2.

2
Examination of the Male Genitalia
Alfredo R. Guzman, MD

11 August
2014

Rudeness is merely an expression of fear. People fear they won't get what they want.
M. Gustav, The Grand Budapest Hotel
Paulo Coelho
TOPIC OUTLINE
I.
II.

Anatomical Appreciation
Anatomy of the Male Genitalia
a. Innervation & Erection
b. The Groin
c. Inguinal Hernias
III. Health History
IV. Symptom Analysis
a. Pain
b. Dysuria
c. Frequency
d. Incontinence
e. Polyuria
f. Reddish Urine
g. Discharge
h. Lesions
i. Genital Rash
V. Testiicular Self-Examination
VI. Techniques of Examination
a. Penis
b. Scrotum
VII. Hernias
a. Inspection
b. Palpation
c. Differentiation of Hernias in the Groin
VIII. Summary
IX. Abnormalities of the Penis & Scrotum
X. STD of Male Genitalia
a. Genital Warts
b. Genital Herpes Simplex
c. Primary Syphilis
d. Chancroid
XI. Abnormalities of the Testis
a. Cryptorchidism
b. Small testis
c. Acute Orchitis
d. Tumor of the Testis
XII. Abnormalities of the Epididymis & Spermatic Cord
a. Spermatocele & Cyst of the Epididymis
b. Acute Epididymitis
c. Tuberculous Epididymitis
d. Varicocele of the Spermatic Cord
e. Torsion of the Spermatic Cord
XIII. Inguinal Hernias
a. Indirect
b. Direct
XIV. Femoral Hernia
ANATOMY
THE STUFF THIS GUY IS MADE OF!

From 2B 2016 trans and Bates:

PENILE SHAFT The shaft of the penis has three
columns of vascular erectile tissue:
o Corpus Spongiosum: contains the
urethra; forms the bulb of the penis
ending with the cone-shaped glans
and wide corona
o 2 Corpora cavernosa
PREPUCE OR loose hood like fold of skin covering the
FORESKIN
glans.
secretion of the glans is called
smegma.
URETHRAL
slit like opening at the tip of the glans
MEATUS
where the ventrally located urethra
empties
TESTES
ovoid, rubbery structures
approximately 4.5 cm long and size
ranging from 3.5-5.5 cm
Produces spermatozoa and
testosterone
However, it is 5a dihydrostestosterone
that triggers pubertal growth
FSH regulates sperm production
Left testes usually lies lower than the
right
SCROTUM
loose, wrinkled pouch containing the
testes
Tunica vaginalis: serous membrane
covering the anterior 2/3rd of the testes
except posteriorly
o
THIS SPACE can accumulate
fluid
Epididymis: tightly-coiled spermatic
ducts that provides reservoir for
storage, maturation, and transport of
sperm from the testes to the vas
deferens
VAS
ascends from the scrotal sac into the
DEFERENS
pelvic cavity through the external
inguinal ring, then loops around the
ureter to the prostate behind the
bladder
Merges with the seminal vesicle to
become the ejaculatory duct
Secretions from the vasa diferentia,
seminal vesicles, and the prostate all
contribute to the seminal fluid
LYMPHATICS
Penile and scrotal surface:
inguinal nodes

Carefully assessed in
inflammation and malignancy
Testes: drains to the abdominal nodes

Enlarged nodes ARE

UNDETECTABLE
From 2B 2016 Trans

Epididymis is also palpable

UTI in young men is rare because of the longer

urethra malayo sa source on infection (anus)
unlike women

PROSTATE is a common cause of obstruction in

males

TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.

Page 1 of 7

Examination of the
Male Genitalia

children, may be
adults
ABOVE inguinal
ligamentm near
its midpoint
(internal inguinal
ring)

older than 40;

rare in women
ABOVE inguinal
ligament, close to
the pubic tubercle
(near external
inguinal ring)

OFTEN into the

scrotum
The hernia comes
down the inguinal
canal and
TOUCHES THE
FINGERTIPS of
the examiner

RARELY into
scrotum
The hernia
bulges
ANTERIORLY
and PUSHES the
SIDE of the finger
forward

BELOW inguinal
ligament; appears
more lateral than
an inguinal hernia
Hard to
differentiate from
lymph nodes
NEVER into
scrotum
Inguinal Canal is
EMPTY

From 2B 2016 Trans

Epididymis is also palpable

UTI in young men is rare because of the longer

urethra malayo sa source on infection (anus)
unlike women

PROSTATE is a common cause of obstruction in

males

INNERVATION and ERECTION

It is due to venous engorgement of the corpora cavernosa
from two stimuli:
o
Visual, auditory or erotic cues: higher brain
centers to T11-L2 SNS
o
Tactile stimulation: genitalia to S2-S4 reflex arc
and pudendal nerve PNS
Both sets of stimuli increase the levels of nitric oxide
and cyclic GMP resulting in local vasodilation.
Remember the principle Point and Shoot! P =
parasympathetic and S = sympathetic - Yukito
THE GROIN
Basic Landmarks:
ASIS
Pubi Tubercle
Inguinal Ligament
Inguinal canal: above and parallel to the inguinal
ligament
o Provides a tunnel for the spermatic cord
External inguinal ring: triangular slit like structure
palpable just above and lateral to the pubic tubercle
Internal inguinal ring: 1 cm above the midpoint of the
inguinal ligament
Neither the canal nor internal ring is palpable through
the abdominal wall
INGUINAL HERNIAS

Loops of bowel force their way through weak areas of the

inguinal canal, they produce inguinal hernias

2 Potential Areas for Herniation

1. Weak areas of the inguinal canal
2. Femoral Canal

How do we estimate the location of the femoral canal?

o
R index finger femoral artery
o
R middle finger femoral vein
o
R ring finger femoral canal

HEALTH HISTORY
From 2D 2016 trans lifted from Bates
Common or Concernaing Symptoms
A. SEXUAL PREFERENCE AND SEXUAL RESPONSE

Discussing gender identity and sexual function touches

a vital and multifaceted core of your patients lives.
Causes of lack of libido:
o Psychogenic causes such as depression
o Endocrine dysfunction
o Side effects of medications
Causes of Erectile dysfunction:
o Psychogenic causes, especially if early morning
erection is preserved
o Decreased testosterone
o Decreased blood flow in the hypogastric arterial
system
o Impaired neural innervation
Premature Ejaculation
o Common, especially in young men
Reduced or Absent Ejaculation
o Affecting middle-aged or older men.
o Possible causes:
o Medications
o Surgery
o neurologic deficits
o lack of androgen
Lack of orgasm with ejaculation is usually psychogenic.
PENILE DISCHARGES OR LESIONS

Penile discharge may accompany gonococcal (usually

yellow) and non-gonococcal urethritis (may be clear or
white).
(According to Dr. Tengco, identification based on color of
discharge is not conclusive. GRAM STAINING AND CULTURE are
still recommended in order to have definitive dx and provide
appropriate treatment.)
Gonorrhea
Yellow Penile Discharge
Chlamydia
White Discharge

Direct Inguinal
Most common,
all ages, both
sexes. Often in

Indirect
Inguinal
Less common.
Usually in men

Femoral
Least common.
FEMALE < MALE

TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.

SCROTAL PAIN, SWELLING OR LESION

Infections from oralpenile transmission
Gonorrhea
Chlamydia
Syphilis
Herpes
Symptomatic or asymptomatic proctitis may follow anal
intercourse.
Syphilitic Chancre
Ulcer
Human Papilloma Virus
Warts
Mumps, Orchitis, Scrotal Swelling
Edema, Testicular CA
Testicular
Torsion, Pain
Epididymitis, Orchitis
Fungal Infection
Candida

Bakit ORCHITIS? Kasi galing sa word na ORCHID na

NAKASABIT sa AIR. Eh ang SCROTUM dangling siya so para
siyang ORCHID. Therefore BOYS HAVE FLOWERS TOO.
Review for STIs and HIV discuss the need for HIV testing

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Examination of the
Male Genitalia

SYMPTOM ANALYSIS
PAIN
Flank pain
Distension of ureters, renal
pelvis, or bladder
CVA pain
Renal capsule distention
Acute
pyelonephritis
or
obstructive hydronephrosis
Spasmotic, colicky
Distention of ureter
pain
May be referred to (unilateral)
testis
Lower abdominal
Distended bladder
fullness/suprapubic Accompanied by desire to
pain
urinate
Groin pain
Pathology in spermatic cord,
testicle, or prostate
Lymphadenitis, hernia, herpes
zoster
Neuropathy
(ilioinguinal,
genitofemoral, obturator, T12,
L1, L2)

Pneumaturia
Fecaluria
Pyuria

DYSURIA
Instrumentation, bowel fistula
Gas-producing bacteria (E. coli or
Clostridia)
Fecal material in urine rare
Results from fistula usually with
diverticular disease, cancer, or Crohns
Pus in urine
Bacterial inflammation, cancer, renal
stones, cystitis, prostatitis

FREQUENCY
Decreased bladder size, bladder wall irritation, increased urine
volume
Prostatic hypertrophy, diabetes
INCONTINENCE
Overflow incontinence prostatic hypertrophy
Stress incontinence muscular dysfunction
POLYURIA
Up to 2-3L per day
Diabetes mellitus vs. diabetes insipidus vs psychogenic
diabetes insipidus
REDDISH URINE
Hematuria
Early in flow
Urethral cause
Late in flow
Bladder neck or proximal
urethra
Throughout flow
Prostate
gland
or
big
hemorrhage
1-2 weeks after URI
Glomerulonephritis
With weight loss
Renal carcinoma
Hemoglobinuria
Strenuous physical activity
Blood on
External cause for bleeding
undergarments
Beets,
dyes,
or
drugs
without blood in urine
(pyridium)

Bloody
Purulent (thick
yellowish green)

DISCHARGE
Ulcerations, cancer, or urethritis
Gonococcal urethritis or chronic
prostatitis

LESIONS
Various STDs
Lesions refer to SHIT
GENITAL RASH
Psoriasis
Well-defined bright red scaling
plaques
Contact dermatitis Rash with itching
Drug eruptions
Multiple well-defined macular,
eczematous patches
Sudden onset after drug is given
Lichen planus
Flat shiny papules
(inflammatory
May have white streaks on buccal
disorder)
mucosa

TESTICULAR SELF-EXAMINATION
Men, especially those between ages 15-35
Monthly testicular examination
Best performed after a warm bath or shower
Steps

TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.

1. Stand in front of a mirror and check for any swelling on

the skin of the scrotum.
2. Examine each testicle with both hands by cupping the
index and middle finger under the testicle and placing the
thumb on top
3. Roll the testicles gently between the thumb and the
fingers
4. Normal: One testicle may be larger than the other
5. Focus: Lump or areas of pain
6. Find the epididymis
7. If there is a lump, immediately see a doctor. The lump
may be an infection or cancer.
TECHNIQUES OF EXAMINATION
Explain each step of the examination so that the patient
knows what to expect
Request an assistant (same sex as the patient) to accompany
you
Occasionally, male patients have erections during the
examination. If this happens, explain that this is a normal
response, finish your examination, and proceed with an
unruffled demeanor
If the patient refuses to be examined, respect his wishes
A good genital examination can be done with the patient
either standing up or supine
To check for hernias or varicosities, the patient should be
standing up or sitting comfortably on a chair or stool
A must gown conveniently cover the patients chest and
abdomen
Wear gloves throughout the examination
Expose the genitalia and inguinal areas
PENIS
Inspection
Skin
Prepuce (Foreskin)
o If present, retract the prepuce or ask the patient to retract
it this detects many chancres and carcinomas
o Smegma cheesy whitish material that may accumulate
normally under the foreskin
o Phimosis tight prepuce that cannot be retracted over the
glans
o Paraphimosis tight prepuce that, once retracted, cannot
be returned. This causes edema.
Glans
o Look for any ulcers, scars, nodules, or signs of
inflammation
o Balanitis inflammation of the glans
o Balanoposthitis inflammation of the glans and prepuce
Base of the penis and pubic hairs
o Check for excoriations or inflammation
o Pubic or genital excoriations suggest the possibility of
lice/crabs, or sometimes scabies
Shaft
o Peyronies Disease deviation and pain especially with
erection; usually dorsal angulation of the proximal to
1/3
Urethral Meatus
o Note the location
o Compress the glans gently between your index finger
above and your thumb below. This will open the urethral
meatus and allow the inspection for discharge normally
there is none
o Prepare a glass slide for gram staining
o Hypospadias congenital, ventral displacement of the
meatus on the penis
o Epispadias dorsal displacement of the meatus
Palpation
Any tenderness or induration
Palpation of the shaft may be omitted in a young,
asymptomatic male patient
Induration along ventral surface of the penis suggests
urethral stricture or possibly a carcinoma
Tenderness of indurated area suggests periurethral
inflammation secondary to a urethral stricture
If foreskin is retracted, replace it before proceeding on to
examine the scrotum
SCROTUM
Inspection
Skin
o Lift up the scrotum so that the posterior surface can be
seen
o Rashes, epidermoid cysts, rarely skin cancer
Scrotal contour
o Note any swelling, lumps, or veins
o Epidermoid cysts benign; dome-shaped white or yellow
papules or nodules formed by occluded follicles filled with
keratin debris of desquamated follicular epithelium

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Examination of the
Male Genitalia

o Cryptochordism undescended testicle; suggested by a

poorly-developed scrotum on one or both sides
o Common scrotal swellings:
Indirect inguinal hernias
Hydroceles
Scrotal edema
Palpation
1. Palpate each testis and epididymis between your thumb and
first two fingers
2. Locate the epididymis on the superior posterior surface of
each testicle it feels nodular and cord-like, and should not
be confused with an abnormal lump
o Tender, painful scrotal swelling suggests:
Acute epididymitis
Acute orchitis, torsion of the spermatic cord
Strangulated inguinal hernia
3. Note the size, shape, consistency, and tenderness; feel for
any nodules
o Pressure on the testis normally produces a deep visceral
pain
o Any painless nodule in the testis must raise the possibility
of testicular cancer
4. Palpate each spermatic cord, including the vas deferens,
between your thumb and fingers, from the epididymis to the
superficial inguinal ring
o Multiple tortuous veins in this area, usually on the left,
may be palpable and eve visible. They indicate a varicocele
o Varicocele enlargement of spermatic cord (usually on the
left) that feels like a bag of worms; usually only visible
upon standing, or with straining;
1. Hold the spermatic cord
2. Turn the patients head
3. Ask the patient to cough
4. Sudden pulsation usually indicates a varicocele
5. Note any nodules or swellings.
o The vas deferens, if chronically infected, may feel
thickened or beaded. A cystic structure in the spermatic
cord suggests a hydrocele of the cord
Transillumination
o After darkening the room, shine the beam of or a strong
light from behind the scrotum through the mass. Look for
transmission of the light:
o Hydroceles red glow
o Blood or tissue/tumor/most hernias no red glow
o Spermatocele pea-sized nontender mass containing
sperm at the upper pole of epididymis

feel, with either hand, any bulging tissue that would be

consistent with a hernia.
6. Exam of the left inguinal area is done in the same way,
though hand positioning is reversed.
7. Hernias are generally non-tender and there should be no
evidence of acute inflammation (i.e. skin edema or
redness).
Direct Hernia: external inguinal ring
INdirect Hernia: INternal inguinal ring
N otes from upper batch:
Auscultation on top of a hernia may allow the detection of
bowel sounds, which can be useful information if you are
unsure as to the nature of an inguinal bulge.
In the event that the patient is unable to stand, the above
examination can be performed as described with the patient
supine.
This may actually be a better position for evaluating the
inguinal canal if you are concerned that it may contain a
discrete mass, as in the case of a suspected undescended
testicle. Strenuous physical activity

INDIRECT INGUINAL HERNIA

DIRECT INGUINAL HERNIA

HERNIAS
INSPECTION
Inspect inguinal and femoral areas for bulges.
Ask the patient to strain down or cough
Both of these maneuvers increase intra-abdominal pressure,
forcing intestines/omentum/peritoneal fluid through any
defect which may exist and making a hernia more apparent.
A bulge that appears on straining suggests a hernia.
Usually present as diffuse swelling amidst the cord structures
or the inguinal canal area appears to be protuberant
PALPATION
Palpate for inguinal hernias

FEMORAL HERNIA

Perform the following:

1. Place tip of index finger close to the inferior margin of the
scrotal sac.
o
RIGHT finger is to right side
o
LEFT finger is to left side
2. Move finger along the inguinal canal, invaginating the
scrotum.
3. Follow spermatic cord through the external inguinal ring
into the inguinal canal to the inguinal ligament toward the
internal inguinal ring.
4. Ask patient to strain down or cough, feel for sudden
impulse of hernia.
5. Have the patient repeat the above maneuvers that
increase intra-abdominal pressure and note if you can
TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.

DIFFERENTIATION OF HERNIAS IN THE GROIN

Indirect
Direct
Femoral
Frequency Most
Less
Least common
common
common
All ages
Both
sexes
Age and
Often in
Men over
Women > Men
sex
children
age 40,
rare in
women
Point of
Origin

Above
inguinal
ligament,
near its
midpoint
(the
internal
inguinal
ring)

Above
inguinal
ligament,
close to
the pubic
tubercle
(near the
external
inguinal
ring)

Below the
inguinal
ligament;
appears more
lateral than an
inguinal hernia
and may be
hard to
differentiate
from lymph
nodes

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Examination of the
Male Genitalia

Course
With the
examining
finger in
the
inguinal
canal
during
straining
or cough

Often in
the
scrotum
The
hernia
comes
down the
inguinal
canal and
touches
the
fingertip

Rarely in
the
scrotum
The
hernia
bulges
anteriorly
and
pushes
the side
of the
finger
forward

Never in the
scrotum
The inguinal
canal is empty

Palpate for Femoral Hernia

Place fingers on the anterior thigh in the region of the femoral
canal.
Ask the patient to strain down or cough.
Note for swelling or tenderness.
Incarcerated hernia - contents cannot be returned in the
abdominal cavity
Strangulated hernia- blood supply to the entrapped content is
compromised (+ tenderness, nausea and vomiting)
Evaluating a Possible Scrotal Hernia
If you find a large scrotal mass and suspect that it may be a
hernia:
o
Ask the patient to lie down.
When it return to the abdomen by itself = (+)
hernia
If the findings suggest a hernia, gently
try to reduce it (return it to the
abdominal
cavity)
by
sustained
pressure with your fingers.
Do not attempt this maneuver if the
mass is tender or the patient reports
nausea and vomiting.
Did not return by itself:
1. Can you get your fingers above the mass in
the scrotum?
2. Listen to the mass with a stethoscope for
bowel sounds.
SUMMARY
I. PENIS
A. INSPECT
1. Skin
2. Prepuce
3. Glans
4. Base of the penis and pubic hairs
5. Shaft
6. Urethral meatus
7. Discharge
B. PALPATE
II.SCROTUM and its contents
A. INSPECT
1. Skin
2. Scrotal contours
B. PALPATE
1. Testis and Epididymis
a. Size
b. Shape
c. Consistency
d. Tenderness
e. Nodules
2. Spermatic cord
III. HERNIAS (PATIENTS POSITION: STANDING)
A. INSPECT
1. Inguinal regions and genitalia
B. PALPATE
1. Inguinal
2. Femoral
3. Scrotal

Hypospadias
A congenital displacement of
the urethral meatus to the
inferior surface of the penis.
A groove extends from the
actual urethral meatus to its
normal location on the tip of
the glans

Scrotal Edema
Pitting edema may make the
scrotal skin taut
seen in heart failure or
nephrotic syndrome.

Peyronies Disease

Palpable, nontender, hard

plaques are found just
beneath the skin,
Usually along the dorsum of
the penis.
Complains
of
crooked,
painful erections.

Hydrocele

Nontender, fluid-filled mass

within the tunica vaginalis.
Transilluminates
Examining fingers can get
above the mass within the
scrotum.

Carcinoma of the Penis

An indurated nodule or ulcer
that is usually nontender.
Limited almost completely to
men
who
are
not
circumcised, it may be
masked by the prepuce.

Scrotal Hernia

Usually an indirect inguinal

hernia, that comes through
the external inguinal ring
Examining fingers cannot
get above it within the
scrotum.

ABNORMALITIES OF THE PENIS AND SCROTUM

Review yourself!
Choices:
a. Indirect Hernia
b. Direct Hernia
c. Femoral Hernia
____1. Which among the following types of hernia is more
common in adult males over 40 years old?
____2. The course of this type of hernia is rarely in the
scrotum.
TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.

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Examination of the
Male Genitalia

BB
SEXUALLY TRANSMITTED DISEASES
OF MALE GENITALIA
GENITAL WARTS (CONDYLOMATA ACUMINATA)
Appearance
single or multiple papules or
plaques of variable shapes
may be round, acuminate (or
pointed), or thin and slender
may be raised, flat, or
cauliflower-like (verrucous)
Causative Organism
HPV
usually from subtypes 6,11
carcinogenic subtype: rare
Incubation: weeks to months
infected contact may have no
visible warts
Can arise on penis, scrotum,
groin, thighs, anus; usually
asymptomatic,
occasionally
cause itching and pain.
May
disappear
without
treatment.
GENITAL HERPES SIMPLEX
Appearance
small, scattered or grouped
vesicles (1-3 mm) on glans or
shaft of penis
appear as erosions if vesicular
membrane breaks
Causative Organism
HSV 2
double-stranded DNA virus
Incubation: 2-7 days after
exposure
Primary
episode
may
be
asymptomatic;
recurrence
usually less painful, of shorter
duration
Associated with fever, malaise,
headache, arthralgia, local pain
and edema, lymphadenopathy
Need to distinguish from genital
herpes zoster.
PRIMARY SYPHILIS
Appearance
small red papule that becomes
a chancre, or painless erosion
up to 2 cm in diameter
base of chancre is clean , red,
smooth and glistening
borders
are
raised
and
indurated.
chancres heal within 3-8 wks
Causative organism
Treponema Pallidum
Incubation: 9-90 days after
exposure
May develop inguinal lymphadenopathy within 7 days
Lmph
nodes
are
rubbery,
nontender, mobile.
20-30% of patients develop 2
syphilis
while
chancre
still
present suggests coinfection
with HIV
CHANCROID
Appearance
red papule or pustule initially,
then forms a painful deep ulcer
with ragged non-indurated
margins
contains necrotic exudate, has
a friable base
Causative organism
Haemophilus ducreyi
anaerobic bacillus
Incubation: 3-7 days after
exposure
Painful inguinal adenopathy.

TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.

Suppurative buboes in 25% of

patients.

ABNORMALITIES OF THE TESTIS

CRYPTORCHIDISM
Testis is atrophied and may lie in
the inguinal canal or the
abdomen, resulting in an unfilled
scrotum.
No palpable left testis or
epididymis.
Markedly raises the risk for
testicular cancer.
SMALL TESTIS
Adults, normal testicular length:
3.5cm
Klinefelters syndrome: small,
firm testes, usually 2 cm
Small, soft testes suggesting
atrophy are seen in:
Cirrhosis
Myotonic dystrophy
use of estrogens
hypopituitarism
May also follow orchitis
ACUTE ORCHITIS
Testis is acutely inflamed,
painful, tender, and swollen
It may be difficult to distinguish
from the epididymis
The scrotum may be reddened
Seen in mumps and other viral
infections
Usually unilateral

TUMOR OF THE TESTIS

Usually appears as a painless
nodule.
Any nodule within the testis
warrants investigation for
malignancy.
As a testicular neoplasm grows
and spreads, it may seem to
replace the entire organ.
The testicle characteristically
feels heavier than normal.

ABNORMALITIES OF THE
EPIDIDYMIS AND SPERMATIC CORD
SPERMATOCELE AND CYST OF THE EPIDIDYMIS
A painless, movable cystic mass
just above the testis
Both transilluminate
Spermatocele: contains sperm,
Cysts of epididymis does not
Clinically indistinguishable

ACUTE EPIDIDYMITIS

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Examination of the
Male Genitalia

Tender and swollen and may

be difficult to distinguish from
the testis.
Scrotum may be reddened and
the vas deferens inflamed.
Occurs chiefly in adults, most
commonly with Chlamydia
infection.
Coexisting urinary tract infection
or prostatitis supports the
diagnosis.

Varicocele: varicose veins of the

spermatic cord
Usually found on the left
Feels like a soft bag of worms
separate from the testis, and
slowly collapses when the
scrotum is elevated in the supine
patient
Infertility may be associated

TORSION OF THE SPERMATIC CORD

An acutely painful, tender, and
swollen organ that is retracted
Upward in the scrotum.
Scrotum becomes red and
edematous.
No associated urinary infection.
Torsion, most common in
adolescents, is a surgical
emergency
obstructed circulation

TUBERCULOUS EPIDIDYMITIS
Firm enlargement of the
epididymis, which is sometimes
tender
With thickening or beading of
the vas deferens

VARICOCELE OF THE SPERMATIC CORD

INGUINAL HERNIAS
INDIRECT

DIRECT

FEMORAL HERNIA

FREQUENCY,
AGE, AND
SEX
POINT OF
ORIGIN

Most common, all ages, both

sexes. Often in children; may be
in adults
Above inguinal ligament, near its
midpoint (the internal inguinal
ring)

Less common. Usually in men

older than 40; rare in women

Least common. More common in

women than in men

Above inguinal ligament, close to

the pubic tubercle (near the
external inguinal ring)

COURSE

Often into the scrotum

The hernia comes down the
inguinal canal and touches the
fingertip.

Rarely into the scrotum

The hernia bulges anteriorly and
pushes the side of the finger
forward.

Below the inguinal ligament;

appears more lateral than an
inguinal hernia.
Can be hard to differentiate from
lymph nodes
Never into the scrotum
The inguinal canal is empty.

EXAMINING
FINGER IN
INGUINAL
CANAL DURING
STRAINING

REVIEW QUESTIONS
1. It is readily visible in proctoscopic examination but not
palpable?
2. These may also prolapsed at the anal canal and appear as
reddish, moist mass located in one or more locations
3. Presence of transillumination of scrotum suggests:
4. Congenital ventral displacement of the meatus of the penis
5. Multiple tortuous veins in this area may be visible/ palpable
may indicate
6. A fully developed scrotum on one or both sides suggests
7. Prepuce that once retracted cannot be returned
8. Painless moveable cystic mass just above testis that
transilluminates suggests
9. Induration at the ventral side of the penis suggest
10. Painful erections (and a lot more symptoms)

Choose the answers from the following choices:

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.

Carcinoma
Hypospadia
Epididymal cyst
Pectinate/ Dentate line
Cryptorchidism
Internal haemorrhoids
Paraphimosis
Varicocele
Hydrocele
Peyronies disease

Answers:
1.D, 2.F, 3.I, 4.B, 5.H, 6.E, 7.G, 8.C, 9.A, 10.J
TRANSCRIBED BY: M. GUSTAVE, ZERO, MR. MOUSTAFA, AGATHA, SERGE X.

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