Examination of the Male Genitalia

Patient history

 The history the patient presents with determines

why the examination is conducted and what the
anticipated findings may be.
 Therefore, take a full and as comprehensive
history that you can obtain.
 Examples of presenting complaints may include:
lump, swelling, discharge or pain.
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 General
 Introduce yourself and check the patient’s identity
 Explain the procedure fully and gain consent
 Ensure the clinical room is appropriate for an intimate
examination
 Regardless of gender, a chaperone should be present
for the duration of the examination
 The patient should be examined both standing
(especially if scrotal swellings are suspected, refer to
slide 6) and lying flat (supine)

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 General 2
 Wash hands using the Ayeliffe technique
 Disposable gloves are worn for hygienic
reasons and to provide a more clinical
approach
 Expose as little of the patient as possible
 Leave upper abdomen and thighs covered
where possible
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 Inspection
 Observe the patient in general – are they in pain?
 Observe the distribution of facial, axillary and
abdominal hair and note the breasts for evidence
of gynaecomastia (if appropriate)
 Inspect the genitals for any abnormalities
(swellings, discharge, rashes etc)
 Examination of the penis is usually carried out
with the patient in a supine position
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 Examination of the Scrotum
 Inspect the scrotal skin which is
pigmented compared to the rest
of body
 The left testis lies lower than
the right but both should be
visible
 The tone of the dartos muscle
is influenced by ambient
temperature
 Consequently the normal
scrotal appearance varies with
temperature

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 Obvious Scrotal Swelling
 True scrotal swelling
 A swelling originating in the scrotum
 Torsion of testis
 Epididymitis
 “Lump” on the testis
 False Scrotal swelling (may not be palpable when the
patient is supine)
 Swelling in the scrotum that originates out side the
scrotum
 A loop of bowel that has herniated into the
scrotum
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 Examination of testes
 Use gentle pressure to examine both testicles (one at a
Palpation of the time)
testes  Using the thumb and first two fingers
 Note the size and consistency of the testis
 To size the testicles you may use an orchidometer this is
a chart or a set of beads indicating the size / volume of
the testicle in millilitres.
 Palpate the epididymis situated along the posterolateral
surface
 This should feel smooth and is broadest superiorly, at its
head
 Finally roll with the finger and thumb to palpate the vas
deferens
 Examination of the scrotum & testes should be
Palpation of the epididymis performed with the patient both standing and supine

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 Orchidometer
A set of beads such as
those depicted to the right
may be used to estimate
the size of the patient’s
testis.

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 Examination of the Penis
 Gently retract foreskin to  Inspect both ventral and dorsal
expose the glans (the surfaces of the shaft of the
patient may wish to do penis for any abnormalities
this themselves)
 The foreskin should be
supple allowing smooth
and painless retraction.
 Observe the glans penis Dorsal
for any abnormalities
 An odourless, curd-like
smegma often underlies
the foreskin
Ventral

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 Examine the external urethral meatus
 Using your thumb apply gentle pressure to the
glans to gently open the urethral meatus
 This should expose healthy glistening pink mucosa
 If a discharge is present a swab should be taken
 If the patient has complained of urethral discharge
and no discharge is apparent the patient may be
shown how to take a swab themselves next time
the discharge is noticed.

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 Inguinal Lymph Nodes
 Superficial Lymph nodes
drain,
 External Genitalia
 Lower Limbs
Superficial
nodes  Deep Lymph nodes
(situated near the femoral
Deep artery & vein) drain
nodes  External Genitalia
 Lower anterior abdominal
wall
 Lower limbs

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 Recording your findings
 Don’t forget when recording your findings
 Patient identifier, date (and time), signature and
name
 When documenting or describing your findings
remember to comment on the penis, scrotum, palpation
of the scrotal contents (testes, vas deferens,
epididymis) and any abnormal masses palpated.
 Remember to describe your findings as fully as
possible: eg size, position, shape of a swelling etc
 A diagram may often be useful in written notes

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