PENIS

Normal Findings
- Pubic Hair: Coarser than scalp hair, covering the entire groin area, extending to the medial
thighs and up the abdomen toward the umbilicus. In older adults, it may be gray and sparse.
- Shaft Skin: Wrinkled, hairless, free of rashes, lesions, or lumps. Genital piercings may be
present.
- Foreskin (Uncircumcised): Intact, uniform in color with the penis, retracts easily. A small
amount of whitish smegma may accumulate underneath.
- Glans: Size and shape vary; surface is normally smooth, free of lesions and redness.
- Urethral Meatus: Slit-like, normally found in the center of the glans, free of discharge.
Abnormal Findings
- Absence or Scarcity of Pubic Hair: May be seen in clients receiving chemotherapy
- Pediculosis Pubis ("Crabs"): Lice or nit infestation at the base of the penis or pubic hair.
- Rashes, Lesions, or Lumps: May indicate STI or cancer. Drainage around piercings indicates
infection.
- Phimosis: Tight foreskin that cannot be retracted.
- Paraphimosis: Foreskin that, once retracted, cannot be returned to cover the glans.
- Syphilitic Chancre: Red, oval ulceration, painless, a sign of primary syphilis
- Herpes Progenitalis: Clusters of pimple-like, clear vesicles that erupt and become ulcers;
painful.
- Genital Warts: Single or multiple, moist, fleshy papules; painless.
- Hypospadias: Displacement of the urethral meatus to the ventral surface of the penis.
- Epispadias: Displacement of the urethral meatus to the dorsal surface of the penis.
- Urethral Discharge: Yellow discharge (gonorrhea), clear or white discharge (urethritis).
SCROTUM
Normal Findings
- Size and Shape: Varies according to temperature; the left side usually hangs lower than the
right.
- Scrotal Skin: Thin, rugated (crinkled), with little hair dispersion; color slightly darker than the
penis; sebaceous cysts may be present.
- Testes: Ovoid, approximately 3.5-5 cm long, smooth, firm, rubbery, mobile, free of nodules,
slightly tender to pressure.
- Epididymis: Nontender, smooth, softer than the testes.
- Spermatic Cord and Vas Deferens: Uniform on both sides, smooth, nontender, rope-like.
Abnormal Findings
- Enlarged Scrotal Sac: May result from fluid (hydrocele), blood (hematocele), bowel (hernia), or
tumor (cancer).
- Rashes, Lesions, Inflammation: Abnormal findings
- Absence of a Testis: Suggests cryptorchidism (undescended testicle).
- Painless Nodules: May indicate cancer
- Tenderness and Swelling: May indicate acute orchitis, torsion of the spermatic cord,
strangulated hernia, or epididymitis. Prehn's sign (relief of pain with passive elevation of the
testes) may be present in epididymitis.
- Palpable, Tortuous Veins: Suggest varicocele
- Beaded or Thickened Cord: Indicates infection or cysts.
- Cyst: Suggests hydrocele of the spermatic cord.
- Hydrocele: Collection of serous fluid in the scrotum. Transilluminates.
- Testicular Tumor: Initially a small, firm, nontender nodule; as it grows, the scrotum appears
enlarged. Does not transilluminate.
- Scrotal Hernia: A loop of bowel protrudes into the scrotum
- Cryptorchidism: Failure of one or both testicles to descend into the scrotum.
- Epididymitis: Infection of the epididymis; sudden pain, enlarged, red scrotum.
- Orchitis: Inflammation of the testes; pain, heaviness, fever, enlarged, reddened scrotum.
- Small Testes: Less than 3.5 cm long; may indicate atrophy or Klinefelter's syndrome
- Torsion of Spermatic Cord: Very painful, enlarged, reddened scrotum; thickened cord and
swollen, tender testis. Requires immediate referral.
- Varicocele: Abnormal dilation of veins in the spermatic cord; discomfort, testicular heaviness;
palpable tortuous veins.
Inguinal Area
Normal Findings
- Inguinal and Femoral Areas: Normally free from bulges or masses.
Abnormal Findings
- Bulges: May signal a hernia (inguinal or femoral).
Anus and Rectum
Normal Findings
- Anal Opening: Hairless, moist, tightly closed.
- Perianal Area: Free of redness, lumps, ulcers, lesions, and rashes.
- Sphincter Tone: Normal tone allows for relaxation and insertion during examination.
- Anal Canal and Rectum: Smooth, nontender, free of nodules and hardness. Rectal mucosa is
soft, smooth, nontender, and free of nodules.
- Prostate (Palpated rectally): Nontender, rubbery, two lateral lobes divided by a median sulcus;
lobes are smooth, 2.5 cm long, heart-shaped.
Abnormal Findings
- Lesions: May indicate STIs, cancer, or hemorrhoids.
- Thrombosed External Hemorrhoid: Swollen, itchy, painful, bleeds when passing stool.
- Skin Tag: May indicate a previously thrombosed hemorrhoid or fissure.
- Perianal Abscess: Painful, hardened, reddened mass.
- Anorectal Fistula: Small opening in the skin surrounding the anal opening.
- Pilonidal Cyst: Reddened, swollen, or dimpled area covered by a small tuft of hair located
midline on the lower sacrum.
- Poor Sphincter Tone: May result from spinal cord injury, previous surgery, trauma, or prolapsed
rectum.
- Tightened Sphincter Tone: May indicate anxiety, scarring, or inflammation.
- Tenderness, Nodules, Hardness: May indicate hemorrhoids, fistula, fissure, polyps, or cancer.
- Hardness and Irregularities (Rectum): May be from scarring or cancer.
- Nodules (Rectum): May indicate polyps or cancer.
- Swollen, Tender Prostate: May indicate acute prostatitis.
- Enlarged Prostate: May indicate benign prostatic hypertrophy (BPH).
- Hard Area or Hard, Fixed, Irregular Nodules (Prostate): Suggest cancer.