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The Male Sexual Exam

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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