Have patient lying or standing to start examination.
Male Genitalia
Examination
Technique
Findings
Wear gloves on both hands
Inspect pubic hair
EXPECTED: Coarser than scalp hair.
EXPECTED: Male hair pattern distribution. Abundant in pubic region, continuing around scrotum to anal orifice, possibly continuing in narrowing midline to umbilicus. Penis without hair, scrotum with scant hair.
UNEXPECTED: Alopecia.
Inspect glans penis
EXPECTED: Dorsal vein apparent. Foreskin easily retracted. White, cheesy smegma visible over glans.
UNEXPECTED: Tight foreskin (phimosis). Lesions or discharge.
EXPECTED: Dorsal vein apparent. Exposed glans erythematous and dry.
UNEXPECTED: Lesions or discharge.
Examine external meatus of urethra (foreskin retracted in uncircumcised patient)
EXPECTED: Slit-like opening.
UNEXPECTED: Pinpoint or round opening.
EXPECTED: On ventral surface and only millimeters from tip of glans.
UNEXPECTED: Anyplace other than tip of glans or along shaft of penis.
EXPECTED: Opening glistening and pink.
UNEXPECTED: Bright erythema or discharge.
Palpate penis
Palpate the shaft of the penis.
EXPECTED: Soft (flaccid penis).
UNEXPECTED: Tenderness, induration, or nodularity. Prolonged erection (priapism).
Strip urethra
Firmly compress base of penis with thumb and forefinger; move toward glans.
EXPECTYED: No discharge
UNEXPECTED: Discharge.
Inspect scrotum and ventral surface of penis
EXPECTED: Darker than body skin and often reddened in red-haired patients.
EXPECTED: Surface possibly coarse. Small lumps on scrotal skin (sebaceous or epidermoid cysts) that sometimes discharge oily material.
EXPECTED: Asymmetry. Thickness varying with temperature, age, emotional state.
UNEXPECTED: Unusual thickening, often with pitting.
Palpate inguinal canal for direct or indirect hernia
With patient standing, ask him to bear down as if for bowel movement. While he strains, inspect area of inguinal canal and region of fossa ovalis.
Ask patient to relax, and insert examining finger into lower part of scrotum and carry upward along vas deferens into inguinal canal, as shown in figure on p. 182. Ask patient to cough. Repeat examination on opposite side.
EXPECTED: Presence of oval external ring.
UNEXPECTED: Feeling a viscus against examining finger with coughing. If hernia felt, note as indirect (felt within inguinal canal or even into scrotum) or direct (felt medial to external canal).
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