The male genital examination is a vital component of a comprehensive physical assessment, playing a significant role in the early detection of testicular and penile complications. This article delves into the indications, relevant anatomy, techniques for inspection and palpation of the penis, scrotum, and contents, as well as the significance of testicular self-examination.
Indications
A male genital examination is indicated during routine physical exams and when a patient presents with testicular or penile complications such as pain, swelling, or other abnormalities.
Anatomy
The male reproductive system comprises various accessory ducts, including the ductus deferens, ejaculatory duct, and epididymis. The testes, enclosed within the scrotum, contain seminiferous tubules responsible for sperm production. Leydig cells, located within the testes, produce androgens such as testosterone. The penis consists of the glans, prepuce (in uncircumcised males), shaft, and urethra, with the urethral meatus appearing as a vertical, slit-like opening. The scrotum is a sac of skin and superficial fascia that houses the testes and is divided by a midline septum to form two compartments.
Technique for Penis Examination
The male genital examination consists of two main components: inspection and palpation of the penis and inspection and palpation of the scrotum and its contents.
The examiner should inspect the skin, prepuce, glans, and area around the base of the penis, noting any ulcerations, scars, nodules, signs of inflammation, or excoriations. The foreskin should be retracted gently if possible, and the presence of smegma should be noted. If the patient reports a history of discharge, the examiner should gently milk the shaft and collect a sample for analysis using a glass slide or culture material.
The examiner should palpate the shaft of the penis between the thumb and first two fingers, noting any tenderness, induration, or other abnormalities.
Technique for Scrotum and Contents Examination
Inspection
The patient should be standing and facing the examiner. The examiner should inspect the scrotal skin, testes position, and posterior surface by lifting the scrotum, noting any swelling, lumps, rashes, or loss of rugae.
Palpation
Using a gentle approach and warm hands, the examiner should palpate each testis, epididymis, spermatic cord, and external ring. Findings should be noted, including size (measured with an orchidometer), shape, consistency, tenderness, presence of nodules, dilated veins, thickening, or other abnormalities.
Testicular Self-Examination
The testicular self-examination is essential for the early detection of abnormalities. It may be easiest to perform after a warm shower or bath, as heat relaxes the scrotum. The patient should examine each testicle separately, cupping it between the thumb and fingers and rolling it gently. The epididymis, a soft, tube-like structure at the back of the testicle, should also be identified. Patients should report any abnormalities to their doctor immediately.
Recording the Findings
A normal exam should include documentation of the following: circumcision status, absence of penile discharge or lesions, absence of scrotal swelling or discoloration, bilaterally descended testes with smooth surface and no masses, non-tender epididymis, and absence of inguinal or femoral hernias. Additionally, the examiner should note that the prepuce is easily retractable in uncircumcised males and that the urethral meatus is in the appropriate location.
Conclusion
The male genital examination is crucial in the early detection of testicular and penile complications. Healthcare providers must be proficient in the techniques associated with the examination, and patients should regularly perform testicular self-examinations. Proper documentation of the findings is essential for accurate medical records and to ensure the appropriate follow-up if any abnormalities are detected.
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