Male Genital Exam

1. 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

6. 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
time)
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
performed with the patient both standing and supine
Palpation of the
testes
Palpation of the epididymis

8. 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
expose the glans (the
patient may wish to do
this themselves)
The foreskin should be
supple allowing smooth
and painless retraction.
Observe the glans penis
for any abnormalities
An odourless, curd-like
smegma often underlies
the foreskin
Inspect both ventral and dorsal
surfaces of the shaft of the
penis for any abnormalities
Ventral
Dorsal

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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.

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

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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