Male & Female Genitalia,

and Anus, Rectum, & Prostate

 Reading Assignment
• Anatomy & Physiology
• The Health History
• Health Promotion & Counseling
 Table of contents

01 Male Genitalia

02 Female
Genitalia

03 Anus, Rectum,
& Prostate
Menu

01
Male Genitalia
 The Male Genitalia
• Explain what is involved and review each step of the examination so
that the patient feels reassured and knows what to expect
• When needed, request an assistant to accompany you
• Occasionally, if the patient has an erection, explain that this is a
normal response, finish your examination, and proceed with a calm
demeanor
• If the patient refuses the examination, respect the patient’s wishes
• Wear gloves throughout the examination
• For younger patients, review the sexual maturity ratings
 The Penis
Inspection
• Inspect the penis, including:
o The skin. Inspect the ventral and dorsal surfaces and the base of the
penis for excoriations or inflammation, lifting the penis when necessary
o The prepuce (foreskin). If present, retract the prepuce or ask the patient
to retract it. This step is essential for the detection of chancres and
carcinomas
o The glans. Look for any ulcers, scars, nodules, or signs of inflammation
o The urethral meatus. Inspect the location of the urethral meatus.
 The Penis
Palpation
• Palpate the shaft of the penis between your thumb and first two
fingers, noting any induration or tenderness
• If you retract the foreskin, replace it before proceeding on to examine
the scrotum.
 The Scrotum and its Contents
Inspection
• Inspect the scrotum, including:
o The skin. Lift up the scrotum so that you can inspect its posterior
surface. Note any lesions or scars. Inspect the pubic hair distribution
o The scrotal contours. Inspect for swelling, lumps, veins, bulging
masses, or asymmetry of the left and right hemiscrotum
o The inguinal areas. Note any erythema, excoriation, or visible
adenopathy
 The Scrotum and its Contents
Palpation
• If using a one-handed technique, palpate each testis and epididymis
between your thumb and first two fingers
• If using two hands, cradle the testis at both poles in the thumb and
fingertips of both hands
• Palpate the scrotal contents as you gently slide them back and forth
from the fingertips of one hand to the other, without changing the
position of your hands as they cup the scrotum
• The testes should be firm but not hard, descended, symmetric,
nontender, and without masses
 The Scrotum and its Contents
Palpation
• For each testis, assess size, shape, consistency, and tenderness; feel
for any nodules
• Palpate the epididymis on the posterior surface of each testicle
without applying excess pressure, which can cause discomfort
• The epididymis feels nodular and cord-like and should not be
confused with an abnormal lump
• Palpate each spermatic cord
• Palpate any nodules or swellings
 Hernias
Inspection
• Sitting comfortably in front of the patient, with the patient standing
and an assistant present, if indicated, inspect the inguinal regions and
genitalia for bulging areas and asymmetry

Palpation
• Palpate for an inguinal hernia. Continue to face the patient, who
should still be standing
• Palpate for a femoral hernia
Menu

02
Female
Genitalia
 External Examination
Assess the Sexual Maturity of an Adolescent Patient
• You can assess pubic hair during either the abdominal or the pelvic
examination
• Note its characteristics and distribution, and rate it according to the Tanner
stages
 External Examination
Examine the External Genitalia
• Seat yourself comfortably and warn the patient that you will be touching her
genital area
• Inspect the mons pubis, labia, and perineum
• Separate the labia and inspect:
o The labia minora
o The clitoris
o The urethral meatus
o The vaginal opening, or introitus
• Note any inflammation, ulceration, discharge, swelling, or nodules
• Palpate any lesions
 Bartholin Glands
• If the patient reports labial swelling, examine
the Bartholin glands
• Insert your index finger into the vagina near
the posterior introitus à place your thumb
outside the posterior part of the labium majus
• Palpate each side in turn, at approximately the
“4-o’clock” and “8-o’clock” positions
• Note any discharge exuding from the duct
opening of the gland
 Internal Examination
• Select a speculum of appropriate size and shape, and moisten it with
warm water
• Let the patient know you are about to insert the speculum and apply
downward pressure
• Some clinicians carefully enlarge the vaginal introitus by lubricating
one finger with water and applying downward pressure at its lower
margin, then palpate the location of the cervix in order to angle the
speculum more accurately
 Internal Examination
Inspection
• Inspect the cervix
o Obtain specimens for Cervical Cytology (Pap Smear)

• Inspect the vagina

 Bimanual Examination
Palpation
• Lubricate the index and middle fingers of one of your gloved hands,
and from a standing position, insert your lubricated fingers into the
vagina, again exerting pressure primarily posteriorly

• Note any nodularity or tenderness in the vaginal wall, including the

region of the urethra and the bladder anteriorly
o Palpate the cervix
o Palpate the uterus
o Palpate each ovary
 Rectovaginal Examination
• The rectovaginal examination has three primary purposes:
o To palpate a retroverted uterus, the uterosacral ligaments, cul-de-sac,
and adnexa
o To screen for colorectal cancer in women ages 50 years or older
o To assess pelvic pathology
Menu

03
Anus, Rectum,
& Prostate
 The Male Patient
Patient positioning
• Usually, the side-lying position is satisfactory and allows good visualization
of the perianal and sacrococcygeal areas
• Ask the patient to lie on his left side with his buttocks close to the edge of
the examining table near you
• Flexing the patient’s hips and knees, especially in the upper leg, stabilizes
his position and improves visibility
• Drape the patient appropriately and adjust the light to ensure good
visualization of the perirectal and anal area
• Glove your hands and spread the buttocks apart
 The Male Patient
Inspection
• Inspect the sacrococcygeal and perianal areas for lumps, ulcers,
inflammation, rashes, or excoriations

• Inspect the anus, noting any lesions

 The Male Patient
Palpation
• Examine the anus and rectum
o Lubricate your gloved index finger, explain to the patient what you are
going to do, and tell him that the examination may trigger an urge to
move his bowels but this will not occur
o Ask him to bear down as if having a bowel movement

• Palpate the anal canal

o As the sphincter relaxes, gently insert your fingertip into the anal canal
in the direction pointing toward the umbilicus
 The Male Patient
• If you can proceed without undue discomfort to the patient, note:
o The sphincter tone of the anus. Normally, the muscles of the anal
sphincter close snugly around your finger.
o Tenderness, if any
o Induration
o Irregularities or nodules
 The Male Patient
• Palpate the rectal surface
• Insert your finger into the rectum as far as possible
• Rotate your hand clockwise to palpate as much of the rectal surface as
possible on the patient’s right side
• Counterclockwise to palpate the surface posteriorly and on the patient’s
left side
• Note any nodules, irregularities, or induration
 The Male Patient
• Palpate the prostate gland
o Then rotate your hand further counterclockwise so that your finger can
examine the posterior surface of the prostate gland
o Tell the patient that examining his prostate gland may prompt an urge to
urinate
o Sweep your finger carefully over the prostate gland, identifying its
lateral lobes and the groove of the median sulcus between them
o Note the size, shape, mobility, and consistency of the prostate, and
identify any nodules or tenderness
o The normal prostate is rubbery and nontender, with no evidence of
fixity to the surrounding tissues
 The Female Patient
• The rectum is usually examined after examining the female genitalia
while the woman is in the lithotomy position
• This position allows you to conduct the bimanual examination,
delineate a possible adnexal or pelvic mass, test the integrity of the
rectovaginal wall, and may help you to palpate a cancer high in the
rectum
• If only a rectal examination is needed, the lateral position is
satisfactory and affords a better view to the perianal and
sacrococcygeal areas
 The Female Patient
• Use the same techniques for examination that you use for men
• Note that the cervix is readily palpated through the anterior rectal
wall
• Sometimes, a retroverted uterus is also palpable
• Do not mistake either of these, or a vaginal tampon, for a suspicious
mass
References

● Bickley, L.S. & Szilagyi P.G. (2016). Bates’

Guide to Physical Examination and History Taking,
12th ed. Wolters Kluwer Health | Lippincott Williams &
Wilkins
Thank You
for
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