Male genital examination

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Male genital examination
Test of Male genitals

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development, and is normally a component of an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. [1] A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. [2] The exam can also be conducted to verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities (ex. varicocele), urethral opening abnormalities, problems related to not being circumcised (ex. phimosis), [3] lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues, and many others. In some instances (ex: Peyronie's disease) where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using imaging or ultrasounds will be needed for further evaluation. [4]

Contents

Procedure

During a male genital examination, a doctor will carefully inspect and check the palpation of the scrotum and penis. [1] The exposure of the groin and genital area with adequate lighting is required. The ideal position is with the professional sitting in front of the examinee. The examination may take place with the individual sitting or laying face upward, but to investigate possible varicocele and hernia it is necessary that the person is standing in front of the examiner. [1]

External Examination

Examination of the external genitalia include an inspection and palpation of the penis, scrotum, and urethral meatus. [1]

According to the American College Health Association (ACHA) guidelines for Best Practices for Sensitive Exams, it is required to explain all expectations of the examination to the examinee prior to start.

An external examination may possibly detect structural abnormalities but may require exploratory surgery to determine diagnosis. [1]

Areas for inspection and palpation

Human male reproductive system Human male reproductive system en.svg
Human male reproductive system

Testicular self-examination

Testicular self-examination (TSE) is performed to detect changes and symptoms that can indicate sexually transmitted infections (STI) or a more harmful disease. [6] Testicular self-examinations only take a few minutes and should be done every four weeks. Testicular cancer is most common in males between the age 20–34 years old, and can appear as soon as the age of 15 years old. It is important to start STE at a young age, to detect any possible signs for testicular cancer. [7]

A testicular self-examination can be done in front of a mirror to look at the entire surface. To properly examine the scrotum needs to be warm and relaxed. Each individual testicle needs to be inspected by rolling the testicle between the thumb and fingers over the entire surface of the testicle. It is normal for one testicle to be to be larger than the other. [8] During the examination an individual is searching for the appearance of any swelling, tenderness, bumps or blisters. It is important to reach out to a doctor if any abnormalities or new lumps are found.

Note: during a self-examination a person may detect a ropy tube which is the epididymis. [9]

Structural abnormalities

Benign (not cancerous) mass may be present in scrotum and detected through palpation. These may include epididymal cysts, spermatocele, hydrocele, varicocele, epididymitis. [5] Ultrasounds for a mass growth may be ordered by a doctor for differentiation between spermatocele, varicocele, and epididymal cysts.

Other abnormalities can be detected during male genital examination including Peyronie's disease. Peyronie's disease is caused by an injury or an autoimmune disease that results in plaque build up under the skin of the penis. A lot of build up of this plaque will cause a curvature to the penis and can cause pain during erection. It is more common in males over the age 40 years old. [20]

Male genital exam screening can detect early signs, or indication of cancers that include penile cancer and testicular cancer. Penile cancer is due to trapped fluids under the foreskin of the penis. Uncircumcised individuals have a higher risk of penile cancer. Symptoms that may indicate penile cancer during male examination include lumps on the penis, swelling, and skin around the penis becoming thicker. Penile cancer and its grade is diagnosed by a biopsy to confirm. [21] Testicular cancer is when malignant cells grow in the tissues of the testicles. Males are at higher risk of testicular cancer between the age of 15-35 years old. Testicular cancer signs include swelling and fluid build up in the scrotum. Other signs can be pain, and any new lumps in the testicles. Testicular cancer is confirmed by CT scans or an X-ray. [22]

Genitourinary abnormalities

During the assessment of the genitourinary system, the doctor can detect any of the following: dysuria, foul smelling urine, hematuria, urethral discharge, discomfort, sexually transmitted disease, urinary tract infection, and many others. [23] The assessment may include social history, family history (ex: congenital anomalies), sexual behaviors and habits.

Pediatric genital abnormalities

As part of pediatric medical evaluations, a comprehensive examination of the male genitalia plays a crucial role in identifying and addressing a range of genital abnormalities that can affect young boys. This examination seeks to determine the presence of any dysmorphic features and assess the general health of the baby. Pediatric genital abnormalities encompass a diverse array of conditions that can arise during early development, affecting the sexual and reproductive organs of children. Among the most common anomalies are hypospadias, epispadias, chordee, ambiguous genitalia, undescended testicles, inguinal hernias, and hydroceles. Each of these conditions presents distinct challenges and may require specialized medical attention and surgical intervention. From atypical urethral placements and curvatures of the penis to ambiguous sexual characteristics and fluid accumulations, these conditions can impact a child's overall health and well-being. Early detection and timely management are crucial to achieving optimal outcomes and ensuring a healthy future for affected children. To address these complexities, multidisciplinary teams comprising pediatric urologists, surgical specialists, endocrinologists, geneticists, and neonatal care physicians collaborate to develop personalized treatment plans and deliver comprehensive care. This section explores these genital abnormalities and briefly introduces each of them.

Hypospadias

The second-most frequently encountered genital abnormality in children is known as hypospadias which is present in 1 out of 250 children at birth. This condition is characterized by an atypical placement of the urethral opening, which is situated not at the usual location on the tip of the penis but rather positioned further down on the ventral surface, between the junction of the penile shaft and the scrotum. [24] Alongside this anatomical variation, affected children often exhibit a condition called chordee, wherein the penis presents a curvature pointing downward towards the scrotum. [25]

Epispadias

Epispadias is a congenital condition that is evident from birth. In this condition, the urethra, which serves as the passage for urine from the bladder out of the body, does not fully develop into a complete tube, leading to challenges in the process of urination. Additionally, 90% of children with epispadias often exhibit a co-occurring condition called bladder exstrophy. [26] Early diagnosis and timely management of epispadias are crucial to achieve optimal results and minimize potential complications. A multidisciplinary approach involving pediatric urologists and surgical specialists is essential to provide personalized treatment plans and comprehensive care for children born with this condition.

Chordee

Chordee refers to a curvature of the penis, a condition that can be present from birth. It is important to note that some children may have chordee without any accompanying hypospadias or epispadias. Fortunately, this condition can often be effectively corrected through outpatient procedures involving surgical resection and the placement of placating sutures in the penis. Early detection and timely treatment of chordee contribute to more favorable outcomes, and regular follow-up with healthcare professionals ensures proper healing and successful resolution of the condition. The collaborative effort between pediatric urologists and surgical specialists plays a crucial role in providing tailored treatment plans and delivering comprehensive care for children dealing with chordee.

Ambiguous genitalia

Ambiguous genitalia can manifest as a result of various factors, such as abnormal chromosomes, gonadal complications, or enzymatic disorders. Throughout development, both male and female external genitalia originate from shared fundamental structures. As a consequence, children with XY genes may exhibit female genitalia, while those with XX genes may display male genitalia, leading to ambiguity in their sexual characteristics. During the comprehensive physical examination, it is crucial to assess for any dysmorphic features and evaluate the overall health of the baby. Infants with XY DSD (Disorders of Sex Development) may exhibit a higher likelihood of being small for gestational age and might present with other associated developmental anomalies. [27] Consequently, a thorough evaluation is essential to identify and address any potential health concerns or distinctive physical characteristics that may be present in affected infants.

Undescended testicles

Undescended testicles represent one of the most frequently encountered conditions in newborns. For example, a study shows that undescended testicles affects approximately 4.8 percent of all Malaysian male newborns. [28] During normal development, testes form in the retroperitoneum, the back part of the abdomen, and subsequently descend through the inguinal canal into the scrotum. Diagnosing undescended testicles involves a physical examination. If the testis cannot be felt, it is categorized as "non-palpable." Generally, there are three underlying reasons for nonpalpable testicles:

  1. The testis is in the inguinal canal but cannot be palpated for specific reasons.
  2. The testis is situated inside the abdomen.
  3. The testis does not exist on that side altogether.

In the majority of cases, testicles descend into the scrotum within the first year of a boy's life. However, if this descent does not occur during the initial year, surgical correction is recommended to prevent potential damage to the testis, as it functions optimally and grows best in the scrotal position. When the testis cannot be palpated, laparoscopy is performed to determine the underlying cause. Laparoscopy alone is often effective in moving intra-abdominal testes into the scrotum. The correction of cryptorchidism (undescended testicles) is associated with improved fertility potential, approaching that of the general population.

Inguinal hernias

Inguinal hernias are a common occurrence in young children. [29] Unlike hernias in adults, these hernias involve the failure of the peritoneum, the sac that encloses the intestines, to close properly, resulting in an opening between the abdomen and scrotum. Detecting an inguinal hernia is typically characterized by a noticeable bulge in the groin or scrotum, which may vary in size. Hernias can emerge as strangulated hernia (an emergency situation) or reducible hernia (a less urgent condition). [30]

Hydrocele

Hydrocele refers to the accumulation of fluid along the membrane that covers the front and sides of the testicle. The accumulation can be indicator of tumor, infection, etc. [31] Fortunately, treating hydroceles is a straightforward process that involves closing the opening with an outpatient procedure. This effective intervention leads to a minimal recurrence rate, ensuring successful outcomes for the majority of cases.

Other purposes

This examination serves various purposes, including the detection of conditions such as testicular cancer, Klinefelter syndrome, and urinary issues. [32] Clinicians use the male genital examination as an opportunity to promote sexual/reproductive health (SRH) among young males and provide education on male anatomy, function, and SRH-related matters. [3]

See also

Related Research Articles

<span class="mw-page-title-main">Testicular torsion</span> Medical condition

Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. The most common symptom in children is sudden, severe testicular pain. The testicle may be higher than usual in the scrotum and vomiting may occur. In newborns, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place.

Andrology is a name for the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men. It is the counterpart to gynecology, which deals with medical issues which are specific to female health, especially reproductive and urologic health.

<span class="mw-page-title-main">Cryptorchidism</span> Medical condition

Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. The word is from Greek κρυπτός 'hidden' and ὄρχις 'testicle'. It is the most common birth defect of the male genital tract. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life, making the true incidence of cryptorchidism around 1% overall. Cryptorchidism may develop after infancy, sometimes as late as young adulthood, but that is exceptional.

<span class="mw-page-title-main">Hydrocele testis</span> Medical condition

A hydrocele testis is an accumulation of clear fluid within the cavum vaginale, the potential space between the layers of the tunica vaginalis of the testicle. It is the most common form of hydrocele and is often referred to simply as a "hydrocele". A primary hydrocele testis causes a painless enlargement in the scrotum on the affected side and is thought to be due to the defective absorption of fluid secreted between the two layers of the tunica vaginalis. A secondary hydrocele is secondary to either inflammation or a neoplasm in the testis.

<span class="mw-page-title-main">Epididymitis</span> Medical condition

Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may include swelling of the testicle, burning with urination, or frequent urination. Inflammation of the testicle is commonly also present.

<span class="mw-page-title-main">Epididymal hypertension</span> Condition that arises during male sexual arousal when seminal fluid is not ejaculated

Epididymal hypertension (EH), informally referred to as blue balls for males or blue vulva for females, is a harmless but uncomfortable sensation in the genital regions during a prolonged state of sexual arousal. It usually resolves within hours unless relieved through an orgasm.

<span class="mw-page-title-main">Testicular self-examination</span>

Testicular self-examination (TSE) is a procedure where a man examines his own testicles and scrotum for possible lumps or swelling. It is usually undertaken at home while standing in front of a mirror and after having a warm bath or shower. Monthly self-examination of the testicles starting at puberty may be an effective way of detecting testicular cancer at an early, potentially treatable stage, which can lead to a 5-year survival rate of 98%. In men aged 15 to 40, testicular cancer is the most common cancer, and the annual rate of increase over the last 10 years in cases of testicular cancer has been shown to be approximately 1% each year. Testicular cancer typically presents with a painless testicular swelling or lump or any change in shape or texture of the testicles.

<span class="mw-page-title-main">Orchiopexy</span> Surgery to fix a testicle into the scrotum

Orchiopexy is a surgery to move and/or permanently fix a testicle into the scrotum. While orchiopexy typically describes the operation to surgically correct an undescended testicle, it is also used to resolve testicular torsion.

<span class="mw-page-title-main">Spermatocele</span> Medical condition

Spermatocele is a fluid-filled cyst that develops in the epididymis. The fluid is usually a clear or milky white color and may contain sperm. Spermatoceles are typically filled with spermatozoa and they can vary in size from several millimeters to many centimeters. Small spermatoceles are relatively common, occurring in an estimated 30 percent of males. They are generally not painful. However, some people may experience discomfort such as a dull pain in the scrotum from larger spermatoceles. They are not cancerous, nor do they cause an increased risk of testicular cancer. Additionally, unlike varicoceles, they do not reduce fertility.

<span class="mw-page-title-main">Polyorchidism</span> Medical condition

Polyorchidism is the incidence of more than two testicles. It is a very rare congenital disorder, with fewer than 200 cases reported in medical literature and six cases in veterinary literature.

<span class="mw-page-title-main">Hydrocele</span> Accumulation of fluid in a body cavity

A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis, the most common form of hydrocele, is the accumulation of fluids around a testicle. It is often caused by fluid collecting within a layer wrapped around the testicle, called the tunica vaginalis, which is derived from peritoneum. Provided there is no hernia present, it goes away without treatment in the first year. Although hydroceles usually develop in males, rare instances have been described in females in the canal of Nuck.

<span class="mw-page-title-main">Varicocele</span> Medical condition

A varicocele is, in a male person, an abnormal enlargement of the pampiniform venous plexus in the scrotum; in a female person, it is an abnormal painful swelling to the embryologically identical pampiniform venous plexus; it is more commonly called pelvic compression syndrome. In the male varicocele, this plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Varicoceles occur in around 15% to 20% of all men. The incidence of varicocele increase with age.

<span class="mw-page-title-main">Hematocele</span> Medical condition

A hematocele is a collections of blood in a body cavity or potential space. The term most commonly refers to the collection of blood in the tunica vaginalis around the testes, known as a scrotal hematocele. Hematoceles can also occur in the abdominal cavity and other body cavities. Hematoceles are rare, making them harder to diagnose and treat. They are very common especially as slowly growing masses in the scrotum usually in men older than 50 years.

<span class="mw-page-title-main">Male reproductive system</span> Reproductive system of the human male

The male reproductive system consists of a number of sex organs that play a role in the process of human reproduction. These organs are located on the outside of the body, and within the pelvis.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

<span class="mw-page-title-main">Testicular pain</span> Medical condition

Testicular pain, also known as scrotal pain, occurs when part or all of either one or both testicles hurt. Pain in the scrotum is also often included. Testicular pain may be of sudden onset or of long duration.

<span class="mw-page-title-main">Epididymal cyst</span> Medical condition

Epididymal cyst is a harmless sac in the testicles filled with fluid. The most frequent clinical presentation occurs when a routine physical examination yields an unexpected finding, which is then confirmed by scrotal ultrasonography. Although the exact cause of epididymal cysts is unknown, it is likely a congenital anomaly associated with hormonal imbalances during the embryonic stage of development.

<span class="mw-page-title-main">Scrotum</span> Sac of skin that protects the testicles

In most terrestrial mammals, the scrotum or scrotal sac is a part of the external male genitalia located at the base of the penis. It consists of a sac of skin containing the external spermatic fascia, testicles, epididymides, and vasa deferentia. The scrotum will usually tighten when exposed to cold temperatures.

<span class="mw-page-title-main">Scrotal ultrasound</span> Medical ultrasound examination of the scrotum.

Scrotalultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.

References

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  17. ↑ "Epididymitis - STI Treatment Guidelines". U.S. Centers for Disease Control and Prevention. 2021-07-14. Retrieved 2023-07-30.
  18. 1 2 "What is Epididymitis?". Urology Care Foundation. Retrieved 2023-07-30.
  19. ↑ Yin Z, Ming X (2019). "General Techniques of Scrotoscopic Surgery: 4.4.3.2 Epididymal Cyst". Scrotoscopic Surgery. pp. 23–53. doi:10.1016/B978-0-12-815008-5.00004-2. S2CID   81292862. An epididymal cyst mostly occurs at the head of the epididymis, and it is rarely seen at the body and tail of the epididymis. An epididymal cyst is round or oval, with a smooth and transparent surface, capillary vessels on the surface of the cyst are visible, and boundaries between the cyst and its surrounding tissues are clear.
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