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The Male Sexual Exam

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Urological and genital examinations are performed in order to identify pathology affecting the male penis, testes and prostate. The male breast exam may also be performed to assess for disease.

Positioning: patient lying supine with one pillow

The Patient

General Features
Age, gender, general comfort
Body Habitus
Weight (change), BMI, waist-hip ratio

Male Breast Exam

If appropriate
Inspect
Enlargement, deformity, nipples
Palpate For Masses
Flat hand, spiral motion outward from nipple
Location, size, shape, consistency, mobility
Axillary Lymph Nodes
Size, tenderness, consistency, mobility

The Groin

Patient lying supine
Hernia
Inguinal / femoral
Palpate and ask patient to cough
Lymph Nodes
With or without tenderness

Testicular Examination

Patient standing, exposed from the waist down
Prepare
Consent, undress, position
Inspection
Lower abdomen, penis and scrotum
Lower Abdomen
Rashes, scars, masses
Penis
Rash, scars, ulcers, masses, swelling
Scrotum
Erythema, rash, ulcers, masses
Testicular Palpation
Between the thumb and index finger
For masses
Size
Shape
Consistency
Hard / soft / ‘bag of worms'
Tenderness
Continuity with Testes
Continuous or a separate mass
Ability to Palpate Above
Cough Impulse
Transillumination
Epididymis
Tenderness, enlargement
Spermatic Cord
Tenderness, masses
Cremasteric Reflex
Stroke inner thigh, look for retraction of testes

Digital Rectal Examination

Prepare
Consent, chaperone, undress, position
Perianal Inspection
Fissure, fistula / sinus, rash, mass, blood
Rash
Erythematous patches / plaques
Blood
From the anus
Fissure in Ano
Tear in anal opening
Abnormal Opening
Sinus / Fistula
Mass
Around or protruding from anus
Rectal Wall Palpation
Haemorrhoids, fissures, look for blood on glove
Masses
Size, consistency, mobility
Rectal Wall Tenderness
Focal / generalised / associated with mass
Blood
On the glove after rectal examination
Prostate Palpation
Size, consistency, mobility, tenderness
Size
Assess for enlargement
Nodularity
Single or multiple nodules
Tenderness

On this page: The Patient Male Breast Exam The Groin Testicular Examination Digital Rectal Examination

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Horenblas S, Krogh GV. Diagnosis and clinical presentation of premalignant lesions of the penis. Scandinavian Journal of Urology and Nephrology. 2000 Jan 1;34(203):201-14.

Kass EJ, Lundak B. The acute scrotum. Pediatric Clinics of North America. 1997 Oct 1;44(5):1251-66. Knight PJ, Vassy LE. The diagnosis and treatment of the acute scrotum in children and adolescents. Annals of surgery. 1984 Nov;200(5):664. Lont AP, Besnard AP, Gallee MP, Van Tinteren H, Horenblas S. A comparison of physical examination and imaging in determining the extent of primary penile carcinoma. BJU international. 2003 Apr 1;91(6):493-5. Pryor JL, Howards SS. Varicocele. The Urologic clinics of North America. 1987 Aug;14(3):499-513.

Ringdahl E, Teague L. Testicular torsion. Am Fam Physician. 2006 Nov 15;74(10):1739-43.

Tiemstra JD, Kapoor S. Evaluation of scrotal masses. American family physician. 2008 Nov 15;78(10). Wampler SM, Llanes M. Common scrotal and testicular problems. Primary Care: Clinics in Office Practice. 2010 Sep 30;37(3):613-26.

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