We're now going to proceed with examination

of the male genitalia.

Uh, may I just bring this down?

Patient: Okay.

We're first going to inspect the skin and hair distribution.

We're going to inspect the penis and the scrotum,

and we're going to palpate inguinal nodes.

We're looking at the penis.

We're looking at whether or not the man is circumcised,

or uncircumcised.

We're looking to see if the penis is erect,

or flaccid.

And we're looking to see the shape and contour

of the scrotal sacs.

Because when the man stands up, we're going to see

is there a change in the size,

which might be indicative of a hernia or a varicocele.

We're also going to inspect, now, the perineum

because this is the only time that we can evaluate this area

adequately.

Would you just let your legs come apart?

And we're going to inspect this area.

And we're looking at this area for any lesions

that might be present.

We continue with examination of the male genitalia

by having the man assume a standing position,

and the examiner seated in front of the patient.

May I ask you to just open your robe please?

We first begin the examination by inspection of the penis

and the scrotum.

We compare the size of the scrotum to that

which we observed when the man was lying

during the abdominal examination.

The next part of the examination is evaluation

of the urethral meatus.

By gently holding the shaft of the penis,

we open up the urethral meatus

to observe whether or not there is any discharge

or any warts or lesions present.

We then observe the corona of the penis

and the shaft.

We then palpate the shaft of the penis

starting at the base

and palpate the bilateral corpora cavernosa.

And elevating the penis, we then palpate the

corpora spongiosa

all the way to the base of the penis,

to the bulbourethral area.

We then continue the evaluation of the scrotum.

And may I ask you to just hold your penis up for me.

Maybe perhaps you use the other hand?

Okay.

We notice the size of the scrotum

and the two scrotal sacs.

By placing our hands in the back of the scrotum

we now evaluate the contents of the spermatic cord.

As we come laterally we are evaluating the contents.

The most obvious structure in the cord

is the vas deferens,

which feels as a firm piece often described as

al dente spaghetti.

Normally we will find one vas deferens in each scrotal sac.

The absence of one vas deferens is suggestive

of an absent kidney on that same side.

Evaluation of the testicle is done by gently

holding the scrotum and testicle,

and palpating the testicle for size and consistency.

We can evaluate the epididymis

which begins at the cap

goes posteriorly

down to the tail

and up as the vas deferens.

After we have evaluated one side,

we will evaluate the second side as well.

Now if you just let your penis drop.

The last part of the examination

is the examination for hernia.

By taking scrotal skin, and taking your second finger,

and placing it in the internal ring,

above the testicle,

we can insert it into the external inguinal ring.

As we go into the inguinal canal

we'll ask the patient to cough.

Cough.

[patient coughs]

Again.

[patient coughs]

After we've done one side,

we can use the same finger for the other side,

and it's inserted, as you can see,

in the inguinal canal.

And cough again.

[patient coughs]

And again.

[patient coughs]

The presence of a indirect inguinal hernia

would enter the canal through the internal ring

and come down in this fashion.

The presence of a direct hernia

would NOT enter the canal,

which is related to a tear of the transversalis fascia

and would hit the pad of your finger

in this position.

Okay. Close your robe.

And this concludes the male external genital examination.

We're now going to continue with the rectal examination.