🧼 Wash hands before approaching.
Introduce yourself, confirm patient’s name & DOB.
Explain: “I’d like to examine your testicles to check for lumps, swelling or tenderness.”
Gain consent and ensure privacy with appropriate draping.

🧰 Equipment Needed

Examination gloves 🥼
Good lighting 💡
Sheet/gown for modesty
Optional: Warm cloth (to relax scrotum)
Optional: Pen torch 🔦 for transillumination

👀 Step 1: Inspection

Inspect both sides of scrotum for:

Asymmetry, swelling, scars
Skin changes (erythema, ulceration, rashes)
Bulges (inguinoscrotal hernia, hydrocele)

🤲 Step 2: Palpation of Testes

Examine each testis separately, gently rolling between fingers.
Assess size, shape, consistency, tenderness.
Red flag: A painless, hard intratesticular lump = testicular tumour until proven otherwise 🚩.
Palpate the epididymis (posterolateral) for tenderness/swelling.
If swelling present, perform transillumination test:
- Bright glow → hydrocele (fluid-filled).
- No glow → solid mass (e.g. tumour, hernia).

🧵 Step 3: Spermatic Cord & Inguinal Canal

Palpate cord for thickening, nodules, tenderness.
Assess for varicocele – feels like a “bag of worms”, more obvious on Valsalva.
Check inguinal canal for hernia (ask patient to cough/strain).

⚠️ Step 4: Special Considerations

Infection: Tender, swollen testis or epididymis → epididymo-orchitis (often with fever, dysuria).
Torsion: Sudden pain + high-riding tender testis in young male = surgical emergency 🚨.
Mass localisation: Intratesticular (likely malignant) vs extratesticular (hydrocele, epididymal cyst).

✅ Closure

Thank patient, allow redressing, maintain dignity.
Summarise: “I felt a soft, transilluminating swelling consistent with a hydrocele” (example).
Wash hands 🧼 and document accurately.

⭐ Key OSCE Points

Systematic: Inspection → Palpation → Spermatic Cord → Specials.
Always compare both testes for symmetry.
Explain each step → helps patient relax.
Be ready to state differentials + next steps (USS scrotum, tumour markers).

🚫 Common Pitfalls

Not gaining consent or failing to maintain dignity.
Missing subtle varicocele (check with Valsalva).
Not differentiating intratesticular vs extratesticular lump.
Forgetting torsion as a red-flag emergency diagnosis.

📚 References

Clinical Examination – Talley & O’Connor
Geeky Medics: Testicular Exam
OSCEstop – Practice stations

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OSCE Testicular/Scrotal Examination

👋 Introduction