ASSESSING MALE GENITALIA
PURPOSE
- To detect abnormalities that may range
from life-threatening diseases to painful
conditions that interfere with normal
function.
- DRE (Digital Rectal Exam) may also be
performed because some conditions
such as cancerous tumor.
- To reduce risks factors for diseases and
disorders of the anus, rectum, and
prostate.
COLLECTION OF OBJECTIVE DATA
• Ease client anxiety by explaining in
detail what is going to occur.
• Throughout the examination, explain the
significance of each portion to
encourage relaxation.
• Preserve modesty
• Make sure to always have a chaperone
present in the room while performing.
• Protect client and prevent false
accusations.
PREPARING THE CLIENT
• Empty bladder
• If urine specimen is necessary, provide
client with a container
• Provide a drape
• Ask to lower his pants and underwear
• Explain to client that he will be asked to
stand for most of the examination.
• Client’s torso and legs can be draped to
lessen feeling of vulnerability.
• Also, ask client to LEFT-SIDE LYING
with buttocks as close to the edge of the
examination table to bend right knee.
• Some finds it easier to have the client
stand and bends over the examination
table with hips flexed
• If an examination on the upper rectum
and sigmoid colon is necessary, a
sigmoidoscopy should be performed.
EQUIPMENT
• Stool
• Gown
• Disposable non-latex gloves
• Flashlight (for transillumination)
• Stethoscope
• Water soluble lubricant
• Specimen card
PHYSICAL ASSESSMENT
• Wear disposable gloves
• Prepare client thoroughly
• Perform examination professionally
• Preserve the client’s modesty
• Preserve client’s privacy
• Inspect and palpate penis, scrotum, and
inguinal area for inflammation,
infestations, rashers, lesions, and lumps
• During testicular examination, describe
the importance of testicular self-
examination
• Understand the structures and functions
of the anorectal region
• Make sure to have chaperone
• Wear gloves in every step of the exam
 PENIS
INSPECTION & PALPATION 3. PALPATE THE SHAFT

• Palpate any abnormalities noted during

1. INSPECT THE BASE OF THE PENIS AND inspection
PUBIC HAIR • Note hardened or tender areas.

• Sit on a stool with the client facing

NORMAL FINDINGS:
you and standing
• Ask client to raise gown or drape - Penis in non-erect state is soft, flaccid,
• Note pubic hair: and non-tender
o Growth pattern and any
excoriations
o Erythema ABNORNAL FINDINGS:
o Or infestation at the base of the
- Tenderness may indicate inflammation
penis and within the pubic hair.
or infection

NORMAL FINDINGS:
4. INSPECT THE FORESKIN
- Pubic hair is coarser than scalp hair
- Normal pubic hair pattern: • Palpate any abnormalities noted
o Covers the entire groin area, during inspection.
extending to the medial thighs • Also note any hardened or tender
and up the abdomen toward the areas
umbilicus.
- The base of the penis and pubic hair are
free of excoriation, erythema, and NORMAL FINDINGS:
infestation - The foreskin in an uncircumcised male
ABNORMAL client, is intact and uniform in color with
the penis.
- Absence or Scarcity: Chemotherapy
- Lice or nit (eggs) infestation:
Pediculosis Pubis or “crabs” ABNORMAL

2. INSPECT THE SKIN OF THE SHAFT - Discoloration of the foreskin may indicate
scarring or infection.
• Observe for rashes, lesions, or lumps.

5. INSPECT THE GLANS

NORMAL FINDINGS:
- Skin of the penis is wrinkled and
hairless
- Free of rashes, lesions, or lumps
ABNORMAL FINDINGS:
- STI or Cancer: Rashes, lesions, or
lumps
- INFECTION: Drainage around piercing
• Observe size, shape, and lesions or
redness
• If the client is uncircumcised, ask
him to retract foreskin to allow
observation of the glands.
• Note location of the urinary meatus
on the glans
NORMAL:
- Surface of the glans is normally smooth,
free of lesions and redness.
- Foreskin retracts easily
- Small amount of smegma normally
accumulates under the foreskin
ABNORMAL: 6. PALPATE FOR URETHRAL DISCHARGE
• PHIMOSIS – tight foreskin cannot be
• Gently squeeze the glands between
retracted
your index finger and thumb
• PARAPHIMOSIS – foreskin that once
retracted cannot be returned to cover the
glands
NORMAL:
• CHANCRES – (red, oval ulcerations)
from syphilis and genital warts are - The urinary meatus is normally free of
detected on foreskin discharge
• HYPOSPASDIAS – Displacement of the
urinary meatus to the ventral surface of
the penis ABNORMAL:
• EPISPADIAS – Displacement of the
• Yellow discharge: GONORRHEA
urinary meatus to the dorsal surface of
• Clear or white: URETHRITIS
the penis

ABNORMALITIES OF THE PENIS

 SCROTUM
INSPECTION
1. INSPECT SIZE, SHAPE, POSITION OF
THE SCROTUM
• Ask client to hold his penis out of the
way
• Observe for swelling, lumps, or bulges
NORMAL:
- Scrotum varies in size (accd. To
temperature) and shape
- Scrotal sac hangs below or at the level
of the penis
- Left side of the scrotal sac usually
hands lower than the right side.
ABNORMAL:
- Enlarged scrotal sac from fluid:
HYDROCELE
- From blood: HEMATOCELE
- Bowel: HERNIA
- Tumor: Cancer
- Enlargement of the veins within the
scrotum: VARIOCELE – can cause
infertility.
2. INSPECT SCROTAL SKIN
• Observe color, integrity, and lesions or
rashes
• To perform accurate inspection:
o Spread out the scrotal folds
(rugae) of the skin
o Lift the scrotal sac to inspect the
posterior skin
NORMAL:
- Scrotal skin is thin and rugated, (crinkled)
with little hair dispersion
- Color slightly darker than that of the
penis.
- Lesions and rashes not present
- Sebaceous cysts (small/yellowish, firm,
nontender, benign nodules) are normal
finding.
PALPATION
1. PALPATE THE SCROTAL CONTENTS
• Palpate each testis and epididymis
between your thumb and first two
fingers
• Note size, shape, consistency,
nodules, masses, and tenderness.
• Do not apply too much pressure to
testes for it will cause pain
NORMAL:
- Testes are ovoid, approximately:
o LONG: 3.5 to 5 cm
o WIDE: 2.5 cm
o DEEP: 2.5 cm
- Equal bilaterally in size and shape
- Smooth, rubbery, mobile, free of lesions.
- Epididymis is nontender, smooth, and
softer than the testes.
ABNORMAL:
• CRYPTORCHIDISM: absence of a
testos
• CANCER: Painless nodules
• Tenderness and welling may indicate:
o Acute orchitis
o Torsion of the spermatic cord
o Strangulated hernia
o Epididymitis
If the client has EPIDIDYMITIS, passive
elevation of the testes may relieve the scrotal
pain (Prehn Sign).
2. PALPATE EACH SPERMATIC CORD AND
VAS DEFERENS FROM THE EPIDIDYMIS
TO THE INGUINAL RING
• Spermatic cord will lie between your
thumb and finger.
• Note any nodules, swelling or
tenderness.
NORMAL:
- Spermatic cord and vas deferens should
feel uniform on both sides.
- Cord is smooth, nontender, and rope-like
 ABNORMAL:
- VARIOCELE: Palpable tortuous veins
- INFECTIONS or CYSTS: Beaded or
thickened cord.
- Cyst suggests HYDROCELE of the
spermatic cord
ASSESSMENT OF SCROTAL MASS
FOUND DURING EXAMINATION
1. If an abnormal mass or swelling was
noted, perform TRANSILLUMINATION
INGUINAL AREA
INSPECTION
1. INSPECT FOR INGUINAL AND FEMORAL
HERNIA
• Inspect inguinal and femoral areas for
bulges
• Ask client to TURN HEAD and COUGH
or to BEAR DOWN as if having a bowel
movement
• Continue to inspect the areas
NORMAL:
2. PALPATE INGUINAL LYMPH NODES
- Inguinal and femoral areas are normally
free from bulges
ABNORMAL:
- Bulges that appear at the external
inguinal ring or at the femoral canal
when the client bears down may signal a
hernia.
PALPATION
3. PALPATE FOR FEMORAL HERNIA
1. PALPATE FOR INGUINAL HERNIA AND
INGUINAL NODES
PALPATION OF RIGHT INGUINAL CANAL
• Ask client to shift weight to the left
• Place right index finger into the client’s
right scrotum and press upward,
invaginating the loose folds of the skin
• Darken the room and shine a light
from the back of the scrotum
through the mass.
• Look for a red glow
2. If you palpated a scrotal mass
• Ask client to lie down
• Note whether the mass
disappears
• If it remains, AUSCULTATE for
BOWEL SOUNDS
• Gently palpate the mass and try to
push it upward into the
abdomen.
• Palpate up the SPERMATIC CORD
until you reach the triangular-shaped,
slit-like opening of the external
inguinal ring
• Try to push your finger through the
opening
• Continue palpating up the inguinal
canal
• When finger is in the canal or at the
external inguinal ring, ask client to
bear down or cough
• Feel for any bulges against your finger
• Repeat to the opposite side
• If nodes are palpable, note size,
consistency, mobility, or tenderness
ABNORMAL:
- Enlarged or tender lymph noses may
indicate an inflammatory process or
infection of the penis or scrotum
• Palpate on the front of the thigh in the
femoral canal area.
• Ask client to bear down or cough
• Feel for bulges
• Repeat on the opposite thigh
 ANUS & RECTUM
INSPECTION 3. PALPATE THE ANUS

• Inform the client that you are going to

1. INSPECT PERIANAL AREA perform the internal examination
• Explain that it may feel like his bowels
• Spread the buttocks are going to move but that will not
• Inspect anal opening and surrounding happen.
area for the following: • LUBRICATE your gloved index finger
o Lumps • Ask client to bear down
o Ulcers • Place the pad of your index finger on the
o Lesions anal opening
o Rashes • Apply slight pressure
o Redness • This will care relaxation of the sphincter
o Fissures • NEVER use fingertip – this will cause
o Thickening of the epithelium sphincter to tighten and cause pain.

• Ask client to perform VALSALVA’S When sphincter relaxes:

MANEUVER by straining or bearing • Insert finger gently with the pad facing
down down

• Inspect anal opening for any bulges

or lesions. If sphincter does not relax and reports severe
pain:
• Document any abnormalities by
noting position in relation to a face • Spread gluteal folds with your hands in
of a clock. close approximation to the anus
• Attempt to visualize a lesion that may be
causing the pain
VALSALVA MANEUVER
• If tension is maintained on the gluteal
- Effort to exhale without letting air escape folds for 60 seconds, the anus will
through nose or mouth. normally dilate
AFTER:

2. INSPECT THE SACROCOCCYGEAL • Ask client to tighten the external

AREA
- Inspect this area for any signs of swelling,
redness, dimpling, or hair.
sphincter. Note for the tone
• Rotate finger to examine the muscular
anal ring
• Palpate for tenderness, nodules, and
hardness.

NORMAL:
NORMAL FINDINGS:
- Area is normally smooth, and free of
redness and hair. - Client’s sphincter relaxes, permitting
entry.

ABNORMAL:
4. PALPATE THE RECTUM
- A reddened, swollen, or dimpled area
covered by a small tuft hair located
• Insert your finger further into the
midline on the lower sacrum suggests
Pilonidal Cyst. rectum as far as possible.
• Turn your hand clockwise then
counterclockwise
• This allows palpation of as much rectal
surface as possible
 • Note tenderness. Irregularities, nodules,
and hardness.
NORMAL:
- The rectal mucosa is normally soft,
smooth, nontender, and free of nodules
ABNORMAL:
- Hardness and irregularities may be from
SCARRING OR CANCER
- Nodules may indicate polyps or cancer
5. PALPATE THE PERITONEAL CAVITY
• This area may be palpated in men
ABOVE the prostate gland in the area of
the seminal vesicles on the anterior
surface of the rectum.
• Note tenderness or nodules
NORMAL:
- The area is smooth and nontender
ABDNORMAL:
- RECTAL SHELF – a peritoneal
protrusion into the rectum
- May indicate a cancerous lesion or
peritoneal inflammation.
PROSTATE GLAND
1. PALPATE THE PROSTATE GLAND
• Can be palpated on the anterior
surface of the rectum
• Turn hands FULLY
COUNTERCLOCKWISE so that the
pad of your index finger faces
toward the client’s umbilicus.
• Tell the client that he may feel an urge
to urinate, but he will not
• Move the pad of your index finger
over the prostate gland, trying to feel
the sulcus between the lateral
lobes.
• Note the size, shape, and consistency
of prostate
• Note for any nodules or tenderness
NORMAL FINDING:
- Prostate is nontender and rubbery.
- It has two lateral lobes that are dived by
median sulcus.
- The lobes are smooth, 2.5 cm long and
heart-shaped.
ABNORMAL FINDING:
• Swollen, tender prostate may indicate
acute prostatitis.
SAFETY TIP:
- Palpate the prostate gland prior to
drawing a prostate-specific antigen
(PSA)
CHECK STOOL
1. Inspect STOOL
• Withdraw your gloved finger
• Inspect any fecal matter on your
glove
• Assess the color and test the feces
for occult blood
• Provide the client with a towel to
wipe the anorectal area.
NORMAL:
- Stool is normally semi-solid, brown, and
free of blood