Male Genital Exam

Overview – Male Genital Exam

The male genital exam is a routine yet vital component of clinical assessment in urology, sexual health, and general medicine. It encompasses inspection and palpation of the external genitalia and hernia screening, and may include a digital rectal exam to evaluate the prostate. The male genital exam plays a crucial role in identifying conditions such as testicular cancer, hernias, sexually transmitted infections (STIs), and prostate disease.

Preparation and Introduction

• Wash hands and introduce yourself to the patient
• Confirm the patient’s full name and age
• Explain the examination: involves inspection and palpation of the penis, testes, and hernia assessment
• Obtain informed consent
• Offer a gown or drape and provide privacy
• Ask the patient to stand (preferred for hernia inspection) or lie down if necessary
• Observe general appearance: comfort, distress, mobility

Examination of the Penis

Inspection

• Glans:
  • Note circumcision status
  • Urethral meatus: check for hypospadias, discharge (ask patient to milk shaft)
  • Retract foreskin: look for smegma, phimosis, paraphimosis
• Shaft:
  • Inspect for lesions (vesicles, warts, ulcers), nodules, inflammation (e.g., balanitis)
  • Palpate for tenderness, induration, or deformity
• Skin and Pubic Hair:
  • Inspect base of penis for lice, burrows, excoriation
  • Assess pubic hair distribution and hygiene

Examination of the Scrotum

Inspection

• Examine skin above, below, and behind the scrotum
• Identify rashes, lesions, epidermoid cysts

Palpation

• Testes and Epididymis:
  • Assess size, consistency, shape, and presence of nodules
• Spermatic Cord:
  • Palpate cord structures along the inguinal canal
• Masses:
  • Transillumination test: cystic masses will transilluminate; solid masses will not

Hernia Assessment

Inguinal Hernias

• Inspection: Ask patient to bear down or cough
• Palpation:
  • Use right index finger to examine right inguinal canal
  • If hernia present, impulse felt at fingertip on coughing
• Auscultation: Bowel sounds may be audible in large hernias

Femoral Hernias

• Palpate near femoral artery
• Hernia typically appears just medial to the artery
• Ask patient to cough to provoke herniation

Health Promotion

• Recommend monthly testicular self-examination
• Advise cleaning beneath foreskin in uncircumcised men

Digital Rectal and Prostate Examination

Patient Positioning

• Place patient in left lateral position with knees drawn up
• Ask them to move toward the edge of the bed until they contact your hip

Examination Steps

1. Inspect perianal region: fissures, haemorrhoids, lesions, discharge
2. Inform patient before beginning
3. Lubricate index finger; place at anal verge and request patient to bear down
4. Insert finger gently as sphincter relaxes
5. Assess sphincter tone by asking patient to contract anus

Rectal and Prostate Palpation

• Perform 360° sweep for masses, tenderness, faeces
• Prostate assessment:
  • Normal = smooth, rubbery with clear median sulcus
  • Abnormal = nodular, firm, asymmetrical, obliterated sulcus, or tender (suggests prostatitis)

Completion

• Inform patient before removing finger
• Wipe finger on a towel and check for blood, pus, or mucus
• Gently clean patient’s anus and allow them to dress

Summary – Male Genital Exam

The male genital exam is a fundamental clinical skill encompassing inspection and palpation of the penis, testes, and groin, as well as a rectal exam for prostate assessment. It aids in detecting testicular cancer, sexually transmitted infections, hernias, and prostate abnormalities. For a broader context, see our Clinical Skills Overview page.