Testicular examination

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.
• 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

Hydrocele

Oops! This section is restricted to members. Click here to signup!

Varicocele

Oops! This section is restricted to members. Click here to signup!

Epididymal cyst

Oops! This section is restricted to members. Click here to signup!

Testicular tumour

Oops! This section is restricted to members. Click here to signup!

Inguinal-scrotal hernia

Oops! This section is restricted to members. Click here to signup!

Epididymitis

Oops! This section is restricted to members. Click here to signup!

Testicular torsion

Oops! This section is restricted to members. Click here to signup!

Orchitis

Oops! This section is restricted to members. Click here to signup!

Here’s some viva questions

When may you use Prehn’s test and what do the results indicate?

Oops! This section is restricted to members. Click here to signup!

What is the difference between phimosis and paraphimosis?

Oops! This section is restricted to members. Click here to signup!

List some risk factors for testicular torsion

Oops! This section is restricted to members. Click here to signup!

What are the main types of testicular tumour and which biomarkers may they secrete?

Oops! This section is restricted to members. Click here to signup!

Try an OSCE station

1. Testicular exam
2. Find more here