Ask the patient to hold the penis out of the way and

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Palpate scrotal contents for nodules, lesions or tendernessScrotal contours: swelling, lumps, distended veins (varicocele), cryptorchidism, hydrocele, acute epididymitis, torsion of spermatic cordExpected FindingsDivided into 2 sacs; sebaceous cysts commonly noted; asymmetry is normal – left bigger Anterior and posterior skin darker in pigmentation with a rugous or wrinkled surfaceSmooth nontender scrotal contents17
Scrotum—PalpateEach testis & epididymis between the thumb & 1sttwo fingers Each spermatic cord, including the vas deferens, between thumb & fingers from the epididymis to the superficial inguinal ring – varicocele is an unexpected finding18
Slide 23-19
Slide 23-20Palpating the vas deferens – may be difficult to plapate – smooth, cord-like structure
Done to assess for mass (solid tumour) or fluidContents do NOT normally transilluminate Hydroceles and spermatoceles contain fluid and transillumination Red glow may indicate hydroceleTumours and hernias do notUse a bright penlight and press the light against the scrotal sac21
VaricoceleHydrocele22
Inspect for surface characteristics and tendernessExpected FindingsSkin is clear and smooth with no palpable masses or dimplingUnexpected FindingsA dimple with an inflamed tuft of hair or a tender palpable cyst in the sacrococcygeal area23
With the patient on his side, spread the buttocks and inspect the perineal areaExpected FindingsSkin surrounding the anus is coarse with darkwe pigmentation Anal sphincter is closedUnexpected FindingsWarts, loose sphincter, lesions, hemorrhoids, fissures, fistulas – (an opening between two areas) or polyps24
Place pad of lubricated finger over anus and gently press on the sphincter’s edge. Wait for the sphincter to relax then insert fingertip into anal canal;Pause and allow patient to adjust to your finger, then continue to insert finger fullyNote sphincter tone of the anus – by asking the patient to squeeze anal muscles around your finger
Jarvis (2010)Figure 23-4. p. 787.Palpate Anus/Rectum
Rotate your finger 180 degrees to examine the posterior and lateral walls of the rectumSweep your finger across the anterior and anterolateral walls of the rectum Note texture and elasticity of the rectal lining.

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