Male Genital Examination Flashcards
What is the location of the deep and superficial inguinal ring?
-The deep inguinal ring is located on mid-inguinal point about 0.5 inches or 1.3 cm above the inguinal ligament
-The superficial inguinal ring is a triangular opening in the aponeurosis of the external oblique muscle immediately above and medial to the public tubercle.
Differentiate phimosis from paraphimosis and list down their causes.
-Phimosis is the narrowing of the preputial orifice, thereby preventing retraction of the foreskin.
Causes
-balanitis
-lichen sclerosus
-infections
-Scaring
-Paraphimosis occurs when the foreskin is retracted behind the corona of the penis and cannot be returned to the unretracted position.
Causes
-Forceful retraction
-Trauma
-Infections.
Interpret the Trans-Illumination test
It is a test used to differentiate between different causes of scrotal swelling, specifically fluid filled and solid masses.
Positive Trans-Illumination test: If light passes through the scrotal swelling, it indicates the presence of fluid or cyst
Negative Trans-Illumination test: If light does not pass through, it suggests the presence of a solid mass.
Interpret Prehn’s test?
Purpose: Used to differentiate between testicular torsion and epididymitis.
Interpretation:
Positive Prehn’s Sign: Relief of pain when the scrotum is elevated. This is suggestive of epididymitis, where lifting the testicle reduces strain on the inflamed epididymis.
Negative Prehn’s Sign: No relief of pain with scrotal elevation. This is typically seen in testicular torsion, where there is no improvement in blood flow or pain relief from lifting.
Interpret Cremasteric Reflex loss
-Cremasteric Reflex can be assessed by stroking the skin that overlies the inner part of the thigh
-This causes the Cremasteric muscle to contract, resulting is elevation of the Ipsilateral testicle towards the inguinal canal.
-Absence of crimasteric reflex is suggestive of testicular torsion.
Differentiate direct and Indirect hernia using the following test
1.Deep ring occlusion test
2.Ring invagination test
3.Zieman’s test
NOTES:
Tests to distinguish between direct and indirect hernia.
Deep/Internal ring occlusion test: Internal ring is located half inch above the mid-inguinal point (center point between anterosuperior iliac spine and pubic symphysis). After reducing the contents, in lying down position, internal ring is occluded using the thumb. Patient is asked to cough. If a swelling appears medial to the thumb, then it is a direct hernia. If swelling does not appear and on releasing the thumb swelling appears during coughing, then it is an indirect hernia confirmed in standing position.
Ring invagination test: After reduction of hernia, the little finger/ index finger of the examiner is invaginated from the bottom of the scrotum, gradually pushed up and rotated to enter the superficial inguinal ring. If the impulse on coughing is felt at the tip of the invaginated finger, then it is an indirect hernia. If the impulse is felt on the pulp the invaginated finger, then it is a direct hernia. This test is done only in males.
Zieman’s test: The examiner places his index finger on the deep inguinal ring and middle finger on the superficial inguinal ring, ring finger over saphenous opening. The patient is asked to cough or to hold the nose and blow. If the impulse is felt on the index finger, it is indirect hernia. If the impulse is felt on the middle finger, it a direct hernia. If the impulse is
felt on the saphenous opening, it is a femoral hernia.
Differentiate direct and Indirect hernia using the following test
1.Deep ring occlusion test
2.Ring invagination test
3.Zieman’s test
NOTES:
Tests to distinguish between direct and indirect hernia.
Deep/Internal ring occlusion test: Internal ring is located half inch above the mid-inguinal point (center point between anterosuperior iliac spine and pubic symphysis). After reducing the contents, in lying down position, internal ring is occluded using the thumb. Patient is asked to cough. If a swelling appears medial to the thumb, then it is a direct hernia. If swelling does not appear and on releasing the thumb swelling appears during coughing, then it is an indirect hernia confirmed in standing position.
Ring invagination test: After reduction of hernia, the little finger/ index finger of the examiner is invaginated from the bottom of the scrotum, gradually pushed up and rotated to enter the superficial inguinal ring. If the impulse on coughing is felt at the tip of the invaginated finger, then it is an indirect hernia. If the impulse is felt on the pulp the invaginated finger, then it is a direct hernia. This test is done only in males.
Zieman’s test: The examiner places his index finger on the deep inguinal ring and middle finger on the superficial inguinal ring, ring finger over saphenous opening. The patient is asked to cough or to hold the nose and blow. If the impulse is felt on the index finger, it is indirect hernia. If the impulse is felt on the middle finger, it a direct hernia. If the impulse is
felt on the saphenous opening, it is a femoral hernia.
Differentiate testicular torsion and epididymitis on clinical examination
-Phren’s Test is positive for epididymitis and negative for testicular torsion
-Cremasteric Reflex is lost in testicular torsion but present in epididymitis
Differentiate between direct and Indirect inguinal hernia
-Direct inguinal hernia passes through the superficial inguinal ring while indirect inguinal hernia passes through the deep ring.
-Indirect inguinal hernia enters the scrotum while direct inguinal hernia does not.
-Direct inguinal hernia occurs due to weak abdominal wall /muscle while indirect hernia occurs due to patent or reopen processes vaginalis.
Contents of the ingunal canal
In the inguinal canal:
In males, the spermatic cord passes through.
The spermatic cord contains:
Vas deferens (ductus deferens)
Testicular artery
Pampiniform venous plexus
Genital branch of the genitofemoral nerveLymphatic vessels
Cremasteric artery
In females, the round ligament of the uterus passes through.
This ligament helps to maintain the position of the uterus. Additionally, small blood vessels, lymphatics, and the ilioinguinal nerve also pass through the inguinal canal in both sexes.
