| 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. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis.[1] 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), 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.[2]
During a male genital examination, a doctor will carefully inspect and check the palpation of the scrotum and penis. 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.
Examination of the external genitalia include an inspection and palpation of the penis, scrotum, and urethral meatus.[3]
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.[3]
Testicular self-examination (TSE) is performed to detect changes and symptoms that can indicate sexually transmitted infections (STI) or a more harmful disease.[4] 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.[5]
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.[6] 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.[7]
Benign (not cancerous) mass may be present in scrotum and detected through palpation. These may include epididymal cysts, spermatocele, hydrocele, varicocele, epididymitis.[8] 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.[19]
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.[20] 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.[21]
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.[22] The assessment may include social history, family history (ex: congenital anomalies), sexual behaviors and habits.
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.
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.[23] Alongside this anatomical variation, affected children often exhibit a condition called chordee, wherein the penis presents a curvature pointing downward towards the scrotum.[24]
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.[25] 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 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 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.[26] 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 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.[27] 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:
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 are a common occurrence in young children.[28] 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).[29]
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.[30] 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.
This examination serves various purposes, including the detection of conditions such as testicular cancer, Klinefelter syndrome, and urinary issues.[31] 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.[32]