What is important to begin with to perform a thorough scrotal exam?

• A. There should not be shrinkage; use heating pads if you need to
• B. Begin with palpation
• C. Do transillumination first
• D. Do ultrasound first

Answer: (A)

Beginning with palpation is essential in a thorough scrotal exam. The hands-on assessment reveals the size, shape, consistency, and tenderness of the testes, epididymis, and spermatic cord, and helps you detect any masses or abnormal contours. This tactile information is crucial for guiding the rest of the exam and for spotting urgent conditions, such as torsion or infection, that may require urgent action. After you've palpated, you can use additional findings to decide the next step: transillumination can help distinguish fluid-filled swellings from solid masses, and ultrasound is reserved for cases where more detail or vascular assessment is needed. Warming the scrotum with heating pads is not a standard starting step and does not replace a careful, methodical palpation-based approach.