Male Reproductive System

Steps of male genital exam

Inspect and palpate penis, inspect and palpate scrotum, transilluminate masses, palpate inguinal canal for hernia, palpate lymph nodes

Normal penis finding

No lesions, no discharge, smooth skin

Abnormal penis finding

Lesions, discharge, ulcers, nodules

Normal scrotum finding

Rugated, slightly asymmetrical, testes smooth and oval

Abnormal scrotum finding

Swelling, masses, tenderness, absence of testes

Transillumination finding

Fluid-filled mass (hydrocele) will glow

Hernia assessment

Palpate inguinal canal while patient coughs

Normal testicle finding

Firm, smooth, ovoid, equal size

Abnormal testicle finding

Hard lump, irregular, non-movable mass

Epididymis normal finding

Soft, slightly tender, located posterior to testis

Epididymis abnormal finding

Marked tenderness, swelling (epididymitis)

Age-related variation (infants)

Only inspection of external genitalia, assess for abuse

Age-related variation (adolescents)

Puberty changes, increased testicular size

Age-related variation (older adults)

Prostate enlargement common (BPH)

Normal prostate finding

Firm, rubbery, nontender

Abnormal prostate finding

Hard, nodular (cancer), boggy (prostatitis)

Rectal exam steps

Inspect anus, palpate rectum, assess prostate

Normal rectal finding

No masses, no tenderness

Abnormal rectal finding

Masses, bleeding, hemorrhoids

Melena

Black, tarry stool from upper GI bleeding

Clay-colored stool

Pale stool from lack of bile

Steatorrhea

Fatty, greasy stool from malabsorption

Meconium

First newborn stool, dark green, passed within 24–48 hours

Common male reproductive problems

STIs, epididymitis, torsion, hydrocele, varicocele, Peyronie disease, testicular cancer

Testicular torsion

Sudden severe pain, emergency condition

Hydrocele

Fluid-filled sac around testicle, transilluminates

Varicocele

Dilated veins, “bag of worms” feel

Spermatocele

Benign cyst in epididymis

TSE definition

Monthly self-exam of testes to detect lumps early

TSE teaching age

Begin at 13–14 years through adulthood 

TSE timing

Once a month

TSE best time

During warm shower or bath

TSE steps

Inspect scrotum, palpate each testicle, roll between fingers, check epididymis, compare both sides

TSE teaching points

Timing, shower, examine, report changes immediately

Testicular cancer risk factors

Age 15–35, undescended testicle (cryptorchidism), family history

Most common age for testicular cancer

20–34 years

Signs of testicular cancer

Painless lump, heaviness, swelling

Cultural considerations in assessment

Do not assume sexual orientation, use respectful communication, maintain privacy, provide inclusive care

Sexual history question

Are you currently in a sexual relationship?

Family history question (male)

Any history of prostate or testicular cancer?

Common anorectal problems

Hemorrhoids, fissures, abscess, polyps, cancer

Hemorrhoids

Swollen veins causing pain or bleeding

Anal fissure

Tear causing pain with defecation

Rectal prolapse

Rectum protrudes through anus

Prostate enlargement

Common with aging, may cause urinary symptoms

Benign prostatic hyperplasia (BPH)

Noncancerous enlargement of prostate common in older men

Prostatitis

Inflamed, tender prostate with urinary symptoms

Prostate cancer finding

Hard, nodular prostate

Rectal bleeding assessment

Onset, duration, associated symptoms

Rectal pain assessment

Onset, severity, cause

Fecal incontinence question

Do you soil your underwear?

Urinary change question

Any changes in urinary function?

Chlamydia

STI causing dysuria, discharge, often asymptomatic

Gonorrhea

STI causing purulent discharge, dysuria

Syphilis

STI causing painless chancre, later systemic symptoms

Genital herpes

Painful vesicles/ulcers on genitalia

HPV (genital warts)

Flesh-colored warts on genitalia

Cryptorchidism

Undescended testicle; risk factor for testicular cancer

Rectal prolapse

Rectum protrudes through anus

Rectal cancer

Blood in stool, change in bowel habits, weight loss