Table of Contents

Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain examination and obtain consent
Get a chaperone
Patient should stand up and be exposed from waist down
Put on gloves

Inspect from the front but also ensure you lift the scrotum to inspect posteriorly.

Skin: erythema, rashes, excoriations, scars, ulcers
Testes: level (left usually lower), swelling, oedema, obvious masses
Inspect penis and retract foreskin: check for phimosis, adhesions and glans abnormalities. (Make sure you replace the foreskin.)

Support the testes with your non-dominant hand and palpate with the index finger and thumb of your dominant hand.

Testes: feel inferior, middle and superior parts of testes. Note size, consistency, and any lumps or masses.

If you feel a mass/swelling, note its characteristics (SSSCCCTTT)
- Size, Shape, Surface, Consistency, Contours, Colour, Temperature, Tenderness, Transillumination

Epididymis: feel around the posterior aspect of each testis for the epididymis (tenderness/swelling = epididymitis)
Spermatic cord: with thumb anteriorly and index finger posteriorly, feel neck of scrotum for spermatic cord (superior to testes, feels like string)
Palpate for inguinal lymphadenopathy (infection/inflammation)
Reflexes
- Prehn’s test: if testicular pain is relieved by elevating the testes, suspect epididymitis; if not, suspect testicular torsion
- Cremasteric reflex: stroke inside of leg and watch scrotal skin tighten (usually absent in torsion)

Palpate for supraclavicular lymphadenopathy: testicular cancer commonly metastasises here (rather than superficial inguinal nodes)

Thank patient and allow them to get dressed in privacy
‘To complete my examination, I would perform a full abdominal examination and examine herneal orifices.’
Summarise and suggest further investigations you would consider after a full history (e.g. urinalysis, testicular ultrasound)