Do you routinely perform a genital exam on your male adolescent patients? If not, you may want to reconsider. This simple evaluation can help you monitor growth, uncover common anomalies, and identify serious but treatable conditions before real damage is done.
Although primary care physicians know that a genital examination should be part of routine health care for adolescent boys, many of them avoid the procedure unless the patient has a specific complaint. This is a mistake. An essential part of the routine health maintenance visit, the genital exam is used 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; supraclavicular adenopathy; and genital discomfort require a thorough genital examination for diagnosis and management. This article will remind physicians of the value of the male genital examination through review of important anatomic structures and landmarks, benign findings of the penis, and common non-painful masses in the scrotum.
Where and how to perform the exam
Even the most modest adolescent will agree to be examined if you explain why it is important and tell him what to expect. Explain that assessment of the penis and testicles is an important part of the physical examination, as it allows you to ensure that development is proceeding normally and to identify early signs of potential problems. Point out that, in the rare circumstances in which a teenage male gets cancer, testicular cancer is the most likely possibility and that only a thorough genital exam can pick this up at an early, treatable stage.
If at all possible, perform the examination with a chaperone in attendance-a nurse, nurse's aide, medical student, or any clinician who is available at the time. Most adolescent male patients are equally comfortable with a male or female examiner. Keep the examination room warm, which relaxes the scrotum and makes it easier to examine, and warm your gloved hands before starting the exam. Ask the patient to remove his undergarments and to stand facing you. First inspect and then palpate the pubic area, inguinal canals, penis, and scrotum.
The public area
Inspect the public hair and underlying skin 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 (see Figure 1). The means is 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, take a speciman. Collection of material for Gram's stain or culture requires insertion of the swab at least 2 cm past the meatus to reach the columnar epithelium of the urethra (see Figure 2). The prepuce should be evaluated for phimosis.
In uncircumcised males, retract the foreskin to inspect the glans for erythema or evidence of Candida infection, balanitis, or contact dermatitis. Ulceration of glans...