From the Guidelines
A physical examination for epididymitis entails a comprehensive assessment including examination of the penis, measurement and palpation of the testes, checking for the presence and consistency of the vasa and epididymides, and a digital rectal examination. The examination should begin with a visual inspection of the scrotum for redness and swelling, followed by careful palpation to assess tenderness, swelling, and whether the epididymis feels distinct from the testicle 1. The examiner should also perform a prehn sign test and check for a cremasteric reflex. Additional components may include checking for discharge from the penis and examining the abdomen for tenderness. Some key points to consider during the physical examination include:
- Examination of the penis, including the location of the urethral meatus
- Measurement and palpation of the testes
- Checking for the presence and consistency of the vasa and epididymides
- Checking for the presence of a varicocele
- Body habitus and secondary sex characteristics, including hair distribution and breast development
- A digital rectal examination 1. It is also important to consider the patient's age and sexual history, as epididymitis can be caused by different organisms in different populations 1.
From the Research
Physical Examination for Epididymitis
A physical examination for epididymitis entails several key components, including:
- Inspection of the scrotum for swelling and redness
- Palpation of the epididymis to assess for tenderness and swelling
- Evaluation of the testis to determine if it is in an anatomically normal position 2
- Assessment for urinary symptoms such as dysuria and urinary frequency 2
Key Findings
Key findings on physical examination may include:
- A swollen and tender epididymis 2
- The testis in an anatomically normal position 2
- Presence of posterior scrotal pain 2
- Urinary symptoms such as dysuria and urinary frequency 2
Diagnostic Considerations
In addition to physical examination, diagnostic considerations may include:
- Laboratory tests such as urine analysis and culture to evaluate for infection 3
- Imaging studies such as ultrasonography or radionuclide scan to evaluate the scrotum and epididymis 3, 4
- Evaluation of acute-phase proteins such as C-reactive protein to differentiate epididymitis from noninflammatory conditions 4