in the male reproductive system, The scrotum is a thin-walled sac that is suspended

below the pubic bone and posterior to the penis. This darkly pigmented structure contains
sweat and sebaceous glands and consists of folds of skin (rugae) and the cremaster muscle. The
scrotum significant functions ACT AS A protective covering for the testes, epididymis, and vas
deferens and helps to maintain the cooler-than-body temperature necessary for production of
sperm (less than 37°C) and storing sperm. They also produce several hormones, the main one
being testosterone. The scrotum can maintain temperature control because the cremaster
muscle is sensitive to changes in temperature. The muscle contracts when too cold, raising the
scrotum and testes upward toward the body for warmth (cremasteric reflex). This accounts for
the wrinkled appearance of the scrotal skin. When the temperature is warm, the muscle relaxes,
lowering the scrotum and testes away from the heat of the body. When the cremaster muscle
relaxes, the scrotal skin appears smooth.
The primary technique for Inspecting the scrotum size, shape, and position. Ask the client to
hold his penis out of the way. Observe for swelling, lumps,or bulges.
The normal findings of this The scrotum varies in size (according to temperature) but in adult
size commonly 3 to 5 cm x 2 to 4 cm x 3 cm and oval-shaped. The scrotal sac hangs below or at
the level of the penis. The left side of the scrotal sac usually hangs lower than the right side.
There are also abnormal findings of this (hydrocele) An enlarged scrotal sac may result from
fluid filled sacs Hydroceles are common in newborns. ,Hematocele occurs where there
Traumatic
collection is blood between the layers of a sac that surrounds each testicle,
injury, such as a direct blow to the testicles, is the most likely cause.
bowel (hernia) SCROTAL HERNIA
• A loop of bowel protrudes into the
scrotum to create what is known as
an indirect inguinal hernia. • Hernia appears as swelling in the
scrotum.
• Palpable as a soft mass and fingers
cannot get above the mass., or tumor (cancer) an inguinal hernia may extend down into the
scrotum and cause a lump or bulge in the area of the groin
Inspect the scrotal skin. Observe color,integrity, and lesions or rashes. To perform an
accurate inspection, you must spread out the scrotal folds (rugae) of skin. When inspecting
the scrotal skin, have the clienthold the penis aside while the examiner inspects. Lift the
scrotal sac to inspect the posterior skin.

The scrotal skin is thin , rugated (crinkled), and has minimal hair growth. The color of it is a little
slightly darker than the penis'. Rashes and lesions are typically absent. Sebaceous cysts, which
are benign nodules that are tiny, yellowish, firm, and non-tender, are also a sign of a normal
findings.

Abnormal findings
Rashes, lesions, and Inflammation of the penis and scrotum may be seen in Reiter’s syndrome,
an idiopathic inflammatory disorder affecting the skin, joints, and mucous membranes.

Palpate the scrotal contents. Palpate each testis and epididymis between your thumb and first
two fingers (Fig. 26-11). Note size,shape, consistency, nodules, masses and tenderness.
Testes are ovoid, approximately measures about 3.5–5 cm long, 2.5 cm wide, and 2.5 cm deep,
and equal bilaterally in size and shape. They are smooth, firm, rubbery, movable, negative of
nodules, and rather tender to pressure. Compared to the testes, the epididymis is smoother,
softer, nontender and less sensitive.

Absence of a testis suggests cryptorchidism (an undescended testicle)  is a

testicle that hasn't moved into its proper position in the bag of skin hanging
below the penis (scrotum) before birth. Painless nodules may indicate cancer.
Tenderness and swelling may indicate acute orchitis an acute inflammatory
reaction of the testis secondary to infection caused by bacteria or virus ,
torsion of the spermatic cord  it occurs when a testicle rotates, twisting the
spermatic cord that brings blood to the scrotum. The reduced blood
flow causes sudden and often severe pain and swelling , a strangulated
hernia, or epididymitis. If the client has epididymitis, passive elevation of the
testes may relieve the scrotal pain (Prehn’s sign).  The elevation takes the
weight of the testis off the epididymal suspension.
Avoid putting excessive pressure on the testes as this can pain. Testes do
not get smaller with normal aging, although they may decrease in size with
long-term illness.
Palpate each spermatic cord and vas deferens from the epididymis to the
inguinal ring. The spermatic cord will lie between your thumb and finger.we
should take Note of any nodules, swelling, or tenderness.
The normal finding of this is The spermatic cord and vas deferens should
feel uniform on both sides. The cord is smooth, nontender, and rope-like.
Palpable, tortuous veins suggest varicocele  pathologically enlarged,
tortuous veins of the pampiniform plexus, leading to an increased
testicular temperature and adrenal metabolite reflux into the testes.
Varicocele can impair spermatogenesis and is considered to be the
most common cause of male infertility..A beaded or thickened cord
indicates infection or cysts. A cyst suggests hydrocele of the spermatic
cord.
If an abnormal mass or swelling was noted during inspection and palpation
of the scrotum, perform transillumination will aid in differentiating a
hydrocele from an intrascrotal indirect inguinal hernia.  helps to easily
assess whether a mass is fluid-filled is cystic (light shines through) or solid (light
Darken the room and shine a light from the back of the
blocked by the mass).
scrotum through the mass.Look for a red glow.
 the testis is enlarged, nontender, has a firm consistency.Normally scrotal contents do
not transilluminate.
The abnormal findings of this Swellings or masses that contain serous Fluid
indication of hydrocele, spermatocele an abnormal sac (cyst) that
develops in the epididymis — the small, coiled tube located on the
upper testicle that collects and transports sperm. Noncancerous and
generally painless, a spermatocele usually is filled with milky or clear
fluid that might contain sperm. Light up with a red glow. Swellings or
masses that are solid or filled with blood iof ndication tumor, hernias, or
varicocele—do not light up with a red glow.
Ask the patient to lie down if you felt a scrotal mass while inspecting and
palpating the scrotal contents. Keep track of whether the mass vanishes.
Auscultate it for bowel sounds if it is still there. Last but not least, gently
palpate the mass and make an effort to push it upward into the
abdomen.clinical tip If the client complains of extreme tenderness or
nausea, do not try to push the mass up into the abdomen.

There is no scrotal hernia if the bulge goes away, although the mass could
be a result of something else. Refer the client for further testing. Prior to
testing, a lump on or around the scrotum should be considered as
malignant demonstrates the contrary.
Kapag may mass remains, ilagay mo yung fingers above the scrotal mass.
If you can get your fingers above the mass,it is suspected hydrocele
Kapag may Bowel sounds as auscultated over the mass indication ng
presence of bowel and a scrotal hernia. Bowel sounds will not be heard
over a hydrocele. Kapag hindi naman napupush the mass into the
abdomen,it is suspect an incarcerated hernia.A hernia is strangulated
when its blood supply is cut off. Usually, the customer complains intense
tenderness and nausea. Refer the patient to the physician right away to
prepare him ready for surgery if you think they might have a strangulated
hernia.

In males, it transmits the spermatic cord and lymphatics. The sole purpose

of the inguinal canal is to provide a conduit that facilitates gonadal descent. In males, this
results in the testes leaving the lumbar region of the posterior abdominal wall to enter the scrotal
sac. When assessing the male genitalia, the nurse needs to be familiar with structures of the
inguinal or groin area because hernias (protrusion of loops of bowel through weak areas of the
musculature) are common in this location.The inguinal area is contained between the anterior
superior iliac spine laterally and the symphysis pubis medially. Running diagonally between
these two landmarks, just above and parallel with the inguinal ligament, is the inguinal canal.
The inguinal canal is a tube-like structure (4–5 cm or 1.5–2 inches long in an adult) through
which the vas deferens travels as it passes through the lower abdomen.The external inguinal
ring is the exterior opening of the inguinal canal, which can be palpated above and lateral to the
symphysis pubis. It feels triangular and slit-like. The internal inguinal ring is the internal opening
of the inguinal canal. It is located 1 to 2 cm above the midpoint of the inguinal ligament and
cannot be palpated. The femoral canal is another potential spot for a hernia. The femoral canal
is located posterior to the inguinal canal and medial to and running parallel with the femoral
artery and vein.

Inspect for inguinal and femoral hernia.Inspect the inguinal and femoral areas for bulges. Ask
the client to turn head and cough or to bear down as if having a bowel movement, and continue
to inspect the areas may reveal a visible bulge or an abnormal motion..
The inguinal and femoral areas are normally free of any presence of bulges.
The bnormal findings of this a hernia may be detected by bulges that develop at the external
inguinal ring or the femoral canal when the client bears down.
As for Palpate for inguinal hernia and inguinal nodes.we need to Ask the client to shift his
weight to the left for palpation of the right inguinal canal and vice versa. Place your right index
finger into the client’s right scrotum and press upward, invaginating the loose folds of skin. We
should Palpate up the spermatic cord as well hanggang sa ma reach the triangular-shaped, slit-
like opening of the external inguinal ring. attempt to push your finger through the opening and,
if possible, continue palpating up the inguinal canal. When your finger is in the canal or at the
external inguinal ring, ask the client to bear down or cough. Feel while examining for any bulges
against your finger. Repeat the process on the other side after that.
Bulging or masses are not normally palpated.
A bulge or mass may indicate a hernia.
Palpate inguinal lymph nodes. If nodes are palpable, we should take the note size, consistency,
mobility or tenderness.
Negative of enlargement or tenderness is normal findings
Enlarged or tender lymph nodes may indicate an inflammatory process or infection of the penis
or scrotum.
Palpate for femoral hernia. Palpate on the front of the thigh in the femoral canal area (Fig. 26-
14). Ask the client to bear down or cough. Feel for bulges. Repeat on the opposite thigh.
Bulges or masses are not normally palpated. Palpable Bulge can be painful or mass as client
especially when bears down or coughs.