MALE GENITALIA ASSESSMENT

Preparation of the Client

1. Instruct the client to empty his bladder so he will be comfortable. If a urine
specimen is necessary, provide the client with a container
2. If the client is not wearing is not wearing an examination gown for a total physical
examination, provide a drape and ask him to lower his pants and underwear
3. Explain to the client that he will be asked to stand (if able) for most of the
examination

Equipments
 Stool
 Gown
 Disposable gloves
 Flash light (for possible illumination)
 Stethoscope (for possible auscultation)

Consideration
 Wear disposable gloves
 Preserve client’s privacy
 Inspect and palpate penis, scrotum, and inguinal area for inflammation,,
infestation, rashes, lesion, and lumps
 During testicular examination, describe the importance of testicular self-
examination and explain how to perform the examination as you are performing
it.
 Wear gloves for every step of the male genitalia examination

PHYSICAL ASSESSMENT

Penis
Assessment Procedure Normal Findings Abnormal Findings
INSPECTION AND
PALPATION
Inspect the base of the  Pubic hair is courser  Absence of scarcity of
penis and pubic hair. Sit on than scalp hair. The pubic hair may be seen
a stool with the client facing normal pubic hair in clients receiving
you and standing. Ask the pattern in adult is hair chemothepy. Lice or nits
client to raise his gown or covering the entire groin (eggs) infestation at the
drape. Note pubic hair area, extending to the base of the penis or
growth pattern and any medial tights and up the pubic hair is known as
excoriation, erythema, or abdomen toward the pediculosis pubis. This
infestation at the base of umbilicus. The base of is commonly referred to
the penis and within the the penis and the pubic as “crabs”
pubic hair hair are free of
excoriation, erythema,
and infestation
Inspect the skin of the  Skin of the penis is  Rashes, lesions, or
shaft. Observe for rashes, wrinkled and hairless lumps may indicate STD
lesions, or lumps and is normally free of or cancer
rashes, lesion, or lumps
Palpate the shaft. Palpate  The penis is in non erect  Hardness along the
any abnormalities noted state is usually soft, ventral surface may
during inspection. Also note flaccid, and non tender indicate cancer or a
any hardened or tender urethral stricture.
areas. Tenderness may
 indicate inflammation or
infection
Inspect the foreskin.  The foreskin, which  Discoloration of the
Observe for color, location, covers the glans in an foreskin may indicate
and integrity of the foreskin uncircumcised male scarring or infection
in uncircumcised men. client, is intact and
uniform in color with the
penis
Inspect the glans. Observe  The glans size and  Chancers (red oval
for size, shape, and lesion shape vary, appearing ulceration) from
or redness. rounded, broad, or even sphylllis, vereneal warts,
pointed. The surface of and pimple like lesions
the gland is normally from herpes are
If the client is not smooth, free of lesions sometimes detected on
circumcised, ask him to and redness the glans.
retract his foreskin, (if the  The foreskin retracts  A tight foreskin that
client is unable to do so, easily. A small amount cannot be retracted is
the nurse may retract it) to of whitish materials, called phimosis. A
allow observation of the called smegma, foreskin that once
glans. This may be painful normally accumulates retracted cannot be
under the foreskin returned to cover the
glans is called
paraphimosis. Chancres
(red, oval, ulceration) fro
syphilis and venereal
warts are sometimes
detected under the
Note the location of the  The urinary meatus is foreskin
urinary meatus on the glans slit-like a nd normally  Hypospadias is
found in the center of displacement of the
the glans urinary meatus to the
ventral surface of the
penis. Epispadias is
displacement of the
urinary meatus to the
dorsal surface of the
penis
Palpate the urethral  The urinary meatus is  A yellow discharge is
discharge. Gently squeeze normally free of usually associated with
the glans between your discharge gonorrhoea. A clear or
index finger and thumb white discharge is
usually associated with
urethritis. All discharge
should be cultured

Tanner’s Sexual Maturity Rating for Boys

Stage Pubic Hair Penis Testes and Scrotum
I (preadolescent)  None, except for  Same size and  Same size and
fine body hair proportions as in proportion as in
childhood childhood
II  Sparse growth,  Slightly or no  Both larger,
slightly curly enlargement reddened,
exhibiting
textural changes
III  Darker, coarse,  Larger, longer  Further
curly, sparse enlargement
 hair over
symphysis pubis
IV  Coarse, curly  Increased length  Further
hair that does and width, enlargement and
not extend to development of scrotal skin
medial thighs glans darkens
v  Adult hair in  Adult size and  Adult size and
texture and shape shape
quantity extends
to medial aspect
of thighs

Scrotum
Assessment Procedure Normal Findings Abnormal Findings
INSPECTION
Inspect the size, shape and  The scrotum varies in  An enlarged scrotal sac
position. Ask the client to size (accrdg to may result from fluid
hold his penis out of the temperature) and (hydrocele), blood
way. Observe for swelling, shape. The scrotal (hematocele), bowel
lumps, or bulges hangs below or at the (hernia) or tumor
level of the penis. The (cancer)
left side of the scrotal
sac usually hangs lower
that the right side
Inspect the scrotal skin.  Scrotal skin is thin and  Rashes, lesion, and
Observe color, integrity and rugated (crinkled) with inflammation are
lesions or rashes. To little hair dispersion. Its abnormal findings
perform an accurate color is slightly darker
inspection, you must than that of the penis.
spread out the scrotal folds Lesions and rashes are
(rugae) of skin. Lift the not normally present.
scrotal sac to inspect the Sebaceous cysts (small,
posterior skin. yellowish, firm, non-
tender, benign nodules)
are a normal findings
Palpation
Palpate the scrotal  Testis are ovoid,  Absence of a testis
contents. Palpate each approximately 3.5 to 5 suggests cryptorchidism
testis and epididymis cm long, 2.5 cm wide, (an indescended
between your thumb and 1st and 2.5 cm deep, and testicles). Painless
two fingers. Note size, equally bilaterally in size nodules may indicate
shape, consistency, and shape. They are cancer. Tenderness and
nodules, and tenderness smooth, firm, rubbery, swelling may indicate
mobile, free of nodules, acute orchitis, torsion of
and rather tender to the spermatic cord, a
pressure. The strangulated hernia, or
epididymis is nontender, epididymitis
smooth, and softer than If the client has a
the testis epididymitis, passive
elevation of the testes
may relieve the scrotal
pain (Prehn’s sign). If
client should be referred
immediately to the
physician and prepared
for surgery.
 Palpate each spermatic  The spermatic cord and  Palpable, tortuous veins
cord and vas deferns from vas deferens should feel suggest varicocele. A
the epididymis to the uniform on both sides. beaded or thickened
inguinal ring. The spermatic The cord is smooth, cord indicates infection
cord will lie between your nontender, and ropelike or cysts. If you palpate
thumb and finger. Note any the scrotal mass, have
nodules, swelling or the client lie down. The
tenderness mass return to the
abdomen by itself. If it
does not, place your
fingers above the scrotal
mass. If you can get
your fingers above the
mass, suspect
hydrocele. Cysts
suggests hydrocele of
the spermatic cord
Auscultation
Continue the examination  Normal findings are not  Bowel sounds may be
of a scrotal mass by expected auscultated over a
auscultating with a hernia but will not be
stetoscope heard over a hydrocele
Transillumination
Transilluminate the scrotal  Normally scrotal  Swelling or masses that
contents. If an abnormal contents do not contain serous fluid –
mass or swelling was noted transilluminate hydrocele, spermatocele
in the scrotum, – light up with a red
transillumination should be glow. Swellings or
performed. Darken the masses that are solid or
room and shine a light from filled with blood – tumor,
the back of the scrotum hernias, or varicocele –
through the mass. Look for do not light up with a red
red glow glow

Inguinal Area
Assessment Procedure Normal Findings Abnormal Findings
INSPECTION
Inspect for inguinal and  The inguinal and  Bulges that appear at
femoral hernia. Inspect the femoral area are the external inguinal ring
inguinal and femoral area normally free from or at the femoral canal
for bulges. Ask the client to bulges when the client bears
turn head and cough or to down may signal a
bear down as if having a hernia
bowel movement, and
continue to inspect the
areas
Palpation
Palpate for inguinal hernia  Bulging or masses are  A bulge or mass may
and inguinal nodes. Ask the not normally palpated indicate a hernia
client to shift his weight to
the left for palpation of the
right inguinal canal and vice
versa. Place your right
index finger into the client’s
right scrotum and press
upward, invaginating the
 loose fold of skin. Palpate
up to the spermatic cord
until you reach the tri-
angular shape, slitlike
opening of the external
inguinal ring. Try to push
your finger through the
opening and if possible,
continue palpating up the
inguinal canal. When your
finger is in the canal or at
the external inguinal ring,
ask the client to bear down
or cough. Feel for any
bulges against your finger.
Then, repeat the procedure
on the opposite side.
Palpate inguinal lymph  No enlargement or  Enlarged or tender
nodes. If nodes are tenderness is normal nodes may indicate an
palpable, note size, inflammatory process or
consistency, mobility or lesion on the penis or
tenderness scrotum
Palpate for femoral hernia.  Bulges or masses are  Bulge or mass may be
Palpate on the front of the not normally palpated from hernia
thigh in the femoral canal
area. Ask the client to bear
down or cough. Feel for
bulges. Repeat on the
opposite thigh
Inspect and palpate for  If bulges disappears, no  If the bulging disappears
scrotal hernia. If you scrotal hernia is present, when the client lies
discovered a mass during but the mass may result down, a scrotal hernia is
inspection and palpation of from something else present. Bowel sounds
the scrotum and you and the client should be auscultated over the
suspect it may be a hernia, referred for further mass indicate the
ask the client to lie down; evaluation. A mass on presence of bowel and
note whether the bulge or around the scrotum thus a scrotal hernia. If
disappears. If bulge should be considered you cannot push the
remains, auscultate it for malignant until testing mass into the abdomen,
bowel sounds. Finally, proves otherwise suspect an incarcerated
gently palpate the mass hernia. A hernia is
and try to push it upward strangulated when its
into the abdomen blood supply is cut off.
The client typically
complains of extreme
tenderness and nausea.

DOCUMENTATION

Sample Objective Data

 Pubic hair growth pattern is normal for adult male

 Pubic hair and base of penis free from excoriation and infestation
 Circumscised penis is soft, flaccid, and nontender on palpation
 Glans is rounded and free of lesions
 Urinary meatus is centrally located on glans, no discharge is palpated from
urinary meatus
  No masses or swelling noted in scrotum, and left side hangs slightly lower than
right side
 Skin is free of lesions and appears rugated and darkly pigmented
 Two descended testes palpated
 No swelling, tenderness, or masses palpated aling the testicle, epididymis, or
spermatic cord on either side
 No bulges or masses palpated in inguinal or femoral canal

Appropriate Nursing Diagnoses

Wellness Diagnoses
 Health-seeking behavior: Requests information for health management of the
reproductive system
 Health-seeking behavior: Requests information on testicular self-examination
 Health-seeking behavior: Requests information on ways to prevent STD
 Health-seeking behavior: Requests information on birth control
 Health-seeking behavior: Requests information on proper lifting technique to
prevent hernia formation

Risk Diagnoses
 Risk of ineffective therapeutic regimen management (monthly testicular self-
examination) related to lack of knowledge of the importance of TSE
 Risk for injury related to poor lifting techniques
 Risk for infection related to unprotected sexual intercourse
 Risk for ineffective sexuality patter related to impending surgery

Actual Diagnoses
 Fear of testicular cancer related to existing risk factors
 Disturbed body image related to hernia repair
 Pain: Dysuria related to gonorrhoea, infection, or genital reproductive surgery
 Ineffective therapeutic regimen management related to lack of knowledge of the
importance of TSE
 Sexual dysfunction related to decreased libido secondary to fear of urinary
incontinence, pain in surgical site, anxiety, or fear
 Sexual dysfunction related to erectile dysfunction secondary to psychological or
physiological factors
 Sexual dysfunction related to lack of ejaculation secondary to surgical removal of
seminal vesicles and transaction of the vas deferens
 Anxiety related to impending genital reproductive surgery and lack of knowledge
of outcome of surgery