ANATOMIC REVIEW AND PHYSICAL EXAM OF MALE GENITALIA

JAY GILBAUGH, MD

CLASS #8, LESSON #15

This lesson will cover a brief review of male anatomy and common disorders of the male genitourinary tract,
prostate and rectum.

I. INTRODUCTION

II. ANATOMIC REVIEW

A. Penis

B. Scrotum

C. Inguinal Canal

D. Testes

E. Epididymis

F. Spermatic Cord

G. Prostate Gland

H. Seminal Vesicles

III. GENITOURINARY HISTORY

A. Previous GU surgeries or conditions

B. Previous urinary tract infections or STDs

C. Testicular pain or mass

D. Penile lesion or discharge

E. Voiding History:

1. quality of urinary stream

2. nocturia - quantitate

2. urinary frequency

3. hesitancy, urgency, double voiding, post-void dribbling or feeling of incomplete

emptying

4. dysuria

6. hematuria

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 7. incontinence

a) stress

b) urge

F. Sexual history

1. quality of libido

2. quality of erections

3. problems with ejaculation

IV. APPROACH TO PHYSICAL EXAMINATION

A. General

1. Inspection, palpation, transillumination

2. Exam easiest with patient standing

3. Professional, straight-forward approach will minimize patient anxiety

B. Penis

1. Physical exam technique:

a) inspection of shaft for gross lesions

b) palpate shaft for plaques

c) retract foreskin, if present (except in infants)

d) examine glans for gross lesions

e) examine meatus for size and location

f) evert meatus to inspect fossa navicularis

g) examine for urethral discharge

h) reduce foreskin after exam!

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 2. Common abnormalities:

a) Shaft

(1) Peyronie's disease

(2) skin lesions:

(a) herpes

(b) condylomata accuminatum (venereal warts)

(c) molluscum contagiosum

(3) Priapism - persistent, prolonged erection

b) Prepuce

(1) phimosis

(2) paraphimosis

c) Glans

(1) balanitis/ balanoposthitis

(3) pearly papules

(4) chancre/ulcer

d) Meatus

(1) stenosis

(2) abnormality of position:

(a) epispadias

(b) hypospadias

(c)
C. Scrotum:

1. Exam technique:

a) inspection for gross lesions

b) palpate for thickness

c) palpate inguinal canal

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 2. Common abnormalities:

a) sebaceous cysts of scrotum

b) scrotal edema

b) scrotal erythema

(1) yeast infection

(2) Fournier's gangrene (necrotizing fasciitis)

d) inguinal hernias

D. Scrotal Contents

1. Exam technique:

a) palpate testis for consistency and masses

b) palpate epididymis for consistency, tenderness and masses

c) palpate vas deferens for presence

d) palpate spermatic cord for varicosities - have patient perform valsalva

maneuver

e) check cremasteric reflex

. 2. Common abnormalities:

a) Testis:

(1) hydrocele – transilluminate

(2) testicular cancer

(5) testicular torsi

b) epididymis:

(1) epididymitis

(2) spermatocele (epididymal cyst)

c) spermatic cord:

(1) varicocele

E. Groin - palpate for presence of inguinal adenopathy

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E. Prostate

1. Exam technique:

a) use plenty of water-soluble lubricant

b) have patient bear down as if having a bowel movement

c) palpate both sides of prostate to compare size, consistency and tenderness

2. Common abnormalities:

a) prostatic hypertrophy

b) prostatitis syndromes

c) prostate cancer