Male Genitalia Examination Flashcards
What are the steps?
Introduction and Identification
Explanation
Position the patient correctly
Inspection
Palpation
Complete the examination
Introduction & Identification
Give your name and status
Ask the patient for their name and DOB
Explanation
Explain what you would like to examine and await the patient’s verbal consent
Inform the patient that a chaperone will be present and check if this is alright
Ask the patient to remove their trousers and undergarments, this should be done before they lay down
Position the patient correctly
Lie the patient down (i.e. supine) with the abdomen and genitalia exposed (i.e. from umbilicus to the thighs)
At the end get the patient to stand up and cough to accentuate varicocoeles and hernias if present
Maintain the patients dignity by covering them with sheeting prior to and after the examination
Inspection
- Pubic hair distribution
- Inspect the scrotal skin for rashes or nodules
- Inspect scrotal contours for obvious swellings, scars or veins (varicocoele)
- Inspect the urethral meatus and note the present and absence of foreskin
- Assess size of urethral meatus (e.g. for stenosis) and its position (e.g. for hypospadias)
- Assess for foreskin problems (e.g. phimosis, paraphimosis)
- Inspect the glans penis for signs of inflammation (balanitis), warts, ulcers (STIs) or tumours (discrete, irregular red lesion)
Palpation
Ask if patient has any discomfort
Examine each testicle separately
Testicles - size (normal 16cc), consistency (i.e. soft or firm), texture (smooth or rough), abnormal masses
Examine the epididymis for nodules or swelling and added tenderness
Examine spermatic cord to the level of the superficial inguinal ring if possible and assess for presence fo varicocele
What do you do if you detect scrotal swelling?
Determine if the swelling is separate from the testis involving the testis:
Can you get above the swelling?
Is the swelling reducible?
Is there a cough impulse?
Is the swelling fluctuant (i.e. containing fluid) or solid?
Transillumination is done by holding a pen light behind the scrotum and determining if the mass is cystic (light shines through it) or solid (light blocked by mass)
What would usually be performed after palpation?
Examination of hernial orifices
Complete the examination
Inform the patient that you have completed the examination and ask them to get dressed and that you will let them know the examination findings
Don’t forget to thank the patient!
Doff PPE in correct order and dispose in an orange bag
What are some pathologies of the sac?
Hydrocele - fluid in sac
Epididymitis - swollen tender epididymitis
Tumour of testes - mass within testes