Medically Fit For Exams
Medically Fit For Exams

Testicular examination

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination and gain consent
  • Put on gloves
  • Ask for a chaperone/mention that you have the examiner to act as a chaperone

 

Inspection

  • Ask the patient to undress from the waist down, provide a modesty sheet
    • If possible ask the patient to undress behind a screen and tell you when they are ready
  • General inspection
    • Gynecomastia
  • Inspect the scrotum
    • Assess the size and shape for obvious lumps, asymmetry, swelling or redness
    • Left testicle is often lower
    • Look for ulcers, rashes and scrotal oedema
    • Look at the distribution of pubic hair (may suggest hormone changes)
    • Look for scars
    • Ensure you look at both the back and front of the scrotum
  • Inspect the penis
    • Look for discharge and ulcers
    • Look at the position of the urethral meatus

 

Palpation

  • Ask about pain, and explain what you are about to do
  • Ask the patient to stand up
  • Start with the normal side
  • Palpate the testes, noting the following:
    • Presence of two testes
    • Size – is size difference due to a mass or swelling? Hypogonadism?
    • Lumps
      • Likely inguinal hernia if you can’t palpate above. Ask the patient to cough to enhance the hernia
      • Is the lump separate from the testes, or part of it?
      • Is it cystic or solid?
      • Is it tender or non-tender?
      • Does light shine through it? Suggests hydrocele
      • Attempt to measure or estimate the size of the lump
  • Palpate the epididymis head, body and tail
  • Palpate the spermatic cord from the testes up as far as you can
  • Palpate inguinal lymph nodes (although testicular malignancy normally spread to para-aortic lymph nodes)
  • Offer to teach the patient how to do a self-examination (just talk through the steps you did)

 

Management/intervention options

  • Ultrasound for malignancy, spermatocoele vs hydrocele
  • Surgery for suspected torsion

 

 

Testicular pathologies from examination

 

Consistency

Testicular

Separate from testes

Solid

Tender

Orchitis

Testicular torsion

Tender

Epididymitis

Non-tender

Tumour

Granuloma

Cystic

Non-tender

Hydrocele

Non-tender

Epididymal cyst

Hydrocele of spermatid cord

Varicocele

Spermatocele

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spermatocele

  • Smooth, soft, well circumscribed lump
  • Usually in the head of the epididymis
  • Fluid aspiration usually contains sperm

 

Hydrocele

  • Fluid collection, covers lateral and anterior aspects of testes
  • Soft, non-tender swelling,
  • Transilluminates

 

Varicocele

  • Is a dilated vein along the spermatic cord
  • Typically feels like a ‘bag of worms’
  • More common in left than right

 

Haematocele

  • Haemorrhage into tunica vaginalis, usually after trauma
  • Pain, tenderness
  • Refills rapidly on examination
  • Doesn’t transilluminate

Get social with us.

Print Print | Sitemap
© medicallyfitforexams.co.uk