This male genital examination OSCE guide provides a structured approach to examining the penis and testicles. This is an intimate examination and therefore extra attention should be paid to the communication aspect to ensure the patient feels as comfortable as possible.
Scars –may provide clues as to previous operations (e.g. vasectomy or testicular fixation)
Masses – note any obvious lumps, these will require examination later
Swelling – unilateral or bilateral? / associated with erythema?
Necrotic looking tissue – Fournier’s gangrene is a diagnosis not to be missed and is often first noted on the perineum
1. Retract the foreskin to check for phimosis (narrowing of the foreskin) or adhesions and describe any abnormalities on the glans (ulcers/discharge/scarring)
If you are unable to retract the foreskin, ask the patient to do this himself
Be aware that a patient may be circumcised and comment on this to the examiner
2. Open the urethral meatus to check patency.
3. Replace the foreskin once examined to prevent paraphimosis (this is where the retracted foreskin obstructs venous return from the glans, thus resulting in painful swelling of the glans.
Examine each testicle individually.
If abnormalities have been identified on inspection or the patient is concerned about a particular testicle, start examination on the other testicle.
Ask the patient to report any pain or discomfort they experience during the examination.
1. Use both thumbs and index fingers to gently palpate the whole testicle:
Your remaining fingers should be placed behind the testicle to immobilise it
Palpation involves a gentle rubbing motion between thumb and index finger to methodically examine the whole body of the testicle
2. If you are unable to locate a testicle, palpate along the path of the inguinal ligament for an undescended testicle (if the patient also has a scar in their inguinal region this would suggest a previous orchidectomy or orchidopexy).
Is there a cough impulse? –presence of a cough impulse suggests hernia / varicocele
Does the mass transilluminate?
To transilluminate place a pen torch behind the scrotal swelling in a darkened room and it will produce a red glow
Transillumination suggests the mass is fluid filled – e.g. hydrocele (some hydroceles are so large that you cannot properly palpate the testicles)
Palpate the epididymis (located at the posterior aspect of the testicle).
Pain in the epididymis may suggest epididymitis.
If testicular pain is relieved by elevating the testes this is strongly suggestive of epididymitis.
Stroke or pinch the patient’s medial thigh which leads to stimulation of the cremaster reflex and elevates the testicle
Loss of cremaster reflex may suggest testicular torsion
Start palpation at the superior aspect of the testicle using your thumb and index finger.
The spermatic cord should be palpable connecting to the testicle at this region.
Palpate along the cord assessing for masses and tenderness.
Assess the scrotum whilst the patient is standing
At the end of the examination, ask the patient to stand.
Inspect and palpate the posterior scrotum for varicocele (a bag of worms) or a hernia (a mass which you cannot get above).
To complete the examination
Allow patient time to get dressed
Dispose of gloves
“Today I performed a testicular examination on John Doe, a 42 year old gentleman. On inspection there were no abnormalities identified, however on palpation there was a 1cm smooth solid mass noted on the left testicle. The mass was non tender and fixed to the underlying testicle. I was able to get above the mass and there was no cough impulse or transillumination.“