Male Genitalia

• Inspection


  Visual examination
• Inspection of pubic hair

  • Note hair distribution pattern
  • Normal: triangular, sparsely distributed on scrotum and inner thigh, absent on penis, coarse genital hair, no nits or lice
  • Deviations from normal: sparse, absent hair (alopecia)
• Inspection of penis


  • Note color, lesions, swelling, discharge, or pubic pediculosis on dorsal, lateral, and ventral sides
  • If UNCIRCUMCISED, retract foreskin and note ease of retraction and inspect glans
  • Normal: No lesions or inflammation, 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
  • Deviations from normal: Chancre (signals primary syphilis), Chancroid, Penile Lesions (Condyloma Acuminatum, Candida, Herpetic Lesion, Tinea Cruris), Priapism, Chordee, Phimosis
• Inspection of scrotum


  • Note color, hair distribution, lesions, size, shape, and position
  • Normal: Scrotal skin rugated, thin, and more deeply pigmented than body color, skin firmer in young men and elongates with 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
  • Deviations from normal: Scrotal Mass, Scrotal Swelling (Hydrocele, Spermatocele, Varicocele, Sebaceous Cyst)

  
• Inspection of urethral meatus


  • Note position of urinary meatus
  • Normal: Located centrally on glans, pink in white males and darker pink in darker-skinned males, no discharge
  • Deviations from normal: Epispadias, Hypospadias
• Inspection of inguinal area

  • Note condition of skin, enlarged lymph nodes, have patient bear down and note any bulges
  • Normal: No swelling or bulges, lymph nodes nonpalpable
  • Deviations from normal: Bulge (may indicate a hernia or enlarged lymph node)
• Assessment techniques for anus

  • Note skin condition, lesions, rectal prolapse, hemorrhoids, fissures, bleeding, or discharge
  • Normal: Skin intact with slightly darker pigmentation around anus, anus intact; no lesions, hemorrhoids, fissures, bleeding, or rectal prolapse
  • Deviations from normal: STD lesions, warts, hemorrhoids, fissures, bleeding, rectal prolapse
• Assessment techniques for penis

  • Lightly palpate shaft with thumb and index finger, note consistency, tenderness, masses, or nodules
  • Normal: Pulsations on dorsal sides, nontender, no masses or firm plaques
  • Deviations from normal: Diminished/absent palpable pulse (possible vascular insufficiency), priapism, phimosis and paraphimosis
• Assessment techniques for urethral meatus

  • Note discharge
  • Normal: No discharge and drainage
  • Deviations from normal: Purulent discharge or mucus shreds (bacterial infection of GU tract)
• Assessment techniques for scrotum

  • Use thumb and two fingers to gently palpate scrotum, and note size, shape, consistency, mobility, tenderness, masses, or nodules of testes, palpate the epididymis and vas deferens on posterolateral surface and note swelling or nodules, transillumination
  • Normal: Scrotum contains a testicle and epididymis on each side, 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
  • Deviations from normal: Unilateral mass palpated within or about the testicle, intratesticular masses, testicular torsion, indurated, swollen, tender epididymis, undescended testes, orchitis, atrophic testicle and scrotal edema, red glow on transillumination (serous fluid within scrotal sac)
• Assessment techniques for inguinal area

  • Palpate horizontal and vertical lymph nodes, check for hernias
  • Normal: 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
  • Deviations from normal: Unilateral or bilateral enlargement of inguinal lymph nodes (bacterial infection or metastatic disease), hernias (indirect inguinal, direct inguinal, femoral)
• Assessment techniques for rectum

  • If indicated, change gloves and apply water-soluble lubricant on index finger, have patient bend over exam table and bear down, gently insert finger into rectum, and note sphincter tone, tenderness, masses, hemorrhoids, or bleeding
• Assessment techniques for prostate

  • Note size, shape, symmetry, consistency, mobility, nodules, tenderness, withdraw fingers and test for occult blood if stool present
  • Normal: Rectum smooth and nontender with good anal sphincter tone, prostate small, smooth, mobile, and nontender medial sulcus palpable, negative occult blood
  • Deviations from normal: Soft, nontender, enlarged prostate (BPH), firm, tender, or fluctuant mass on prostate (acute bacterial prostatitis), extremely tender, warm prostate (bacterial prostatitis), firm, hard, or indurated single or multiple nodules (possible prostate cancer), positive occult blood test, palpable mass or nodule (polyp, internal hemorrhoid, rectal cancer)