Clinical summary guide

Step-by-step male genital examination

4 min

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Testicular volume

Testicular volume is assessed using an orchidometer; a sequential series of beads ranging in size from 1 mL to 35 mL (see Image 1). 

Normal testicular volume ranges

< 3ml4-14ml15-35ml

Examination of secondary sexual characteristics

Penile Growth

Image 1 – Orchidometer

Why use an Orchidometer?

Testicular volume is important in the assessment of normal development and diagnosis of androgen deficiency, infertility and Klinefelter syndrome.

Image 2 – 30mL (normal)(left)/4mL (Klinefelter syndrome)(right)

Image 3 – Gynecomastia

(Photo courtesy of Mr G Southwick, Melbourne Institute of Plastic Surgery)

Examination of testis and scrotal contents

TestisGently palpate the testis between your thumb and first two fingers.
Note: Atrophic testes are often more tender to palpation than normal testes.
If a testis cannot be felt, gently palpate the inguinal canal to see if testis can be ‘milked’ down.
Note: Testis retraction can be caused by cold room temperature, anxiety and cremasteric reflex.
Examine the testis surface for irregularities. It should be smooth, with a firm, soft rubbery consistency.
Note: A tumour may be indicated by deep or surface irregularity, or differences in consistency between testes.
EpididymisLocate the epididymis, which lies along the posterior wall of the testis. It should be soft, slightly irregular and non-tender to touch.Tenderness, enlargement or hardening can occur as a result of obstruction (vasectomy) or infection. This can be associated with obstructive infertility.
Cysts in the epididymis are quite common. These are something mistaken for a testicular tumour.
Vas deferensLocate the vas deferens, a firm rubbery tube approximately 2-3 mm in diameter.Nodules/thickening around the vas deferens ends may be apparent after vasectomy.
The vas deferens should be distinguished from the blood vessels and nerves of the spermatic cord.Absence of the vas deferens is a congenital condition associated with low semen volume and azoospermia.
VaricocelePerform examination with the man standing.
A Valsalva manoeuvre or coughing helps delineate smaller varicoceles.
Indicators include:
– Palpable swelling of the spermatic veins above testis
– Swelling is usually easy to feel and can be compressed without discomfort
– Nearly always on left side
– Associated with infertility.
See image below.

Examination of penile abnormalities

Peyronie’s diseaseFibrous tissue, causing pain and curvature of the erect penis.
Check for tenderness or thickening.
PhimosisThe foreskin cannot be pulled back behind the glans penis. Can be normal in boys up to 5-6 years.
HypospadiasAbnormal position of meatus on the underside of the penile shaft. May be associated with a notched penile head.
Urethral strictureAbnormal urethral narrowing, which alters urination. Can be caused by scar tissue, disease or injury.
MicropenisMay indicate androgen deficiency prior to puberty.

Clinical review
Clinical review by Dr Darren Katz, Men’s Health Melbourne
Step-by-step male genital examination

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