Male Genitalia - Examination and Findings

Assessment of the male reproductive system should be completed as part of a comprehensive client assessment, like during a routine physical exam, or as part of a focused exam if the client is experiencing issues like testicular pain. This assessment provides the nurse with information about the client's reproductive health. Now, let's review the process of completing an assessment of the male reproductive system.

Okay, the supplies you'll need include drapes, gloves, penlight, sterile swabs in the event a culture needs to be collected, and a good source of light. Then, prepare for the exam by ensuring your client is in a comfortable position, that your hands are warm, and that the temperature in the room is comfortable. Provide privacy by closing the door and curtains, properly draping your client, and only exposing areas of their body as needed to perform your examination.

Now, as the nurse, you may assist the healthcare provider or act as a chaperone, which is often required by facilities to protect clients and clinicians during exams of the reproductive system. During the examination, keep in mind that this process can be emotionally uncomfortable and anxiety-producing for some clients, particularly those who have experienced sexual trauma or who are transgender. Be sure to use the patient's indicated pronouns and be aware of variations in the genitals for those who have had gender affirming surgeries. It's also crucial to explain exactly what will happen at each step of the exam. Remember to avoid rushing your assessment, use a gentle touch, and to let your client know that at any time the exam can be stopped or paused if they request it.

Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

During this assessment, you will locate the penis, which consists of the shaft, glans, and urethral meatus; scrotum, testes, epididymis, spermatic cord, and inguinal canal.

Methods of assessment include inspection and palpation.

Okay, let's start with inspection. First, inspect the hair distribution in the genital area, which is typically triangular, and sparse. Inspect it for any evidence of lice or lesions on the surrounding skin. Then, examine the shaft and glans. Look for the presence or absence of the prepuce, sometimes referred to as the foreskin. If your client has undergone circumcision, the prepuce will be absent. If the prepuce is intact, gently retract it or ask your client to do so. It should retract easily, but if it is difficult to retract or if you are unable to retract it, this is an abnormal finding called phimosis. Then, inspect the shaft of the penis, which should have a wrinkled, hairless appearance. The presence of any lesions, growths, or ulcers is unexpected and could indicate conditions like genital warts or herpes simplex virus. Before moving on with your assessment, remember to return the prepuce back to its original position.

Next, you'll inspect the glans, which should appear smooth and shiny, though you might notice a cheesy-like substance called smegma, which is a normal finding. Look for the urethral meatus, which should be positioned centrally. If it is located on the ventral aspect of the penis, this is known as hypospadias; if it is located dorsally, it is called epispadias.

As you inspect the scrotum, note the skin covering it, which is typically darker than the rest of the body, and it should have a wrinkled appearance. Firm, non-tender, yellowish lumps on the scrotum could be caused by sebaceous cysts, also called epidermoid cysts, which are a normal finding. The size of the scrotum may vary depending on room temperature, since cold air will cause the scrotum to contract, which pulls the testicles closer to the body for warmth. This is called the cremasteric reflex. Also keep in mind that an asymmetric appearance is expected as the left testicle is usually slightly lower than the right.

Alright, let's move on to palpation. Using your thumb and index finger, gently compress the glans while observing the urethral meatus. The edges of the urethral meatus should appear pink and smooth. A red, edematous appearance or the presence of discharge is an abnormal finding that might be found in infections like chlamydia or gonorrhea. If discharge is present, collect a sample for culture. Next, palpate the penile shaft. It should be smooth and non-tender. Reports of pain with palpation is unexpected and can be caused by urinary tract or sexually transmitted infections.

Next, palpate the scrotum using your thumb and two fingers. It should be soft, boggy, nontender, and without edema. Gently palpate the testes, which are about the size of a walnut, and oval-shaped. They should move freely within the scrotal sac and feel rubbery, firm, and smooth. If you feel a lump on the testicle, you can use your penlight to transilluminate the scrotal sac to determine if it's solid or filled with fluid. If it transilluminates, meaning that light passes through the mass producing a red glow, then it's likely a hydrocele, which is a collection of fluid in the scrotum. If the mass is solid, it will be opaque to transillumination. If there's a solid, unilateral, and painless mass, it could be a malignancy. On the other hand, if you palpate a lump with a "bag of worms" feeling, this is consistent with a varicocele, or an enlargement of the veins in the scrotum.

Then, move to the posterolateral part of the testicle to find the epididymis, which is small and crescent-shaped. A tender and swollen epididymis along with a sudden onset of scrotal pain is associated with an infection called epididymitis. Next, slide your fingers just above each testicle to locate the rope-like structure called the spermatic cord.

Now, you may use a special technique to check for the presence of an inguinal hernia, where part of the small intestine protrudes into the groin area. To do this, assist your client to a standing position. Then, ask them to bear down, as if they were trying to have a bowel movement. As the client bears down, inspect the inguinal area for any obvious signs of bulging which might be herniations. Another way to assess for an inguinal hernia is to palpate the inguinal canal. Gently insert your finger into the external inguinal ring, and ask your client to bear down. You should feel no pressure or bulging against your fingertip. If you do, this could be evidence of an inguinal hernia.

As the nurse, it's your responsibility to correctly assess, interpret, report, and document your assessment findings. If your assessment reveals something that's potentially abnormal or emergent, like a testicular mass or scrotal swelling, you should report this immediately to the provider, while monitoring client progress and changes from baseline.

Alright, as a quick recap…. Assessment of the male reproductive system provides the nurse with information about the client's reproductive health. Supplies you'll need for the exam include drapes, gloves, penlight, sterile swabs in the event a culture needs to be collected, and a good source of light. Methods of assessment include inspection and palpation, as well as a special test to identify an inguinal hernia. As the nurse, it's your responsibility to correctly assess, interpret, report, and document your assessment findings.