Male Genital Urinary Exam

Overview

• The exam includes taking a sexual history and conducting a physical examination through inspection and palpation.
• Always wear gloves during the exam.

Sexual History

• Important aspects:
  • Sexual function or response
  • Past penile discharge or lesions
  • Scrotal pain or swellings/masses

General Inspection

• Position: Patient is standing, examiner sitting on a stool.
• Inspect for:
  • Hair distribution (report Tanner stage for adolescents)
  • Inguinal swelling or pulsations
  • Penile discharge
• Scrotal inspection:
  • Note that the left side typically hangs lower
  • Look for nits or lice in the pelvic region
• Inspect the penis:
  • Check the shaft, corona, and meatus
  • Look for discharge or lesions
• Scrotal examination:
  • Inspect anterior and underside
  • Check for contour, evenness, masses, or lesions

Palpation

• Palpate the penile shaft from the base to the head
• Check for discharge at the meatus
• Palpate the vas deferens and the epididymis
• Examine testicles:
  • Ensure full coverage of the testicles during palpation

Reflex Testing

• Cremasteric reflex:
  • Stroke inner thigh on both sides
  • Look for scrotum ascent on the stroked side

Hernia Examination

• Invaginate the scrotum to feel the inguinal ring
• Have the patient turn and cough
• Check for indications of inguinal hernia

Rectal Exam

• Position: Left lateral cubitus position
• Inspect for:
  • Sebaceous cysts, lesions, abscesses
  • Fissures and hemorrhoids
• Use lubricating jelly for examination
• Digital rectal exam:
  • Perform a 360-degree sweep
  • Check prostate for nodules or tenderness

Occult Blood Test

• Apply stool sample to test card windows
• Use developer to test samples for blood presence
• Ensure the use of latex-free lubricating jelly

Patient Care

• Use drapes to protect patient modesty
• Explain procedures and ensure patient comfort throughout the exam