Introduction

• 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

General inspection

• Patient: well/unwell, pain/discomfort, cachexia, gynaecomastia

Inspection

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.)

Palpation

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)

Finally

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

To complete

• 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)

Types of testicular pathology

Here’s some viva questions

Try an OSCE station

1. Testicular exam
2. Find more here