Hernia Exam

To assess for hernias, inspect the areas of the external inguinal ring and the femoral canal for bulges and continue to watch as the patient bears down. Please bear down. If none is seen, palpate for an inguinal hernia. Using your right index finger for the patient's right side, invaginate some loose scrotal skin and follow the spermatic cord up to the external inguinal ring, and if possible, through it to the inguinal canal. Ask the patient to bear down or cough and feel for a bulging mass that touches your finger.

Now palpate for a femoral hernia. Using the femoral pulse and inguinal ligament for orientation, place your fingers at the femoral canal and feel for swelling or tenderness as the patient again bears down or coughs. Please bear down. Repeat inspection and palpation on the left side using your left index finger to palpate the external inguinal ring. When a male patient cannot or should not stand up for this exam, perform it while he is lying down. This position also makes it easier to inspect all surfaces of the penis and scrotum,

cover the patient's legs and expose his genitalia. To assess sexual maturity, if indicated, inspect the patient's pubic hair and genitalia. Inspect the skin around the base of the penis for inflammation, excoriation, nits or lice. After retracting the foreskin, if necessary, inspect the glands and note the location of the urethral meatus. Compress the glands to open the meatus. If discharge is present, culture it. Then palpate the shaft of the penis. Continue by inspecting the scrotum, including its contours and all skin surfaces. Then palpate each testis and epididymis.

Feel each spermatic cord, including the vast efferents, and palpate it from the epididymis to the external inguinal ring.