Assessing Male Genitalia

• Assessing male genitalia involves a comprehensive assessment or focused exam.
• The purpose is to detect abnormalities ranging from life-threatening diseases to painful conditions.
• Objective data collection involves easing client anxiety by explaining the process, preserving modesty, and having a chaperone present.
• Essential to respect client privacy, be professional, and explain the procedure.
• Equipment needed includes a stool, gown, non-latex gloves, flashlight and stethoscope.
• The four steps in genital examinations are initial inspection, palpation of external structures, palpation of internal structures and palpation of surrounding areas.
• Assessment areas include the general pubic region, penis, urethra, scrotum, testes and inguinal region.

General Pubic Region

• Assess sexual maturity using Tanner stages, which evaluate pubic hair, penis, and scrotum development.
• Puberty typically begins between ages 9 and 13, lasting about 3 years, with a range of 2 to 5 years.
• Normal hair distribution is diamond-shaped, abundant in the pubic region, and may continue in a narrowing midline pattern.
• Hair should be more coarse than scalp hair, and free of nits or lice; geriatric variations include thinner and sometimes gray hair.
• Abnormal findings include pediculosis pubis and herpes simplex in genitals.

Assessing the Penis

• During inspection, examine the glans, and if uncircumcised, retract the foreskin to inspect the underlying area.
• Inspect the anterior surface first, then have the client lift the penis to check the posterior surface.
• Note the shape of the penis; normal findings include a cylindrical shape without lesions and loose, wrinkled shaft skin.
• Glans penis should be smooth, pink, bulbous, and vary in size, without lesions.
• Foreskin should retract easily and have no discharge; uncircumcised findings include a wrinkled prepuce and possible smegma.
• Circumcised findings include absent or small flaps of prepuce and absence of smegma.

Penis Palpation

• Between the thumb and first two fingers, palpate the entire length, and note any pulsations, tenderness, masses, or plaques.
• Abnormal conditions include priapism, phimosis, paraphimosis and congenital chordee.
• Other abnormalities include acquired curvature (Peyronie's disease), penile trauma (human bite, trauma-induced fistula, penile strangulation), and penile diseases such as balanitis, tinea cruris, condyloma acuminatum, penile cancer and donovanosis.

Assessing the Urethra

• Note the location of the urethral meatus and observe for discharge which can be cultured
• Normal findings include a central, slit-like opening at the distal top of the glans that is glistening, smooth, pink, and non-tender.
• Abnormalities include epispadias, hypospadias, nonspecific urethritis, and chemical urethritis.
• Hold the glans between the thumb and forefinger and gently squeeze to expose the meatus.
• If a discharge is seen, a culture should be taken; if discharge is suspected but not present, have the client milk the penis.

Assessing the Scrotum

• Displace the penis to one side, lift the scrotum to inspect the posterior side, and stand with legs slightly spread apart.
• Observe the scrotum for lesions, inflammation, swelling, nodules, and dilated testicular veins.
• Normal findings of the scrotum include loose skin, coarse surface, variable sizes, and deeper pigmentation than body skin.
• It is divided in half by a septum, with the left sac often longer than the right.
• It should contract in cold temperatures, be deeply pigmented, and have a rugose surface.
• With geriatric variation, the scrotal sac appears elongated or more pendulous.
• Abnormal findings include orchitis, sebaceous cyst, cryptorchidism, prepenile scrotum, scrotal edema, hydrocele, elephantiasis, and carcinoma.

Testes Palpation & Exam

• Gently Palpate left testicle.
• Note the the size, shape, consistency, presence of masses.
• The epididymis should also be palpated for consistency, tenderness and masses.
• The spermatic cord should also be palpated from the epididymis to the external ring for consistency and tenderness.
• The testes must be present in each sac, with the left testis often being lower than the right.
• The normal size is approximately 4cm × 3cm × 2cm (1 ½ × 1 × ¾ inches).
• It should be mildly sensitive to gentle compression but not tender.
• They should be equal in size, but not hard.
• Should have a smooth, rubbery, ovoid shape and no nodules.
• The testes should be movable and may feel softer and smaller in geriatric variations

Epididymis Palpation

• Normal findings for the epididymis include a comma shape, being non-tender, resilient, smooth, and insensitive to pressure.
• Epididymis should usually be located on the posterolateral surface of each testis and lies towards the top and back of each one.
• An abnormal finding is epididymitis.
• Normal findings for the spermatic cord include a smooth, round, and firm, wirelike feel.
• It is composed of the vas deferens, testicular artery/vein and ilio-inguinal nerve and is located above each testicle.
• It lies along the posterior aspect of the bundle and is discretely palpable from the epididymis to the external inguinal ring, but unable to specifically identify all the remaining structures.
• Abnormal findings in testes include testicular lump, spermatocele, and varicocele.

Cremasteric Reflex

• It involves striking the inner thigh with the handle of a reflex hammer.
• A normal result is the testicle and scrotum rising on the stroked side.
• ABNORMAL: Testicular torsion

Advanced Techniques

• Auscultation, performed when a scrotal mass is found, involves placing the client supine and listening over the mass for bowel sounds.
• No bowel sounds are a normal finding; a hernia is an abnormal finding.
• Transillumination, performed when a scrotal mass is found, involves telling the patient what you are going to do and informing that it is not be painful
• The room must be darkened, lighting the side behind the scrotum: a normal testicle does not illuminate.
• Abnormal findings showing serous fluid include hydrocele and spermatocele, and those showing vascular structures include varicocele, hernia, epididymis, and tumor.

Assessing the Inguinal Region

• Ask the client to stand if supine.
• Looking for swelling, enlarged nodes, and to check for hernia.
• For palpation of lymph nodes, use index and middle fingers of the right hand, palpate the skin overlying the inguinal and femoral areas. Note the size, consistency, tenderness, and mobility.
• Normal findings include small, movable, non-tender nodes less than 1cm in diameter.

Palpation of Inguinal Region

• Palpation for an indirect inguinal hernia involves asking the patient to bear down while palpating the inguinal area.
• Place the right index finger in the client's right scrotal sac above the right testicle and invaginate the scrotal skin.
• Follow the spermatic cord until you reach a triangular, slit-like opening at the external inguinal ring.
• If the inguinal area is large enough, continue to advance the finger along the inguinal canal and ask the client to turn his head and cough.
• Finger follows spermatic cord upward to triangular slit-like opening.
• As client strains, no bulging will be felt against fingertips; a tightening around the finger is normal.
• Palpation for a femoral hernia: palpate the femoral canal and ask the client to bear down.
• No bulging or swelling should occur.
• Abdominal muscle tightens and scrotum lowers as client bears down.
• Abnormal findings in the inguinal region are inguinal and scrotal hernias.