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The Male Sexual Exam

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

Read More...

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