Introduction
- Wash hands (and don PPE if needed)
- Introduce yourself (name and role)
- Confirm patient’s name and DOB
- Explain what the examination involves
- Explain need for chaperone
- Gain consent to continue
- Ask if patient in any pain before continuing
Gather equipment
- Gloves
General Inspection
Penis, groin and abdomen
- Skin changes - brusing swelling, warts, erythema
- Scars
- Masses
- Retract foreskin to inspect glans
Scrotum and perineum
Ask the patient to lift their penis out of the way to allow for close inspection of scrotum and perineum
- Skin changes
- Scars
- Masses
- Swelling
- Bruising
Palpation
Testicles
- Box technique to palpate the whole testicle
- Palpate the epididymis and spermatic cord
- If mass found, assess for site, size, shape, consistency, tenderness, fluctuant, transillumination, cough impulse and ability to get above the lump.
Prehn’s test
Used to differentiate testicular pain caused by acute epididymitis and Testicular Torsion
- Elevate the testes and assess the impact on pain
- A reduction in pain is associated with epididymitis
- Doppler is needed to rule out torsion
Cremasteric reflex
Loss of the reflex is associated with Testicular Torsion
- Stroke inside of thigh
- Ipsilateral testicle should move towards the inguinal canal
Hernias and Lymph nodes
- Palpate for enlarged inguinal/supraclavicular lymph nodes
- Palate for inguinal hernia
Standing
Ask the patient to stand and re-assess the scrotum
- Inspect and palpate the posterior scrotum for evidence for varicocele
To Complete the Exam
- Explain to the patient that the examination is now finished.
- Thank the patient for their time.
- Dispose of PPE appropriately and wash your hands.
- Summarise your findings.
Further Assessments and Investigations
- Vital signs
- Abdo exam
- Urethral swabs
- Urinalysis