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Historically, men have delayed seeking medical care, but recent changes in cultural attitudes about health care have led men to be more open to seeking preventive care and earlier care for disease. Men commonly ask questions about their reproductive health, including questions about male hypogonadism, erectile dysfunction, and infertility. A thoughtful, sensitive physical examination that focuses attention on disorders that are related to men’s hypothalamic-pituitary-testicular axis can identify important, underdiagnosed diseases such as Klinefelter syndrome and may also open up a dialogue between the clinician and patient about common concerns such as gynecomastia, genital anatomy, and erectile function.
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This chapter is organized into two main sections: the initial examination of a man who is “asymptomatic” and reports no concerns about male reproductive health and the examination of a man who reports symptoms that might be attributed to disorders of the male reproductive system. Symptoms such as gynecomastia and erectile dysfunction are included in this chapter because they are common, and a complete evaluation of these symptoms often includes an assessment for androgen deficiency.
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There is overlap in this typology. Many men initially do not report symptoms that might be secondary to dysfunction of the male reproductive system, but they might feel more comfortable reporting their symptoms and concerns as the clinician is performing an exam that includes the man’s breasts and genitals. Conversely, many men who report symptoms of dysfunction of the hypothalamic-pituitary-testicular axis or male reproductive function have never had an exam that includes careful evaluation of breast and genital anatomy; for these men, the “initial” as well as the “problem-related” exam should be performed.
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In this chapter, the physical exam elements for the evaluation of male reproductive health symptoms are organized in the order that clinicians are often taught to perform the exam. However, the author generally performs the genital examination at the end of the physical examination in order to allow for a more relaxed segue into a part of the exam that makes many men uncomfortable or embarrassed. Thus, the most important element of the physical examination for the evaluation of symptoms or signs of dysfunction of the hypothalamic-pituitary-testicular axis is the last to be done.
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THE APPROACH TO THE INITIAL EXAMINATION OF THE MAN WITHOUT REPRODUCTIVE HEALTH CONCERNS
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Key Points
Testicular volume measurement and palpation are the most important parts of the initial male reproductive health exam of the man without apparent symptoms of dysfunction of the male reproductive system.
The initial physical examination may lead to the diagnosis of Klinefelter syndrome, the most common cause of primary hypogonadism, and testicular cancer, the most common malignancy in young men.
The physical examination can distinguish between lipomastia, gynecomastia, and the rare male breast malignancy.
Imaging of the male breast is seldom necessary or useful.
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Two elements of the physical examination are important in a man without symptoms ...