DR. ADELMAN is a Fellow in Adolescent Medicine, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
DR. JOFFE is Director, Adolescent Medicine, and Associate Professor of Pediatrics, Johns Hopkins Medical Institutions, Baltimore.
Do you do a genital exam on your male adolescent patients? You should. These adolescent specialists demystify the process by teaching you where the landmarks are and what to look for.
Pediatricians know that a genital exam should be part of routine health care for adolescent boys, but many of them avoid the procedure unless the patient has a specific complaint. This is a mistake. A genital exam is an essential part of the routine health maintenance visit: to gauge sexual development, identify common anomalies, and pick up early signs of potentially serious conditions. In addition, many acute complaints such as abdominal, back, or flank pain, gynecomastia, supra-clavicular adenopathy, and genital discomfort require a thorough genital examination for diagnosis and management.
This article will familiarize the reader with the male genital examination through review of important anatomical structures and landmarks, benign findings of the penis, and common nonpainful masses in the scrotum. A second ariticle will review the differential diagnosis of the painful scrotum in the adolescent.
Where and how to perform the exam
We have found that even the most modest adolescent will agree to be examined if we explain why it is important and tell him what to expect. We explain that examination of the penis and testicles is an important part of the physical examination, as it allows us to ensure that development is proceeding normally and to identify early signs of potential problems. We point out that, in the rare circumstances in which a teenage male gets cancer, testicular cancer is the most likely possibility, and only a thorough genital exam can pick this up at an early, treatable stage.
We do the examination with a chaperone present--a nurse, nurse's aide, medical student, or any clinician who is available at the time. We have found that most patients are equally comfortable with a male or female examiner, and our experience has been corroborated by other researchers.  We keep the exam room warm, which relaxes the scrotum and makes it easier to examine, and the examiner warms his or her gloved hands before starting the exam. We ask the patient to remove his own undergarments and stand facing the seated examiner. We first inspect and then palpate the pubic area, inguinal canals, penis, and scrotum.
The pubic area
The pubic hair and underlying skin should be inspected to evaluate sexual maturity (Tanner stage) and look for evidence of such conditions as folliculitis, molluscum contagiosum, scabies, or genital warts. Examination of the penis should include inspection of the meatus, glans, corona, and shaft (Figure 1). The meatus should be inspected for discharge, erythema, warts, or hypospadias (urethral opening on the underside of the penis). If a discharge or other sign of sexually transmitted disease is noted, a specimen is taken....