By-product of cognitive-behavioral therapeutic approach to couples experiencing erectile therapy for psychological disorders? Optimising clinical interventions for sexual functioning of obsessive-compulsive patients. International Journal of Impotence Effects on sexual and relationship satisfaction in Research. Principle of sexually dysfunctional women without partnres: A and Practices of Sex Therapy, 3rd Edition. Medical Aspects of life in the multinational Mens Attitudes to Life Events and Human Sexuality. After sildenail: Bridging the gap between sexual desire: An outcome comparison of women-only pharmacological tretament and satisfying sexual groups and couples-only groups. Treatment of Rapid Ejaculation: Psychotherapy, desire in women: The effects of marital therapy. Sex Therapy: Update for the 1990s, 3rd edition New york: [169] Hurlbert D, Fertel E, Singh D, Fernandez F, Menendez, Guilford Press; 2000:242-75. A new combination treatment for premature sexual desire adjustment and psychosocial adaptation of ejaculation. Journal of Consulting and treatment choice in men receiving sildenail citrate and Clinical Psychology. Bibliotherapy for sexual of a multicenter, randomized, open-label, crossover study. Reliable and vaid self-report outcome [215] Dunn K, Jordan K, Croft P, Assendelft W. Psychotherapy in the journal: erectile dysfunction: Systematic review and meta- Whats missing? Clinical practice guidelines in dysfunction: Are they effective and do we need them? A and Interpersonal Dimensions of Sexual Function and comparison of written materials vs. In: Lue T, Basson R, Rosen R, Giuliano F, counselling for women with sexual dysfunction and Khoury S, Montorsi F, eds. Persistant sexual arousal syndrome: A newly discovered pattern of female sexuality. Long-term outcome arousal: Disordered or normative aspect of female sexual of sex therapy. A comparative study using orgasm consistency psychologic factors in persistent genital arousal disorder training in the treatment of women reporting hypoactive in women: A report of six cases. London: [234] Trudel G, Marchand A, Ravart M, Aubin S, Turgeon Taylor and Francis; 2006:674-85. Attitudinal and experiential testosterone replacement in surgically menopausal women correlates of anorgasmia Archives of Sexual Behavior. New methods in the behavioral [284] Bergeron S, Binik Y, Khalife S, Pagaida K, Glazer H. Journal of Behavior randomized comparison of group congitive-behavioral Therapy and Experimental Psychiatry. Sexual enhancement [288] Ter Kuile M, Van Lankveld J, de Groot E, Melles R, Neffs groups for dysfunction women: A evaluation. The treatment of anorgasmia: Long-term effectiveness of a short-term [289] Sarwer D, Durlak J. Sexual Dysfunction: The Brain [273] DeAmicus L, Goldberg D, LoPiccolo J, Friedman J, Body Connection. Clinical follow-up of couples treated for sexual [293] Nicolosi A, Laumann E, Glasser D, et al. Treatment of secondary orgasmic dysfunction: global study of sexual attitudes and behaviors. Impotence and its medical and psychosocial woman: The importance of age and partners sexual correlates: Results of the Massachusetts Male Aging functioning. The effectiveness of sex therapy for alignment and its relation to female orgasmic response chronic secondary psychological impotence. The Perfect Fit: How to Achieve of two components in the treatment of erectile dysfunction. Psychotherapy for erectile dysfunction: dysfunction recondsidered: Challenging existing now more relevant than ever. The role of the sex therapists in treating [281] Binik Y, Reissing E, Pukall C, Flory N, Kimberley A, Khalife erectile dysfunction: Working toward multidisciplinary S. Psychologic Male sexuality and regulation of emotions: A study on the proiles of and sexual function in women with vulvar association between alexithymia and erectile dysfunction vestibulitis and their partners.
Contra-indications: Hypersensitivity to impotence 25 order genuine zudena on line the active substance or to erectile dysfunction doctors boise idaho purchase 100mg zudena visa any of the excipients listed in section 6 erectile dysfunction treatment jaipur 100mg zudena for sale. Agents for the treatment of erectile dysfunction erectile dysfunction natural treatment reviews buy 100mg zudena amex, including sildenafl, should not be used by those men for whom sexual activity may be inadvisable, and these patients should be referred to their doctor. Sildenafl should not be used in patients with severe hepatic impairment, hypotension (blood pressure < 90/50 mmHg) and known hereditary degenerative retinal disorders such as retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases). This is because the safety of sildenafl has not been studied in these sub-groups of patients, and its use is therefore contraindicated. If after several attempts on diferent dosing occasions patients are still not able to achieve a penile erection sufcient for satisfactory sexual activity, they should be advised to consult a doctor. Elderly: Dosage adjustments are not required in elderly patients (? 65 years old). Renal Impairment: No dosage adjustments are required for patients with mild to moderate renal impairment. Hepatic Impairment: Sildenafl clearance is reduced in individuals with hepatic impairment (e. The safety of sildenafl has not been studied in patients with severe hepatic impairment, and its use is therefore contraindicated (see section 4. With the exception of ritonavir, for which co- administration with sildenafl is contraindicated (see section 4. In order to minimise the potential of developing postural hypotension in patients receiving alpha blocker treatment (e. Erectile dysfunction: a harbinger or consequence: does its detection lead to a window of curability? Clinically meaningful improvement on the self-esteem and relationship questionnaire in men with erectile dysfunction. Efects of sildenafl on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic nucleotide phosphodiesterase isozymes. Being knowledgeable about anatomy and physiology increases our potential for pleasure, physical and psychological health, and life satisfaction. Beyond personal curiosity, thoughtful discussions about anatomy and physiology with sexual partners reduces the potential for miscommunication, unintended pregnancies, sexually transmitted infections, and sexual dysfunctions. Lastly, and most importantly, an appreciation of both the biological and psychological motivating forces behind sexual curiosity, desire, and the capacities of our brains can enhance the health of relationships. Usually they are practical and straightforward, and tend to be about sexual anatomy (Stephens-Davidowitz, 2015)for example, How big should my penis be? The second most frequently asked questions about sex on Google are about sexual physiologyfor example, How can I make my boyfriend climax more quickly? However, the accuracy of answers we get from friends, family, and even internet authorities to questions about sex is often unreliable (Fuxman et al. For example, when Buhi and colleagues (2010) examined the content of 177 sexual-health websites, they found that nearly half contained inaccurate information. If you learn this material, then we promise you wont need nearly as many clandestine Google excursions, because this module contains unbiased and scientifically-based answers to many of the questions you likely have about sexual anatomy and physiology. Even though this module is about a fascinating topicsexit contains vocabulary that may be new or confusing to you. Learning this vocabulary may require extra effort, but if you understand these terms, you will understand sex and yourself better. Masters and Johnson Although people have always had sex, the scientific study of it has remained taboo until relatively recently. In fact, the study of sexual anatomy, physiology, and behavior wasnt formally undertaken until the late 19th century, and only began to be taken seriously as recently as the 1950s. Notably, William Masters (1915-2001) and Virginia Johnson (1925-2013) formed a research team in 1957 that expanded studies of sexuality from merely asking people about their sex lives to measuring peoples anatomy and physiology while they were actually having sex. Masters was a former Navy lieutenant, married father of two, and trained gynecologist with an interest in studying prostitutes. Johnson was a former country music singer, single mother of two, three-time divorcee, and two-time college dropout with an interest in studying sociology. And yes, if it piques your curiosity, Masters and Johnson were lovers (when Masters was still married); they eventually married each other, but later divorced. Despite their colorful private lives they were dedicated researchers with an interest in understanding sex from a scientific perspective. Masters and Johnson used primarily plethysmography (the measuring of changes in blood- or airflow to organs) to determine sexual responses in a wide range of body partsbreasts, skin, various muscle structures, bladder, rectum, external sex organs, and lungsas well as measurements of peoples pulse and blood pressure. They measured more than 10,000 orgasms in 700 individuals (18 to 89 years of age), during sex with partners or alone. Masters and Johnsons findings were initially published in two best-selling books: Human Sexual Response, 1966, and Human Sexual Inadequacy, 1970. Their initial experimental techniques and data form the bases of our contemporary understanding of sexual anatomy and physiology. The Anatomy of Pleasure and Reproduction Sexual anatomy is typically discussed only in terms of reproduction (see e. However, reproduction is only a (small) part of what drives us sexually (Lucas & Fox, 2018). Thus, we will explore the sexual anatomies of females (see Figures 1a and 1b) and males (see Figure 2) in terms of their capabilities for both reproduction and pleasure. This may be because so much of it is internal (inside the body), or becausehistoricallywomen have been expected to be modest and secretive regarding their bodies. Most femalesespecially postmenopausal femalesat some time in their lives report inadequate lubrication, which, in turn, leads to discomfort or pain during sexual intercourse (Nappi & Lachowsky, 2009). Extending foreplay and using commercial water-, silicone-, or oil-based personal lubricants are simple solutions to this common problem. The clitoris and vagina are considered parts of the vulva as well as internal sex organs (see Figure 1b). They are the most talked about organs in relation to their capacities for female pleasure (e. The visible partsthe glans and prepuceare located above the urethra and join the labia minora at its pinnacle. The vagina, also called the birth canal, is a muscular canal that spans from the cervix to the introitus. It has an average overall excited length of about four and a half inches (Masters & Johnson, 1966) and has two parts: First, there is the inner two-thirds (posterior wall)formed during the first trimester of pregnancy. It is formed during the second trimester of pregnancy and is generally more sensitive than the inner portion, but dramatically less sensitive than the clitoris (Hines, 2001). Only between 10% and 30% of females achieve orgasms by vaginal stimulation alone (Thompson, 2016). At each end of the vagina are the cervix (the lower portion of the uterus) and the introitus (the vaginal opening to the outside of the body). The vagina acts as a transport mechanism for sperm cells coming in, and menstrual fluid and babies going out. This potential problem can be solved with over-the-counter vaginal gels or oral probiotics to maintain normal vaginal pH levels (Tachedjiana et al. These organs include: (a) the uterus (or womb)where human development occurs until birth; (b) the ovariesthe glands that house the ova (eggs; about two million; Faddy et al. These tubes allow for ovulation (about every 28 days), which is when ova travel from the ovaries to the uterus. Menstruation, also known as a period, is the discharge of ova along with the lining of the uterus through the vagina, usually taking several days to complete. The peniss main functions are initiating orgasm, and transporting semen and urine from the body. On average, a flaccid penis is about three and a half inches in length, whereas an erect penis is about five inches (Veale et al. If you want to know the length of a particular males erect penis, youll have to actually see itbecause there are noreliable correlations between the length of an erect penis and (a) the length of a flaccid penis, (b) the lengths of other body parts including feet, hands, forearms, and overall heightor (c) race and ethnicity (Shah & Christopher, 2002; Siminoski & Bain, 1993; Veale et al. The glans penis is highly sensitive, composed of more than 4,000 sensory-nerve endings, and associated with initiating orgasms (Halata, 1997).
But if the client has an inguinal hernia erectile dysfunction type of doctor cheap zudena online amex, you feel pressure from a soft mass pushing through the inguinal canal on to erectile dysfunction over 50 order zudena pills in toronto the tip of your finger; this may be abdominal tissue or the bowel erectile dysfunction surgery cost purchase zudena with a visa. When abdominal tissue penetrates the inguinal canal through the internal inguinal ring erectile dysfunction doctors in cleveland discount zudena, the client has an indirect hernia. If abdominal tissue penetrates the inguinal canal through an abnormal opening in the abdominal wall, you feel a direct hernia pressing against the more proximal portion of your examining finger, away from the tip. When palpating for an inguinal hernia, also palpate the inguinal lymph nodes for swelling and tenderness. Infection and cancers of the penis and scrotal wall, as well as those of the legs, can spread to the inguinal and subinguinal nodes. When assessing a client with these conditions, remember to check for inguinal node enlargement and tenderness. Overview: Palpating for an Inguinal Hernia When you palpate for an inguinal hernia, keep in mind the following important points: Palpating for an inguinal hernia may routinely be performed as part of an abdom- inal or genital examination. Ask the client (who is wearing a drape) to assume the lateral recumbent position, with both knees flexed, with the upper knee flexed more than the lower knee; or ask the client to bend forward, place his elbows on the examination table, and place his feet comfortably apart (you will sit behind him). Next, look at the perineum, which should be smooth and unbroken, and should have a regular contour with no significant discoloration or bulges. Then check the anal orifice, which should be brown or pinkish-brown and should not have any visible protruding masses. After explaining to the client what you are about to do, obtain the rectal specimen. Then slowly and gently insert a cotton swab in to his anus, and gently rotate the swab to capture the purulent dis- charge on the swab. Before you continue the rectal examination, check for rectal fissures (deep cracks), hemorrhoids, and anal herpes. If the client has any of these conditions, use an anes- thetic gel to lessen his pain before proceeding with the rectal examination. Wait at least five minutes after applying the gel to ensure that the anesthetic has time to work. If the client has a history of pain or bleeding with defecation, carefully examine the anus for rectal fissures, which may be hidden between the skin folds. If the client has a history of erectile dysfunction (particularly if he also has a history of possible neurological disease, injury, pelvic surgery, or diabetes), check for the bulbocavernosus reflex before touching the anal area. Overview: Obtaining a Rectal Specimen When you obtain a rectal specimen, keep in mind the following information: Lubricant gels contain phenols to keep them free of bacteria, and the phenols can inhibit accurate results from collected rectal specimens. To prevent false negatives even when an infection is present, use lubricants that do not contain phenols. Checking the urethral meatus (if prostatitis is indicated) Note: Before you begin the prostate examination, tell the client that he does not have to change position. Tell the client that it enables you to inspect the prostate gland and to check for tumors and other possi- ble disorders. Remind the client that he may feel the urge to defecate or urinate, that this is normal, and that he will not lose bowel or bladder control. Before inspecting the prostate gland, place your nonexamining hand on the clients hip or against his buttock to stabilize him and to enable him to prepare himself psycho- logically for the examination. Place the ball (the soft, fleshy part of the tip) of your well-lubricated, gloved finger flat against the anus. Ask the client to do the Valsalva maneuver as you slowly insert your finger in to the anus. Note: Rarely, a client may have a spasm of the rectal sphincter, which can be very painful. If this occurs during the prostate examination, hold your finger still and wait for the spasm to subside. This usually takes at least one minute but may last several minutes, especially if the examination is not gentle or unhurried or if the client is anxious. Next, with your finger pressing against the anterior wall of the rectum, feel for the prostate gland. The prostate gland is a roughly heart-shaped, symmetric organ, with two halves (lobes) that may be separated by an indentation through the rectal canal. The base of the prostate gland is wider than its apex and will be farther away from the examining finger than from the apex. The prostate gland usually feels rubbery and smooth; it should not feel hard, nodular, irregular, enlarged, or tender. Note: Most clients feel a mild-to-severe burning sensation in the penis when the ex- amining finger pushes on the prostate gland. To do this, you must know the length and width of your examining finger in centimeters. Typically, a prostate gland is palpable 2 to 5 cm inside the anal sphincter through the anterior rectal wall. With your examining finger, find the median sulcus, move your finger from the sulcus to the lateral borders of the right and left lobes, and assess the size of each lobe. Typically, a prostate gland is approx- imately 3 cm wide and 4 cm long, and its two lobes are symmetrical in size and shape. If you have long fingers, try to palpate for the seminal vesicles, which are superior and lateral to the prostate gland, for palpability and tenderness. During the prostate examination, feel the rectal walls to check for polyps, fissures, internal hemorrhoids, and tumors. If, given the clients history and the examination findings, you think that the client may have prostatitis, check the urethral meatus during the prostate examination for any discharge that might indicate this condition. When you have finished the genital examination, explain to the client that you are about to withdraw your finger. After the rectal examination, take a sample of stool from your glove to test for occult blood. Explain to the client that he should have an annual rectal examination for occult blood and prostate disorders. Overview: Inspecting the Prostate Gland When you inspect the prostate gland, keep in mind the following points: Poor sphincter tone (a very relaxed sphincter) indicates that the client has a history of either anal penetration (which is common among male homosexuals) or possi- ble neurological deficit. In neurological disorders with widespread nerve involve- ment, both sensory and motor nerves may be affected. The effect on sensory nerves may lead to decreased sensation in the clients perianal area. A prostate gland also may have a somewhat soft, boggy consistency if ejaculation is infrequent or if chronic infection impairs the drainage of prostatic fluid. Give the client tissues to wipe away excess lubricant used during the examination. Once the client has dressed, meet with him to review the examination findings, answer any questions that he may have, discuss treatment and management plans and refer- rals, and provide client education. If you will need to take a urethral smear during the second visit, explain to the client that he cannot urinate for two hours beforehand, to prevent washing away any urethral secretions. Write the examination findings on the clients chart as soon as possible after the exam- ination to avoid omitting any important details. Draw diagrams as needed to record any abnormal findings, including their locations and dimensions. Interpreting Laboratory Test Results Part of the male genital examination involves laboratory test results that help the service provider make a differential diagnosis and determine the appropriate treatment. To effec- tively diagnose and treat mens reproductive health disorders, the provider should be able to interpret the results of two commonly used laboratory tests: the urine test and prostate secretions tests. Urine Test A urine sample is easy to obtain and can provide important information. Urine can indi- cate the condition of the kidneys, as well as infections of the genitourinary tract. A urine sample also can provide information about systemic conditions, including diabetes and hypertension. Urine is usually checked for blood, protein, glucose, ketones, nitrites, and leukocyte esterase.
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