Testicular Examination

Question 1

Introduction

Answer 1

PPE, wash hands
FULL NAME, ROLE
Patient ID check

I would like to peform an examination of your genitals. This will involve me examining your penis, testicles and the groin
There will be a chaperone present throughout.
This will require you to remove your underwear. I will provide you a sheet to maintain dignity
Do you have any questions about the examination? Do I have your consent to carry out the examination

Ask for pain

Question 2

Inspection - penis, groin, abdomen

Answer 2

Skin changes - bruising, swelling, warts (HPV?), redness

Scars

• penis - circumcision?
• inguinal region - hernia repair, orchidopexy?

Masses

• penis - chancre in primary syphilis
• inguinal region - hernia, lympahdenopathy, undescended testicles?

Question 3

Inspection - scrotum, perineum

Answer 3

Ask patient to lift penis out the way so you can examine the scotum and perineum

Skin -

• warts - HPV?
• redness - cellulitis?

Scars -
-vasectomy, testicular fixation?

Masses -

• scrotum - testicular cancer?
• perineum - abscess?

Swelling
-hydrocele, varicocele, edema?

Bruising - local trauma

Necrotic tissue - Fournier’s gangrene found 1st on perineum

Question 4

Palpation - penis

Answer 4

Retract foreskin
-phimosis

Open urethral meatus - assess patency
Glans - assess for ulcers, warts, discharge, scars

Replace foreskin to prevent paraphimosis

Question 5

Palpation - testicles

Answer 5

Examine normal side first

• use both thumbs and 1st fingers to palpate whole testicle
• use remaining fingers to immobilise it
• gentle rubbing motion to examine whole testicle

If unable to find testicle, palpate along path of inguinal ligament for undescended testicle

Question 6

Assessment of scrotal mass

Answer 6

Can you get above the swelling?

• No => inguinal swelling => hernia
• Yes => scrotal swelling

Is it solid?

• Yes => MALIGNANCY UNTIL PROVEN OTHERWISE
• No => cystic, will transiluminate

Can you feel the testis?

• Yes => epididymal cyst
• No => hydrocele

Tenderness - infective/inflammatory?
Shape - are borders regular?

Question 7

Palpation - epididymis

Answer 7

Posterior of testicle

-tenderness = epididymitis

Question 8

Palpation - spermatic cord

Answer 8

Vas deferens + surrounding tissue => each testicle

Palpate from superior aspect of testicle with thumb and index => testicle

• masses - spermatocele
• tenderness

Question 9

Prehn’s test - differentiate between testicular pain caused by acute epididymitis and testicular torsion

Answer 9

Elevate testes to assess impact on testicular pain

-reduced pain on elevation => epididymitis

Question 10

Cremasteric reflex

Answer 10

Stroke skin => cremaster muscle contracts and pulls ipsilateral testicle towards inguinal canal

Loss of reflex => testicular torsion

Question 11

Reassessment of scrotum whilst patient stands

Answer 11

Varicocele - dull ache
Cough accentuates varicocele
-disappears when lying down

Inspect, palpate posterior scrotum for varicocele (bag of worms), hernias (mass you cannot get above)

Question 12

Further assessments and investigations

Answer 12

Abdo exam
DRE
US testicles