24. The male genitalia

Andrological examination involves intimate body parts, so these patients tend to be tense. Accordingly, the way in which the examination is conducted merits extra attention. Inspection involves looking at the development of secondary sexual characteristics, hygiene and abnormalities of the penis and scrotum, such as scars, warts, ulcers, redness, swelling and discharge. The penis should only be palpated on indication (if required). Palpation of the scrotum is used to check whether the vas deferens is complete and for scrotal swellings, which could be in the skin or intrascrotal (alongside or around the testes). When palpating the testes and epididymis, check them for symmetry, size, consistency, surface texture and the presence or absence of pain. The skin around the anus should be inspected during rectal examination. When palpating the prostate, assess it for size, symmetry, surface texture, the presence or absence of sulcus, pain, delineation and consistency. The discussion includes the following abnormalities of the penis: phimosis, balanitis, lichen sclerosis, hypospadias, meatal stenosis, condylomata acuminata, syphilis, genital herpes and Peyronie’s disease. Abnormalities of the scrotum can include testicular dysgenesis syndrome (TSD), testicular cancer, hydrocele, spermatocele, varicocele, testicular torsion, orchitis and epididymitis. Prostate abnormalities can be indicative of conditions like benign prostate enlargement, prostate cancer and prostatitis.