Male Genitals and Inguinal Area

Complete Examination in adult men:

 assessment of the external genitals;
 presence of any hernias; and
 prostate gland
All male clients should be screened for the presence of inguinal or femoral hernias.
Ahernia is a protrusion of the intestine through the inguinal wall or canal.
Cancer of the prostate gland is the most common cancer in adult men and occurs primarily in men over age 50.
Testicular cancer is much rarer than prostate cancer and occurs primarily in young men ages 15 to 35. Testicular cancer is most
commonly found on the anterior and lateral surfaces of the testes. Testicular self-examination should be conducted monthly.

The Male Urogenital Tract

Tanner Stages of Male Pubic Hair and External Genital Development (12 to 16 Years)

Stage Pubic Hair Penis Testes/Scrotum

None, except for body hair like Size is relative to body size, as Size is relative to body size, as
that on the abdomen in childhood in childhood

Scant, long, slightly pigmented Slight enlargement occurs Becomes reddened in color
at base of penis and enlarged

Darker, begins to curl and Elongation occurs Continuing enlargement

becomes coarser; extends
over pubic symphysis

Continues to darken and Increase in both breadth and Continuing enlargement; color
thicken; extends on the sides, length; glans develops darkens
above and below

Adult distribution that extends Adult appearance Adult appearance

to inner thighs, umbilicus, and
anus
Assessing the Male Genitals and Inguinal Area
1. Perform hand hygiene, apply gloves, and observe appropriate infection control procedures.
R: Prevents transmission of microorganisms.

2. Introduce self and verify the client’s identity. Explain to the client what you are going to do, why it is necessary, and how he can
participate.
R: Reduces client’s anxiety and promotes cooperation of the client.

3. Provide for client privacy. Request the presence of another person if desired or requested by the client.
R: Promotes comfort and avoid embarrassment to the client.

4. Inquire about the following: usual voiding patterns and changes, bladder control, urinary incontinence, frequency, urgency,
abdominal pain; symptoms of sexually transmitted infection; swellings that could indicate presence of hernia; family history of
nephritis, malignancy of the prostate, or malignancy of the kidney.

5. Cover the pelvic area with a sheet or drape at all times when not actually being examined.
R: Promotes comfort and avoid embarrassment to the client.

6. Inspect the distribution, amount, and characteristics of pubic hair.

Normal Findings: Triangular distribution, often spreading up the abdomen
Deviations from normal: Scant amount or absence of hair

7. Inspect the penile shaft and glans penis for lesions, nodules, swellings, and inflammation.
Normal Findings:
 Penile skin intact
 Appears slightly wrinkled and varies in color as widely as other body skin
 Foreskin easily retractable from the glans penis
 Small amount of thick white smegma between the glans and foreskin
Deviations from normal:
 Presence of lesions, nodules, swellings, or inflammation
 Foreskin not retractable
 Large amount, discolored, or malodorous substance

8. Inspect the urethral meatus for swelling, inflammation, and discharge.

Normal Findings:
 Pink and slit like appearance
 Positioned at the tip of the penis
Deviations from normal:
 Inflammation; discharge
  Variation in meatal locations (e.g., hypospadias, on the underside of the penile shaft, and epispadias,
on the upper side of the penile shaft)

9. Inspect the scrotum for appearance, general size, and symmetry.

 Inspect all skin surfaces by spreading the rugated surface skin and lifting the scrotum as needed to observe posterior
surfaces.
Normal Findings:
 Scrotal skin is darker in color than that of the rest of the body and is loose
 Size varies with temperature changes (the dartos muscles contract when the area is cold and relax
when the area is warm)
 Scrotum appears asymmetric (left testis is usually lower than right testis)
Deviations from normal:
 Discolorations; any tightening of skin (may indicate edema or mass)
 Marked asymmetry in size

10. Inspect both inguinal areas for bulges while the client is standing, if possible.
 First, have the client remain at rest.
 Next, have the client hold his breath and strain or bear down as though having a bowel movement. Bearing down may
make the hernia more visible.
Normal Finding: No swelling or bulges
Deviation from normal: Swelling or bulge (possible inguinal or femoral hernia)

11. Remove and discard gloves. Perform hand hygiene.

R: Prevent transmission of microorganisms.

12. Document findings in the client record.

Diseases and disorders

Female Genitals and Inguinal Area
The examination of the genitals and reproductive tract of women includes assessment of the inguinal lymph nodes and inspection and
palpation of the external genitals. Completeness of the assessment of the genitals and reproductive tract depends on the needs and
problems of the individual client. In most practice settings, generalist nurses perform only inspection of the external genitals and palpation
of the inguinal lymph nodes.
Papanicolaou test (Pap test) is used to detect cancer of the cervix. If there is an increased or abnormal vaginal discharge, specimens
should be taken to check for sexually transmitted disease.

Assessing the Female Genitals and Inguinal Area

1. Perform hand hygiene, apply gloves, and observe appropriate infection control procedures.
R: Prevents transmission of microorganisms.

2. Introduce self and verify the client’s identity. Explain to the client what you are going to do, why it is necessary, and how she can
participate.
R: Reduces client’s anxiety and promotes cooperation of the client.

3. Provide for client privacy. Request the presence of another woman if desired or requested by the client.
R: Promotes comfort and avoid embarrassment to the client.

4. Inquire regarding the following: age of onset of menstruation, last menstrual period (LMP), regularity of cycle, duration, amount of
daily flow, and whether menstruation is painful; incidence of pain during intercourse; vaginal discharge; number of pregnancies,
number of live births, labor or delivery complications; urgency and frequency of urination at night; blood in urine, painful urination,
incontinence; history of sexually transmitted infection, past and present.

5. Cover the pelvic area with a sheet or drape at all times when the client is not actually being examined. Position the client supine.

R: Promotes comfort and avoid embarrassment to the client.

6. Inspect the distribution, amount, and characteristics of pubic hair.

Normal Findings:
 There are wide variations; generally kinky in the menstruating adult, thinner and straighter after menopause.
 Distributed in the shape of an inverse triangle
Deviations from normal:
 Scant pubic hair (may indicate hormonal problem).
 Hair growth should not extend over the abdomen

7. Inspect the skin of the pubic area for parasites, inflammation, swelling, and lesions. To assess pubic skin adequately, separate the
labia majora and labia minora.
Normal Findings:
 Pubic skin intact, no lesions
 Skin of vulva area slightly darker than the rest of the body
 Labia round, full, and relatively symmetric in adult females
Deviations from normal: Lice, lesions, scars, fissures, swelling, erythema, excoriations, varicosities, or leukoplakia

8. Inspect the clitoris, urethral orifice, and vaginal orifice when separating the labia minora.
Normal Findings:
 Clitoris does not exceed 1 cm (0.4 in.) in width and 2 cm (0.8 in.) in length
 Urethral orifice appears as a small slit and is the same color as surrounding tissues
  No inflammation, swelling, or discharge
Deviations from normal:
 Presence of lesions
 Presence of inflammation, swelling, or discharge

9. Palpate the inguinal lymph nodes.

 Use the pads of the fingers in a rotary motion, noting any enlargement or
tenderness.
Normal Findings: No enlargement or tenderness
Deviations from normal: Enlargement and tenderness.
10. Remove and discard gloves. Perform hand hygiene.
R: Prevents transmission of microorganisms.
11. Document findings in the client record using forms or checklists supplemented by
narrative notes when appropriate.
ANUS
Anal examination involves only inspection.
Assessing the Anus
1. Perform hand hygiene, apply gloves, and observe appropriate infection control procedures for all rectal examinations.
R: Prevent transmission of microorganisms.

2. Introduce self and verify the client’s identity using agency protocol. Explain to the client what you are going to do, why it is
necessary, and how he or she can participate.
R: Reduces client’s anxiety and promotes cooperation of the client.

3. Provide for client privacy. Drape the client appropriately to prevent undue exposure of body parts.
R: Promotes comfort and avoid embarrassment to the client.

4. Inquire if the client has any history of the following: bright blood in stools, tarry black stools, diarrhea, constipation, abdominal
pain, excessive gas, hemorrhoids, or rectal pain; family history of colorectal cancer; when last stool specimen for occult blood
was performed and the results; and for males, if not obtained during the genitourinary examination, signs or symptoms of
prostate enlargement (e.g., slow urinary stream, hesitance, frequency, dribbling, and nocturia).

5. Position the client. In adults, a left lateral or Sims’ position with the upper leg acutely flexed is required for the examination. A
dorsal recumbent position with hips externally rotated and knees flexed or a lithotomy position may be used.
 For males, a standing position while the client bends over the examining table may also be used.

6. Inspect the anus and surrounding tissue for color, integrity, and skin lesions. Then, ask the client to bear down as though
defecating. Bearing down creates slight pressure on the skin that may accentuate rectal fissures, rectal prolapse, polyps, or
internal hemorrhoids. Describe the location of all abnormal findings in terms of a clock, with the 12 o’clock position toward the
pubic symphysis.
Normal Findings:
  Intact perianal skin; usually slightly more pigmented than the skin of the buttocks
 Anal skin is normally more pigmented, coarser, and moister than perianal skin and is usually hairless
Deviations from normal: Presence of fissures (cracks), ulcers, excoriations, inflammations, abscesses, protruding
hemorrhoids (dilated veins seen as reddened protrusions of the skin), lumps or tumors, fistula openings, or rectal prolapse
(varying degrees of protrusion of the rectal mucous membrane through the anus)

7. Remove and discard gloves. Perform hand hygiene.

R: Prevents transmission of microorganisms.

8. Document findings in the client record using forms or checklists supplemented by narrative notes when appropriate.
REFERENCES:
Kozier & Erb's Fundamentals of Nursing, 9E - Berman, Audrey, Snyder, Shirlee
MedicineNet