1) The examination of the male genitalia requires obtaining a full patient history, explaining the procedure to gain consent, and ensuring privacy and a chaperone are present. 2) The exam involves inspecting the genitals, scrotum, and penis for abnormalities while the patient is standing and supine, and gently palpating the testes, epididymis, and vas deferens to evaluate for any masses or abnormalities. 3) Findings should be thoroughly documented including any abnormalities detected, with diagrams used when appropriate.

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