Male Genitalia Examination

Question 1

What are the steps?

Answer 1

Introduction and Identification

Explanation

Position the patient correctly

Inspection

Palpation

Complete the examination

Question 2

Introduction & Identification

Answer 2

Give your name and status

Ask the patient for their name and DOB

Question 3

Explanation

Answer 3

Explain what you would like to examine and await the patient’s verbal consent

Inform the patient that a chaperone will be present and check if this is alright

Ask the patient to remove their trousers and undergarments, this should be done before they lay down

Question 4

Position the patient correctly

Answer 4

Lie the patient down (i.e. supine) with the abdomen and genitalia exposed (i.e. from umbilicus to the thighs)

At the end get the patient to stand up and cough to accentuate varicocoeles and hernias if present

Maintain the patients dignity by covering them with sheeting prior to and after the examination

Question 5

Inspection

Answer 5

• Pubic hair distribution
• Inspect the scrotal skin for rashes or nodules
• Inspect scrotal contours for obvious swellings, scars or veins (varicocoele)
• Inspect the urethral meatus and note the present and absence of foreskin
• Assess size of urethral meatus (e.g. for stenosis) and its position (e.g. for hypospadias)
• Assess for foreskin problems (e.g. phimosis, paraphimosis)
• Inspect the glans penis for signs of inflammation (balanitis), warts, ulcers (STIs) or tumours (discrete, irregular red lesion)

Question 6

Palpation

Answer 6

Ask if patient has any discomfort

Examine each testicle separately

Testicles - size (normal 16cc), consistency (i.e. soft or firm), texture (smooth or rough), abnormal masses

Examine the epididymis for nodules or swelling and added tenderness

Examine spermatic cord to the level of the superficial inguinal ring if possible and assess for presence fo varicocele

Question 7

What do you do if you detect scrotal swelling?

Answer 7

Determine if the swelling is separate from the testis involving the testis:

Can you get above the swelling?

Is the swelling reducible?

Is there a cough impulse?

Is the swelling fluctuant (i.e. containing fluid) or solid?

Transillumination is done by holding a pen light behind the scrotum and determining if the mass is cystic (light shines through it) or solid (light blocked by mass)

Question 8

What would usually be performed after palpation?

Answer 8

Examination of hernial orifices

Question 9

Complete the examination

Answer 9

Inform the patient that you have completed the examination and ask them to get dressed and that you will let them know the examination findings

Don’t forget to thank the patient!

Doff PPE in correct order and dispose in an orange bag

Question 10

What are some pathologies of the sac?

Answer 10

Hydrocele - fluid in sac

Epididymitis - swollen tender epididymitis

Tumour of testes - mass within testes