Chapter 9: Male Genital, Rectal and Prostate Exams

INTRODUCTION

Because the male genital and rectal exams involve examining sensitive areas of the body, you need to communicate well with your patients, clearly explaining each aspect of the exam and why it is important prior to beginning. Obtain verbal consent and have a chaperone in the room to assist and observe.

Trauma-Informed Care

• Many patients have experienced physical or sexual trauma in their lifetime, which they may or may not disclose.

• Providers can create a safer space for trauma-informed care if they explain carefully, ask permission, take their time, move slowly, and empower the patient to opt out or stop the exam at any time. Apply the same principles discussed in Chapter 11, the Gynecologic exam.

THE GENITAL EXAM

Indications for Performing the Male Genital Exam

• To explore genital area symptoms (eg, testicular mass or pain, penile discharge).

• To assess for genital area findings in patients with systemic disorders or risk factors that can manifest in this region of the body.

Preparing and Positioning the Patient

• If they have not already done so, ask the patient to remove their underwear and put on a gown.

• It is easier to examine the penis and testicles with the patient standing and the examiner seated or standing in front of them. If that is not possible, the exam can also be performed with the patient supine on the table.

Observation and Examination of the Penis and Scrotum

• Expose the area to be examined. If the patient is standing, have them lift up their gown. If supine, ask them to pull their gown up so that the area is exposed, using a sheet to cover the rest of the body.

• Put on a pair of non-sterile gloves.

• Make note of the main anatomic structures as identified in Figure 9-1: glans and shaft of the penis, urethral opening, testicles, and scrotum.

• Note any obvious skin abnormalities on the penis, scrotum, or surrounding areas.

• Examine the glans (ie, the head of the penis).

• If the patient is uncircumcised, draw back the foreskin so that you can look at the glans in its entirety.

  • Make sure that you return the foreskin to its normal position.

• Examine the shaft and the base of the penis for any skin abnormalities (eg, pigmented areas, ulcers, vesicles), in particular if the patient complains of seeing or feeling something in that region.

• Observe the scrotum. You will need to gently move the penis in order to thoroughly evaluate this area.

• Palpate any abnormal-appearing area to further characterize it (eg, to determine if it is a process within the scrotal wall vs deeper structures).