Physical Exam

Physical Examination

If this is a complaint in a man with no other recognized medical conditions, a full physical examination is necessary. Examination of the male patient is best done in a warm room, in an attempt to avoid any exaggeration of the cremaster reflex . The examination should focus primarily on the genitalia, with consideration for the overall body habitus. For a detailed discussion of the complete male physical examination, refer to the physical assessment article that appears elsewhere in this issue. The structures that are evaluated include the penis, scrotum, testes, epididymis, spermatic cord and vas deferens, prostate, seminal vesicles, and Cowper’s gland; however, not all are easily palpated.

The patient should be examined for age-appropriate development of male secondary sex characteristics, gynecomastia, or hirsutism. He should be evaluated for lesions or scarring to the abdomen or groin (as patients may inadvertently neglect to mention surgery that happened in their remote past), any discoloration to the scrotum, asymmetry of the testicles, and the location and size of the opening of the penile meatus. Physical examination could reveal regression of secondary sexual characteristics such as hair loss and possible loss of muscle bulk. Patients using anabolic steroids may also have skeletal muscle hypertrophy, acne, gynecomastia, and striae; there may be some noticeable testicular atrophy on examination.

A fertility specialist, usually a urologist, will perform a physical examination. A physical examination of the scrotum, including the testes, is essential for any male fertility work-up. It is useful for detecting large varicoceles, undescended testes, absence of vas deferens, cysts, or other physical abnormalities.

If your doctor feels that your partner may have a problem with his reproductive functioning, she will refer him to a urologist, ideally one who has particular experience and expertise with fertility-related issues. Once the urologist is finished asking the male partner a series of questions, he will conduct the physical examination.

He will:
note the male partner’s general appearance, paying particular attention to such secondary sex characteristics as facial, chest and pubic hair; deepness of voice; and physical build
record his height and weight
note whether he has fat deposits around his breasts(that is, gynecomastia)
check his blood pressure
listen to his chest
check his urine
check his reflexes
examine his head and neck, and check his thyroid for enlargement
examine his penis (check the location of the opening of the urethra, note any discharge, investigate any tenderness or unusual firmness, and so on)
examine both of his testes, noting both their size and their firmness
check the epididymis for tenderness or swelling that could indicate an infection
search for varicoceles around the testes (similar to varicose veins)
palpate the prostate and seminal vesicles while he is sitting and then check the prostate gland for any swelling or inflammation by inserting a gloved finger into his rectum
check to ensure that he has full sensation throughout his external genital area.
And after this he need to check these particulars.
• Varicoceles large enough to possibly interfere with fertility can be felt during examination of the scrotum. In such cases, they are described as feeling like “a bag of worms.” They disappear or are greatly reduced when the patient lies down, so the patient should be examined for varicocele while standing.
• Checking the size of the testicles is helpful. Smaller-sized and softer testicles along with tests that show low sperm count are strongly associated with problems in sperm formation. Normal testicles accompanied by a low sperm count, however, suggest possible obstruction. The doctor may also take the temperature of the scrotum with a test called scrotal thermography.
• The doctor will also check the prostate gland for abnormalities.
• The penis is checked for warts, discharge from the urinary tract, and hypospadias (incorrect location of the urethra opening).