Male genitalia

Question 1

When should a male genital exam be performed in an infant/child?

Answer 1

At all pediatric well child exams and at sick visits if indicated

• perform in presence of chaperone or parent/guardian
• Infant: look for ambiguous genitalia, hypospadias, cryptochidism, etc.
• toddler/child: look for retractability of foreskin, development

Question 2

When should a male genital exam be performed in an adolescent?

Answer 2

At all well visits until tanner stage V, then only if indicated by signs/symptoms or specific exam requirements (physicals)

Question 3

When should a male genital exam be performed in an adult?

Answer 3

As indicated by presenting signs/symptoms, PMH of germ cells tumors, history of cryptorchidism, FH of testicular cancer or specific exam requirements

Question 4

What is the significance of cryptorchidism as a patient ages?

Answer 4

Associated with testicular cancer

Question 5

Testicular cancer

Answer 5

Most common in males between ages 15-35

Most are germ cell tumors & prognosis is generally good

Question 6

Screening for testicular cancer

Answer 6

Done by physical exam

Is really only routinely recommended in men with risk factors

Question 7

Signs & symptoms of testicular cancer

Answer 7

• lump of enlargement of either testicle
• feeling of heaviness in scrotum
• dull ache in abd or groin
• sudden collection of fluid in scrotum
• pain or discomfort in testicle or scrotum
• enlargement or tenderness of the breasts
• back pain

Question 8

Order of male genital exam

Answer 8

1. inguinal/pubic regin
2. hernia check
3. penis/glans
4. scrotum (sac, testes, epididymis, spermatic cord/vas deferens)
5. rectal/prostate
6. breast (as needed, based on history)

Question 9

Preparing pt for exam

Answer 9

obtain GU and sexual history
explain what is going to happen and tell them to report any pain/tenderness

Pt stands with feet about shoulder width apart (next to something to lean on). Can be supine if unable to stand
Examiner is sitting on stool facing pt
Pt lifts their gown & lowers underwear

Question 10

Checking for hernias

Answer 10

Visually inspect for signs of hernia

• invaginate the index finger within loose scrotal skin below the inguinal canal, along spermatic cord
• follow cord through neck of scrotum until finger reaches opening of external inguinal ring
• ask pt to bear down or turn head & cough

Question 11

Direct vs indirect on palpation

Answer 11

Indirect: an impulse felt at tip of finger
Direct: impulse at the side of finger

Question 12

Examining the testis and epididymis

Answer 12

Palpate all sides of testis and epididymis individually
One testicle is usually lower (left), and one testicle is usually bigger (right)
Thumb on anterior side, 2-3 fingers on post side–only enough pressure to move testicle between fingers
Note size, shape, consistency, nodules, tenderness
Then palpate spermatic cord

Question 13

Indications for rectal/prostate exam

Answer 13

Blood in stool
chronic constipation
pain with defecation
symptoms of prostate inflammation/infection/enlargement

Question 14

Performing rectal exam

Answer 14

Pt is usually facing away from you, leaning forward, elbows on exam table (can also be lateral recumbant)

• visibly inspect anus & perineal areas
• warn pt before making physical contact
• lube
• place finger against anus for a few sec to allow sphincter to relax
• slowly insert finger following ant wall
• palpate prostate feeling for size, shape, firmness, etc
• sweep all sides of rectum with finger
• if stool is present on finger after removing, test for occult blood

Question 15

Prostate cancer screening

Answer 15

In men 55-69: can undergo PAS testing, pt decision

In men 70+: recommended to not do PAS screening at all

Question 16

Hydrocele

Answer 16

Accumulation of fluid around a testicle– in tunica vaginalis
S/S: PAINLESS scrotal swelling
Usually diagnosed at birth & resolves within 1 yr
Can develop in adulthood
–transilluminate & scrotal US to diagnose

Question 17

Cryptorchidism

Answer 17

An undescended testicle that hasn’t entered the scrotal sac

• 60% are high scrotal
• will often descend by itself within first few months of life
• if not descended after about 6 months, may need surgery
• -assoc with testicular cancer

Question 18

Biggest concern with inguinal hernia

Answer 18

Risk of strangulation/incarceration of tissue

Question 19

Testicular torsion

Answer 19

EMERGENCY– call surgeon

• -happens when spermatic cord rotates & becomes twisted–cuts of testicular blood supply
• -swelling & lots of pain