Physical Examination

Examination of Testicles

The initial step in evaluating a male for infertility is to obtain a thorough medical and urologic history. A scrotal examination is initially performed with the patient being in a supine position. This allows a varicocele, if present, to collapse; testis size and consistency can then be properly assessed. Ninety-five percent of the volume of the testicles is made by the cells that produce sperm. Therefore, a normal-size testicle is often a sign that sperm production is not severely impaired.

The testes should be firm in consistency. A change in testicular consistency is indicative of testicular pathology. Small soft testes indicate poor spermatogenesis. Also, the testicular volume will be checked, which should range between 15cc to 25cc. This can be checked using an orchidometer, callipers or ultrasound.

Examination of Epididymis

The normal epididymis is soft and barely palpable. Any type of sclerosis, modularity, or irregularities is suggestive of epididymal disorders. A full, firm, easily outlined hard epididymis suggests epididymal obstruction. Epididymal cysts are firm, smooth and almost always located in the head of the testicular region.

If there is any blockage of sperm transport, then the backing up of sperm happens into the epididymis, thus causing it to swell. This leads to infection and thus hampering the spermatogenesis process. Inflammation or infection within the epididymis makes it extra soft and tender.

Examination of Penis

The penis is the male organ, and when a male is sexually aroused, it becomes gorged with blood supply and hardens. This is known as erection, and it facilitates sexual penetration. At orgasm, semen is ejaculated through the penis and deposited into the female reproductive tract. On physical examination of the penis, the doctor will locate the urinary meatus, normally at the penis head. Any displacement of the urinary meatus is known as hypospadias or epispadias – causing significant impairment of the individual.

Also, there is a check for any discharge of fluid from the opening of the penis. This could mean he is suffering from some infection either in the urethra or the genital duct system.

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