MED 2.2 Examination of The Male Genitalia
MED 2.2 Examination of The Male Genitalia
2
Examination of the Male Genitalia
Alfredo R. Guzman, MD
11 August
2014
Rudeness is merely an expression of fear. People fear they won't get what they want.
M. Gustav, The Grand Budapest Hotel
Paulo Coelho
TOPIC OUTLINE
I.
II.
Anatomical Appreciation
Anatomy of the Male Genitalia
a. Innervation & Erection
b. The Groin
c. Inguinal Hernias
III. Health History
IV. Symptom Analysis
a. Pain
b. Dysuria
c. Frequency
d. Incontinence
e. Polyuria
f. Reddish Urine
g. Discharge
h. Lesions
i. Genital Rash
V. Testiicular Self-Examination
VI. Techniques of Examination
a. Penis
b. Scrotum
VII. Hernias
a. Inspection
b. Palpation
c. Differentiation of Hernias in the Groin
VIII. Summary
IX. Abnormalities of the Penis & Scrotum
X. STD of Male Genitalia
a. Genital Warts
b. Genital Herpes Simplex
c. Primary Syphilis
d. Chancroid
XI. Abnormalities of the Testis
a. Cryptorchidism
b. Small testis
c. Acute Orchitis
d. Tumor of the Testis
XII. Abnormalities of the Epididymis & Spermatic Cord
a. Spermatocele & Cyst of the Epididymis
b. Acute Epididymitis
c. Tuberculous Epididymitis
d. Varicocele of the Spermatic Cord
e. Torsion of the Spermatic Cord
XIII. Inguinal Hernias
a. Indirect
b. Direct
XIV. Femoral Hernia
ANATOMY
THE STUFF THIS GUY IS MADE OF!
Carefully assessed in
inflammation and malignancy
Testes: drains to the abdominal nodes
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Examination of the
Male Genitalia
children, may be
adults
ABOVE inguinal
ligamentm near
its midpoint
(internal inguinal
ring)
RARELY into
scrotum
The hernia
bulges
ANTERIORLY
and PUSHES the
SIDE of the finger
forward
BELOW inguinal
ligament; appears
more lateral than
an inguinal hernia
Hard to
differentiate from
lymph nodes
NEVER into
scrotum
Inguinal Canal is
EMPTY
HEALTH HISTORY
From 2D 2016 trans lifted from Bates
Common or Concernaing Symptoms
A. SEXUAL PREFERENCE AND SEXUAL RESPONSE
Direct Inguinal
Most common,
all ages, both
sexes. Often in
Indirect
Inguinal
Less common.
Usually in men
Femoral
Least common.
FEMALE < MALE
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Examination of the
Male Genitalia
SYMPTOM ANALYSIS
PAIN
Flank pain
Distension of ureters, renal
pelvis, or bladder
CVA pain
Renal capsule distention
Acute
pyelonephritis
or
obstructive hydronephrosis
Spasmotic, colicky
Distention of ureter
pain
May be referred to (unilateral)
testis
Lower abdominal
Distended bladder
fullness/suprapubic Accompanied by desire to
pain
urinate
Groin pain
Pathology in spermatic cord,
testicle, or prostate
Lymphadenitis, hernia, herpes
zoster
Neuropathy
(ilioinguinal,
genitofemoral, obturator, T12,
L1, L2)
Pneumaturia
Fecaluria
Pyuria
DYSURIA
Instrumentation, bowel fistula
Gas-producing bacteria (E. coli or
Clostridia)
Fecal material in urine rare
Results from fistula usually with
diverticular disease, cancer, or Crohns
Pus in urine
Bacterial inflammation, cancer, renal
stones, cystitis, prostatitis
FREQUENCY
Decreased bladder size, bladder wall irritation, increased urine
volume
Prostatic hypertrophy, diabetes
INCONTINENCE
Overflow incontinence prostatic hypertrophy
Stress incontinence muscular dysfunction
POLYURIA
Up to 2-3L per day
Diabetes mellitus vs. diabetes insipidus vs psychogenic
diabetes insipidus
REDDISH URINE
Hematuria
Early in flow
Urethral cause
Late in flow
Bladder neck or proximal
urethra
Throughout flow
Prostate
gland
or
big
hemorrhage
1-2 weeks after URI
Glomerulonephritis
With weight loss
Renal carcinoma
Hemoglobinuria
Strenuous physical activity
Blood on
External cause for bleeding
undergarments
Beets,
dyes,
or
drugs
without blood in urine
(pyridium)
Bloody
Purulent (thick
yellowish green)
DISCHARGE
Ulcerations, cancer, or urethritis
Gonococcal urethritis or chronic
prostatitis
LESIONS
Various STDs
Lesions refer to SHIT
GENITAL RASH
Psoriasis
Well-defined bright red scaling
plaques
Contact dermatitis Rash with itching
Drug eruptions
Multiple well-defined macular,
eczematous patches
Sudden onset after drug is given
Lichen planus
Flat shiny papules
(inflammatory
May have white streaks on buccal
disorder)
mucosa
TESTICULAR SELF-EXAMINATION
Men, especially those between ages 15-35
Monthly testicular examination
Best performed after a warm bath or shower
Steps
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Examination of the
Male Genitalia
HERNIAS
INSPECTION
Inspect inguinal and femoral areas for bulges.
Ask the patient to strain down or cough
Both of these maneuvers increase intra-abdominal pressure,
forcing intestines/omentum/peritoneal fluid through any
defect which may exist and making a hernia more apparent.
A bulge that appears on straining suggests a hernia.
Usually present as diffuse swelling amidst the cord structures
or the inguinal canal area appears to be protuberant
PALPATION
Palpate for inguinal hernias
FEMORAL HERNIA
Above
inguinal
ligament,
near its
midpoint
(the
internal
inguinal
ring)
Above
inguinal
ligament,
close to
the pubic
tubercle
(near the
external
inguinal
ring)
Below the
inguinal
ligament;
appears more
lateral than an
inguinal hernia
and may be
hard to
differentiate
from lymph
nodes
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Examination of the
Male Genitalia
Course
With the
examining
finger in
the
inguinal
canal
during
straining
or cough
Often in
the
scrotum
The
hernia
comes
down the
inguinal
canal and
touches
the
fingertip
Rarely in
the
scrotum
The
hernia
bulges
anteriorly
and
pushes
the side
of the
finger
forward
Never in the
scrotum
The inguinal
canal is empty
Hypospadias
A congenital displacement of
the urethral meatus to the
inferior surface of the penis.
A groove extends from the
actual urethral meatus to its
normal location on the tip of
the glans
Scrotal Edema
Pitting edema may make the
scrotal skin taut
seen in heart failure or
nephrotic syndrome.
Peyronies Disease
Hydrocele
Scrotal Hernia
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Examination of the
Male Genitalia
BB
SEXUALLY TRANSMITTED DISEASES
OF MALE GENITALIA
GENITAL WARTS (CONDYLOMATA ACUMINATA)
Appearance
single or multiple papules or
plaques of variable shapes
may be round, acuminate (or
pointed), or thin and slender
may be raised, flat, or
cauliflower-like (verrucous)
Causative Organism
HPV
usually from subtypes 6,11
carcinogenic subtype: rare
Incubation: weeks to months
infected contact may have no
visible warts
Can arise on penis, scrotum,
groin, thighs, anus; usually
asymptomatic,
occasionally
cause itching and pain.
May
disappear
without
treatment.
GENITAL HERPES SIMPLEX
Appearance
small, scattered or grouped
vesicles (1-3 mm) on glans or
shaft of penis
appear as erosions if vesicular
membrane breaks
Causative Organism
HSV 2
double-stranded DNA virus
Incubation: 2-7 days after
exposure
Primary
episode
may
be
asymptomatic;
recurrence
usually less painful, of shorter
duration
Associated with fever, malaise,
headache, arthralgia, local pain
and edema, lymphadenopathy
Need to distinguish from genital
herpes zoster.
PRIMARY SYPHILIS
Appearance
small red papule that becomes
a chancre, or painless erosion
up to 2 cm in diameter
base of chancre is clean , red,
smooth and glistening
borders
are
raised
and
indurated.
chancres heal within 3-8 wks
Causative organism
Treponema Pallidum
Incubation: 9-90 days after
exposure
May develop inguinal lymphadenopathy within 7 days
Lmph
nodes
are
rubbery,
nontender, mobile.
20-30% of patients develop 2
syphilis
while
chancre
still
present suggests coinfection
with HIV
CHANCROID
Appearance
red papule or pustule initially,
then forms a painful deep ulcer
with ragged non-indurated
margins
contains necrotic exudate, has
a friable base
Causative organism
Haemophilus ducreyi
anaerobic bacillus
Incubation: 3-7 days after
exposure
Painful inguinal adenopathy.
ABNORMALITIES OF THE
EPIDIDYMIS AND SPERMATIC CORD
SPERMATOCELE AND CYST OF THE EPIDIDYMIS
A painless, movable cystic mass
just above the testis
Both transilluminate
Spermatocele: contains sperm,
Cysts of epididymis does not
Clinically indistinguishable
ACUTE EPIDIDYMITIS
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Examination of the
Male Genitalia
TUBERCULOUS EPIDIDYMITIS
Firm enlargement of the
epididymis, which is sometimes
tender
With thickening or beading of
the vas deferens
DIRECT
FEMORAL HERNIA
FREQUENCY,
AGE, AND
SEX
POINT OF
ORIGIN
COURSE
EXAMINING
FINGER IN
INGUINAL
CANAL DURING
STRAINING
REVIEW QUESTIONS
1. It is readily visible in proctoscopic examination but not
palpable?
2. These may also prolapsed at the anal canal and appear as
reddish, moist mass located in one or more locations
3. Presence of transillumination of scrotum suggests:
4. Congenital ventral displacement of the meatus of the penis
5. Multiple tortuous veins in this area may be visible/ palpable
may indicate
6. A fully developed scrotum on one or both sides suggests
7. Prepuce that once retracted cannot be returned
8. Painless moveable cystic mass just above testis that
transilluminates suggests
9. Induration at the ventral side of the penis suggest
10. Painful erections (and a lot more symptoms)
Carcinoma
Hypospadia
Epididymal cyst
Pectinate/ Dentate line
Cryptorchidism
Internal haemorrhoids
Paraphimosis
Varicocele
Hydrocele
Peyronies disease
Answers:
1.D, 2.F, 3.I, 4.B, 5.H, 6.E, 7.G, 8.C, 9.A, 10.J
TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.
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