Male

• Genitourinary assessment


  Physical assessment of the male genitalia, inguinal area, anus, rectum and prostate gland
• Wear disposable gloves
• Prepare the client thoroughly for the physical examination

  • To put the client at the greatest ease
• Perform the examination professionally

  • Preserve the client's modesty
• Inspection and palpation of penis, scrotum, and inguinal area

  Check for inflammation, infestations, rashes, lesions, and lumps
• During testicular examination

  • Describe the importance of testicular self-examination and explain how to perform the examination as you are performing it
• Understand the structures and functions of the anorectal region
• Make sure to have a chaperone in the room while performing the examination
• Equipment


  • Stool
  • Gown
  • Disposable non-latex gloves
  • Flashlight (for possible transillumination)
  • Stethoscope (for possible auscultation)
  • Water soluble lubricant
• Before the physical examination

  1. Introduce self and verify the client's identity using agency protocol

  2. Explain to the client what you are going to do, why it is necessary, and how he can participate

  3. Perform hand hygiene, apply gloves, and observe other appropriate infection prevention procedures

  4. Provide for client privacy
• Preparing the client


  1. Instruct the client to empty his bladder so that he will be comfortable

  2. If a urine specimen is necessary, provide the client with a container

  3. If the client is not wearing an examination gown, provide a drape and ask him to lower his pants and underwear

  4. Explain to the client that he will be asked to stand (if able) for most of the examination of the genitalia
• Pubic hair


  Coarser than scalp hair, covering the entire groin area in adults
• Normal findings of pubic hair

  • The base of the penis and the pubic hair are free of excoriation, erythema, and infestation
• Abnormal findings of pubic hair

  • Absence or scarcity of pubic hair may be seen in clients receiving chemotherapy
  • Presence of lice or nit (eggs) infestation at the base of the penis or pubic hair is known as pediculosis pubis
• Normal findings of penis skin

  • The skin of the penis is wrinkled and hairless and is normally free of rashes, lesions, or lumps
• Abnormal findings of penis skin

  • Rashes, lesions, or lumps may indicate STI or cancer
• Normal findings of penis palpation

  • The penis in a non erect state is usually soft, flaccid, and non tender
• Abnormal findings of penis palpation

  • Tenderness may indicate inflammation or infection
• Normal findings of foreskin

  • The foreskin, which covers the glans in an uncircumcised male client, is intact and uniform in color with the penis
• Abnormal findings of foreskin


  • Discoloration of the foreskin may indicate scarring or infection
• Normal findings of glans

  • The glans size and shape vary, appearing rounded, broad, or even pointed
  • The surface of the glans is normally smooth, free of lesions and redness
  • The urinary meatus is slit-like and normally found in the center of the glans
• Abnormal findings of glans

  • Chancres (red, oval ulcerations) from syphilis, genital warts, and pimple-like lesions from herpes are sometimes detected on the glans and foreskin
  • Phimosis; Paraphimosis
  • Hypospadias; Epispadias
• Normal findings of urethral discharge


  • The urinary meatus is normally free of discharge
• Abnormal findings of urethral discharge

  • A yellow discharge is usually associated with gonorrhea
  • A clear or white discharge is usually associated with urethritis
• Gonorrhea


  • Urethritis
• Tanner Stages of Male Pubic Hair and External Genital Development


  • Stage 1: None, except for body hair like that on the abdomen
  • Stage 2: Scant, long, slightly pigmented at base of penis
  • Stage 3: Darker, begins to curl and becomes more coarse; extends over pubic symphysis
  • Stage 4: Continues to darken and thicken; extends on the sides, above and below
  • Stage 5: Adult distribution that extends to inner thighs, umbilicus, and anus
• Normal findings of scrotum

  • The scrotum varies in size (according to temperature) and shape
  • The scrotal sac hangs below or at the level of the penis
  • The left side of the scrotal sac usually hangs lower than the right side
• Abnormal findings of scrotum

  • An enlarged scrotal sac may result from fluid (hydrocele), blood (hematocele), bowel (hernia), or tumor (cancer)
• Hydrocele


  • Common, clear fluid in tunica vaginalis
• Varicocele


  • Engorged spermatic cord veins (pampiniform plexus), common cause of infertility/oligospermia
• Spermatocele


  • Epididymis dilatation from trauma/infection, multilocular, containing sperm
• Hematocele


  • Blood in tunica vaginalis, from trauma or tumours
• Normal findings of scrotal skin

  • Scrotal skin is thin and rugated (crinkled) with little hair dispersion
  • Color is slightly darker than that of the penis
  • Lesions and rashes are not normally present
  • Sebaceous cysts (small, yellowish, firm, non tender, benign nodules)
• Abnormal findings of scrotal skin

  • Rashes, lesions, and inflammation are abnormal findings
• Normal findings of testis and epididymis palpation

  • Testes are ovoid, approximately 3.5-5 cm long, 2.5 cm wide, and 2.5 cm deep, and equal bilaterally in size and shape
  • Testes are smooth, firm, rubbery, mobile, free of nodules, and rather tender to pressure
  • The epididymis is non tender, smooth, and softer than the testes
• Abnormal findings of testis and epididymis palpation

  • Absence of a testis suggests cryptorchidism (an undescended testicle)
  • Painless nodules may indicate cancer
  • Tenderness and swelling may indicate acute orchitis, torsion of the spermatic cord, a strangulated hernia, or epididymitis
  • Palpable, tortuous veins suggest varicocele
  • A beaded or thickened cord indicates infection or cysts
  • A cyst suggests hydrocele of the spermatic cord
• Normal findings of transillumination

  • Normally scrotal contents do not transilluminate
• Abnormal findings of transillumination

  • Swellings or masses that contain serous fluid (hydrocele, spermatocele) — light up with a red glow
  • Swellings or masses that are solid or filled with blood (tumor, hernias, or varicocele) — do not light up with a red glow
• Normal findings of auscultation

  • Normal findings are not expected
• Abnormal findings of auscultation

  • Bowel sounds auscultated over the mass indicate the presence of bowel and thus a scrotal hernia
  • Bowel sounds will not be heard over a hydrocele