PHYSICAL EXAMINATION OF THE MALE GENITALIA

Question 1

History of Present Illness

Answer 1

(a) Difficulty achieving or maintaining erection.
(b) Difficulty with ejaculation.
(c) Discharge or lesions on the penis
(d) Infertility.
(e) Enlargement in inguinal area
(f) Testicular pain or mass.
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Question 2

Past Medical History

Answer 2

1. previous genitourinary tract surgeries
2. sexually transmitted infections
3. chronic illnesses

Question 3

Family History

Answer 3

1. infertility problems in siblings
2. hernias in family members
3. family history of prostate, testicular, or penile cancer

Question 4

Personal and Social History

Answer 4

1. employment risks
2. exercise patterns
3. concerns about genitalia
4. testicular self-examination practices
5. concerns about sexual practices
6. reproductive function (number of children, form of contraceptive use)
7. use of medications, alcohol, or street drugs that may interfere with sexual response.

Question 5

Age- and Condition-Related Variations

Answer 5

(a) Infants and children.
1) Information on maternal use of sex hormones or birth control pills during pregnancy. Circumcised infants should be assessed for any
complication from the procedure.
2) Pertinent data for uncircumcised infants. Congenital anomalies (e.g., epispadias) and any
incidence of scrotal swelling when infant is crying or having bowel movements should be recorded. Notation should also be made of any swelling, discoloration, sores on penis or scrotum, and genital pain.
3) Questions about any concerns with masturbation, sexual exploration, or sexual abuse.
(b) Adolescents.
1) Relevant data include knowledge of reproductive function, presence of nocturnal emissions, enlargement of genitalia, sexual activity patterns, use of contraceptives, and concerns of sexual abuse.
(c) Older adults.
1) Relevant data include sexual activity patterns and any changes in sexual response or desire.

Question 6

Components of a Male Genitalia Examination

Answer 6

1. Penis
2. Testicles
3. Epididymides
4. Scrotum
5. prostate gland
6. seminal vesicles.

Question 7

function of the penis

Answer 7

1. to excrete urine introduce semen into the vagina.(The corpus spongiosum expands at its distal end to form the glans penis)

Question 8

a slitlike opening about 2 mm ventral to the tip of glans. The
penis skin is thin, redundant to permit erection, and more darkly pigmented than the
rest of the body.

Answer 8

urethral orifice

Question 9

The scrotum contains

Answer 9

1. testis
2. epididymis
3. spermatic cord
4. muscle layer.

Question 10

Testicular temperature is controlled by

Answer 10

altering the distance of the testes from the body through muscular action.

Question 11

Spermatogenesis requires temperatures lower than

Answer 11

37 Degrees Celsius

Question 12

spermatozoa and testosterone is produced where

Answer 12

the testicles

Question 13

What part provides for the storage, maturation, and transmission of the sperm

Answer 13

Epididymis

Question 14

what forms the ejaculatory duct.

Answer 14

Vas deferens

Question 15

what produces the major volume of ejaculatory fluid, containing fibrinolysin enzyme that liquefies coagulated semen

Answer 15

prostate

Question 16

what occurs when the two corpora cavernosa become engorged with
20 to 50 mL of blood in response to the autonomic nervous system.

Answer 16

Erection
-Erection is a neurovascular reflex induced by psychogenic or local reflex mechanisms. Cortical input can suppress arousal.

Question 17

The emission of secretions from the vas deferens, epididymides, prostate, and seminal vesicles. Constriction of the vessels occurs after

Answer 17

Orgasm

Question 18

Examination

(1) Positioning

Answer 18

(a) Patient may be lying or standing.

(b) Examination of the genitalia involves inspection, palpation, and transillumination of any mass found.

Question 19

Examination

(2) Inspection and Palpation

Answer 19

(a) Inspect the genital hair distribution. Palpate external genitalia.
1) Note hair characteristics. Genital hair is coarser than scalp hair.
(b) Examine the penis. The dorsal vein should be apparent on inspection. If uncircumcised, retract the foreskin or ask the patient to do so. It should retract easily, and a bit of white, cheesy smegma may be seen over the glans. Occasionally the foreskin is tight and can’t be retracted called phimosis.
1) If foreskin is present, retract it and note penis characteristics.
(c) Palpate shaft of penis for tenderness and induration. Strip the urethra for any discharge by compressing the base of the penis with your thumb and forefinger and
moving them toward the glans.
(d) Inspect urethra and urethra meatus locations. The orifice should appear slit like and be located on the ventral surface millimeters from the tip of the glans.
(e) Inspect scrotum and inguinal areas for size, contour, and the presence of hernia.
(f) Palpate testes, epididymis, and vas deferens.
1) Note size, contour, and characteristics of testes.
(g) Palpate prostate gland and seminal vesicles.
(h) Inspect and palpate for hernia with patient in knee-chest position.
(i) Inspect for the cremasteric reflex.
(j) Inspect sacrococcygeal and perianal areas.
(3) Transillumination
(a) Visualize any masses and note transillumination

Question 20

Lifecycle variations
(1)	Adults

Answer 20

(a) Normal findings
1) Dorsal vein is apparent.
2) No masses or abnormalities are visible.
(b) Typical variations
1) Scrotum is normally more red in red-haired persons.
2) Scrotal lumps may be caused from sebaceous cysts.
(c) Findings associated with disorders
1) Uncircumcised males may have balanoposthitis as a result of nonretractable foreskin. Balanitis results from infection. Penile discharge suggests inflammation or infection.
2) Pinpoint opening=meatal stenosis.
3) Priapism, a prolonged and often painful penile erection, may suggest a more serious condition.
4) Thickening of the scrotum from edema= disease. consequences of general fluid retention associated with cardiac, renal, or hepatic disease. Irregular testis texture=sign of infection, cyst, or tumor.
5) Beaded or lumpy vas deferens=diabetes, TB, or inflammatory changes.
6) Hernia - Insert your examining finger into the lower part of the scrotum and carry it upward along the vas deferens into the inguinal canal. The hernia is
described as indirect if it lies within the inguinal canal. This type of hernia occurs more commonly in young men and is the most common of the abdominal
hernias.
7) The vas deferens, itself feels smooth and discrete; it should not be beaded or lumpy in its course as you palpate from the testicle to the inguinal ring.
8) Finally, evaluate the cremasteric reflex. Stroke the inner thigh with a blunt instrument such as handle of the reflex hammer.

Question 21

Lifecycle variations
(2)	Infants and children

Answer 21

(a) Normal findings
1) Examine the genitalia of the newborn for congenital anomalies. Inspect the penis and transitory penile erections are common in infants.
2) Inspect the scrotum for size, shape, rugae, the presence of testicles, and any anomalies. Palpate each side of the scrotum to detect the presence of the testes or any masses.
3) Edema of newborn external genitalia is common, especially after breech delivery.
4) Testicle of newborn is usually 1 cm in diameter.
5) Newborn nonerect penis is 2 to 3 cm in length.
6) Newborn scrotum without rugae and testes indicates preterm birth.
7) Separation of prepuce from glans occurs between ages 3 to 4 years.**
8) Foreskin of noncircumcised males is fully retractable by 3 to 6 years of age.
a) Transillumination- Determine whether it is filled with fluid, gas or solid material. Attempt to reduce the size of the mass. Transilluminate the mass,
and there is no change in size when reduction.
b) A mass that does not transilluminate may indicate incarcerated hernia.
c) Palpate the scrotum to identify the testes and epididymis. The testes should be about 1 cm in size. A scrotum that remains flat, and undeveloped is a
good indication of cryptorchidism. A hard, enlarged painless testicle may indicate a tumor.
Acute swelling

Question 22

Lifecycle variations
(3)	Adolescents

Answer 22

(a) Normal findings
1) Hormonal changes at puberty cause straight hair to appear at base of penis. Scrotal skin reddens and becomes increasingly pendulous.
2) As maturation continues, pubic hair darkens and extends over entire pubic area; the prostate gland enlarges.
3) By completion of puberty, the penis is enlarged in length and breadth.
4) Pubic hair is curly and dense and forms a diamond pattern from the umbilicus to the anus.
(b) Typical variations
1) Varying degrees of maturation should be classified according to the Tanner stages.
(c) Older adults
1) Normal findings
a) With age, pubic hair becomes finer and less abundant.
b) Viability of sperm may decrease.

Question 23

Common abnormalities**

Answer 23

(1) Hernia - The protrusion of a peritoneal-lined sac through some defects in the abdominal wall. Hernias occur because there is a potential space for protrusion of some abdominal organ, commonly the bowel but, occasionally the omentum. Femoral hernias occur at
the fossa ovalis, where the femoral artery exits the abdomen and are more common in females than males. Refer to: “Distinuishing Characteristics of Hernias” in Seidel’s Guide to Physical Examination7th Edition (p. 610).
(2) Paraphimosis is the inability to replace the foreskin to its usual position after it has been retracted behind the glans.
(3) Hypospadias is a congenital defect in which the urethral meatus is located on the ventral surface of the glans, penile shaft, or the perineal area.
(4) Syphilitic chancre lesion of primary syphilis generally occurs 2 WEEKS after exposure. Most commonly located on the glans. PAINLESS lesion has indurated borders with a clear base.**
(5) Herpes is a viral infection that appears as superficial vesicles. Lesions may be located on the glans, penile shaft or base. Painful and associated with inguinal lymphadenopathy.
(6) Condyloma acuminatum is a soft, reddish lesion that arises because of infection with a papovavirus. The lesions are commonly present on the prepuce, glans penis. The lesions may undergo malignant degeneration to squamous cell carcinoma.
(7) Lymphogranuloma venereum is an STI caused by a chlamydial organism. The lesions appear on the genitalia. The initial lesion is a painless erosion at or near the coronal sulcus.**
(8) Molluscum contagiosum is an STI caused by a poxvirus. The lesions are pearly gray, often umbilicated, smooth, dome shaped, with discrete margins.**
(9) Peyronie disease is characterized by a fibrous band in the corpus cavernosum that results in deviation of the penis during erection.
(10) Penile carcinoma is cancer of the penis. Generally squamous and tend to occur in uncircumcised men, who practice poor hygiene. Often appears as a painless ulceration.
(11) Hydrocele is a nontender, smooth, firm mass that results from fluid accumulation in the tunica vaginalis. The mass will transilluminate.
(12) Spermatocele is a cystic swelling occurring on the epididymis.
(13) Varicocele is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord. Most common on the left side and is painful. Occurs in boys and young men and associated with reduced fertility.
(14) Orchitis an acute inflammation of the testis, orchitis is uncommon except as a complication of mumps in the adolescent or adult.
(15) Epididymitis is inflammation of the epididymis is often seen in association with a urinary tract infection. The epididymis is exquisitely tender and overlying scrotum may be marked erythematous.
(16) Testicular torsion is a surgical emergency occurring most commonly in adolescents. It has acute onset and is often accompanied by nausea and vomiting.
(17) Testicular tumor is a neoplasm arising from the testicle appears as an irregular, nontender mass fixed on the testis. It does not transilluminate and is the most common in males.