The Genitals

• Inspection of female genitalia

  • Skin - note pubic hair distribution, lesions, edema, ecchymosis, pubic pediculosis
  • Labia majora and minora - symmetrical, smooth to moderately wrinkled, slightly pigmented skin without ecchymosis, excoriation, nodules, edema, rash, lesions
  • Clitoris - note position, redness or lesions
  • Urethral orifice - note shape, color, size, discharge
  • Perineum and anus - note color, lesions, bulges, hemorrhoids
• Normal findings in female genitalia

  • Pubic hair in inverted triangular pattern, may extend to umbilicus in men
  • Labia majora and minora are symmetrical with smooth to moderately wrinkled, slightly pigmented skin
  • Clitoris is about 2 cm long and 0.5 cm in diameter, no redness or lesions
  • Urethral opening is slit-like, midline, free of discharge, swelling, redness, or lesions
  • Perineum is smooth and slightly darkened, anus is dark pink to brown and puckered
• Deviations from normal in female genitalia

  • Pubic lice, nits, or flecks of residual blood on skin
  • Ecchymosis, labial varicosities, edema, broken areas of skin, rash
  • Chancre, condylomata acuminatum, herpes simplex, hypertrophy of clitoris
  • Discharge of any color from meatus, swelling or redness around meatus
  • External tear, fissure, cystocele, cysto-urethrocele, perineal laceration, vaginal necrosis/ecchymosis, rectocele
• Palpation of female genitalia

  • Labia - soft and uniform in structure, no swelling, pain, induration, or purulent discharge
  • Urethral meatus, Skene's & Bartholin's glands - no pain or urethral discharge
  • Vaginal introitus - tight and strong muscle tone in nulliparous, diminished in parous
  • Perineum - smooth, firm, and homogenous in nulliparous, thinner in parous
• Deviations from normal in palpation of female genitalia


  • Swelling, redness, induration, or purulent discharge from labial folds
  • Significantly diminished/absent muscle tone
  • Bulging from vagina - cystocele, rectocele, uterine prolapse
  • Thin perineum, fissures, tears - atrophy, trauma, unhealed episiotomy
• Inspection of male genitalia

  • Pubic hair - triangular and coarse, sparsely distributed on scrotum and inner thigh, absent on penis
  • Penis - note color, lesions, swelling, discharge, or pubic pediculosis, retract foreskin to inspect glans
• Normal findings in male genitalia

  • Shaft skin loose and wrinkled without erection, glans smooth and free of lesions, swelling, or inflammation, no penile discharge, dorsal vein sometimes visible, foreskin retracts easily
• Palpation of male genitalia


  • Note consistency, tenderness, masses, or nodules - pulsations on dorsal sides, nontender, no masses or firm plaques
• Deviations from normal in male genitalia

  • Diminished/absent palpable pulse - possible vascular insufficiency
  • Phimosis and paraphimosis condition
  • Chancre, chancroid, penile lesions, candida, condyloma acuminatum, herpetic lesion, tinea cruris, priapism, chordee
• Penile Lesions


  Caused by Hemophilus through small breaks in epidermal tissue
• Penile Lesions


  • Pinhead papules to cauliflower – like groupings of painful lesions
• Candida


  Superficial mycotic infection of moist cutaneous sites
• Candida


  • Erythematous plaques with scaling, papule lesions and pustules
• Condyloma Acuminatum (genital warts)


  Caused by HPV infection
• Condyloma Acuminatum (genital warts)


  • Multifocal, wart-like, maculopapular lesions that are tan, brown, pink, violet, or white
• Herpetic Lesion


  Herpes simplex virus 1 and 2 cause painful eruptions of pustules and vesicles that rupture
• Herpetic Lesion


  • Fever, headache, dysuria, DYSPAREUNIA, and urinary retention may occur
• Tinea Cruris


  Fungal infection of the groin often referred to as jock itch
• Priapism


  Often associated with leukemia, metastatic carcinoma, or sickling hemoglobinopathies
• Chordee


  Ventral or dorsal curvature of penis
• Chordee


  • Ventral chordee seen with epispadias
• Phimosis


  Occurs in uncircumcised males, foreskin is unable to retract
• Scrotum


  • Skin rugated, thin, and more deeply pigmented than body color
  • Skin firmer in young men and flaccidity in older men
  • Skin free of lesions, nodules, swelling, inflammation, and erythema
  • Scrotal size and shape vary greatly
  • Left scrotal sac lower than right
• Testicles


  • Firm but not hard, oval, smooth, equal in size, and sensitive to pressure but not tender
  • Epididymis comma-shaped, distinguishable from testicle, and insensitive to pressure
  • Spermatic cord smooth and round
• Hydrocele


  Nontender Accumulation Of Fluid between two layers of tunica vaginalis in scrotum
• Hydrocele


  • May be idiopathic or a result of trauma, inguinal surgery, epididymitis, or tumor
• Spermatocele


  Nontender, well-defined cystic mass on superior testis or epididymis caused by blockage of efferent ductule of rete testis
• Varicocele


  VARICOSE VEINS of spermatic cord that feel like a "bag of worms" and slowly collapse when scrotum is elevated
• Varicocele


  • Caused by DILATED VEINS in pampiniform plexus of spermatic cord
  • Right-sided may indicate obstruction at vena cava
  • More common on the left side of the scrotum
• Sebaceous Cyst


  Round, firm, nontender CUTANEOUS CYST confined to scrotal skin
• Urethral Meatus


  • Located centrally on glans
  • Pink in white males and darker pink in darker-skinned males
  • No discharge
• Epispadias


  Urethral meatus opens on dorsal (upper) side of penis
• Hypospadias


  Urethral meatus opens on ventral (under) side of penis
• Inguinal Area


  • No red glow on transillumination
  • Nodes if palpable should be less than 1 cm and freely mobile
  • No bulges present in inguinal area
  • No palpable masses in inguinal canal
  • No portions of the bowel enter the scrotum
  • No palpable masses at femoral canal
• Anus or Rectum


  • Skin intact with slightly darker pigmentation around anus
  • Anus intact; no lesions, hemorrhoids, fissures, bleeding, or rectal prolapse
• Prostate


  • Rectum smooth and nontender with good anal sphincter tone
  • Prostate small, smooth, mobile, and nontender medial sulcus palpable negative occult blood
• Ecchymosis

  May be caused by blunt trauma
• Labial varicosities - Pregnancy or uterine tumor
• Chancre - Primary syphilis. Painless, reddish, round ulcer with depressed center and indurated edges
• •Condylomata acuminatum (venereal warts): - White, dry, painful growths with narrow bases, cause by HPV - human papilloma virus