Learning_objectives

  • To understand the indications for performing a male genital examination.
  • To understand what is an appropriate environment for this examination.
  • To understand the need to request a chaperone.
  • To demonstrate the ability to perform a male genital examination on a model.

Theory_and_background

Underpinning a male genital examination which is part of the urogenital system, knowledge of the anatomy & physiology of the male genitalia together with applying the basics of the examination, knowing why you do and knowing how to do this examination are essential.

Indications

The history the patient presents with determines why the examination is conducted and what the anticipated findings may be.

Therefore, take a full and as comprehensive history as you can obtain.

Examples of presenting complaints may include: lump, swelling, discharge or pain

The following list of reasons why a patient may present is by no means exhaustive.

  • Passing blood/mucus
  • Presence of lumps or other palpable abnormalities
  • Urinary symptoms
  • Neurological symptoms
  • Health check-up as part of a “Well man’s clinic”

Patient safety

The right environment

The room that the examination is taking place in should be warm and private, with the examination couch off set from the centre of the room. This prevents anyone being unnecessarily exposed if somebody inadvertently enters the room.

  • There should be a good light source that will adequately illuminate the area being examined.
  • There should be screens offering privacy to the patient whilst they disrobe from the waist down with a clean gown or blanket available to preserve modesty.
  • If any samples or swabs are being taken, ensure you know how to complete the paperwork and forward those samples etc. to the correct lab’.
  • There should be handwashing facilities.

Ideally the patient should be relaxed and in a warm environment. The patient should ideally supine on the examination couch, and a chaperone may be able to assist with positioning and helping the patient.

Equipment preparation

The following is a suggested list of equipment.

  • Couch, with sheet and covering blanket
  • Hand wash solution or access to sink
  • Gloves
  • Pen torch for trans illumination
  • Paper to roll up or a small sheet to cover the patient’s genitalia – To aid trans illumination.
  • Clinical waste bin
  • Microbiology equipment & paper work

Procedure

Inspection

  • Observe the patient in general – are they in pain?
  • Observe the distribution of facial, axillary and abdominal hair and note the breasts for evidence of gynaecomastia (if appropriate)
  • Inspect the genitals for any abnormalities (swellings, discharge, rashes etc)
  • Examination of the penis is usually carried out with the patient in a supine position

Examination of the scrotum

  • Inspect the scrotal skin which is pigmented compared to the rest of body
  • The left testis usually lies lower than the right but both should be visible
  • The tone of the dartos muscle is influenced by ambient temperature
  • Consequently the normal scrotal appearance varies with temperature

 

Examination of testes

  • Commonly the dartos will contract under stressful circumstances. To avoid the testis retracting into the inguinal canal place your left hand over the inguinal canal to ‘capture’ the testis in the scrotum.
  • Use gentle pressure to examine both testis (one at a time)
  • Using the thumb and first two fingers
  • Note the size and consistency of the testis
  • To size the testis you may use an orchidometer this is a chart or a set of beads indicating the size / volume of the testicle in millilitres.

Palpation of the testes

  • Palpate the epididymis situated along the posterolateral surface
  • This should feel smooth and is broadest superiorly, at its head
  • Finally roll with the finger and thumb to palpate the vas deferens
  • Examination of the scrotum & testes should be performed with the patient supine unless indicated in history e.g. hydrocele, hernia etc. in which case you would examine the patient in the standing position as well.

Orchidometer

A set of beads such as those depicted to the right may be used to estimate the size of the patient’s testis.

Examination of the penis

  • Gently retract foreskin to expose the glans (the patient may wish to do this themselves)
  • The foreskin should be supple allowing smooth and painless retraction.
  • Observe the glans penis for any abnormalities
  • An odourless, curd-like smegma often underlies the foreskin
  • Inspect both ventral and dorsal surfaces of the shaft of the penis for any abnormalities

Examine the urethral meatus

Using your thumb apply gentle pressure to the glans to gently open the urethral meatus, this should expose healthy glistening pink mucosa.

If there is any discharge then a swab should be taken. Make sure you know how to take the swab and equally important, know how to complete the paperwork and forward the sample to the correct laboratory.

If the patient has complained of urethral discharge and no discharge is apparent the patient may be shown how to take a swab themselves next time the discharge is noticed.

At the end of the examination

Always replace the foreskin (if present) at the end of the examination.

Recording_your_findings

Record your findings on the appropriately formatted history note sheet. Not forgetting that you should have:

  • Patient identification including their hospital / NHS number where applicable
  • Date, time
  • Signature and name printed together with title

When documenting or describing your findings remember to comment on the:

  • Penis
  • Scrotum
  • Scrotal contents – testes vas deferens epididymis, spermatic cord and any abnormal masses.

Remember to describe your findings as fully as possible and aided with any diagrams that you may wish to draw.