Genito-Urinary (GU) Exam


This exam is often used for routine screening of the asymptomatic male adult. Some components (such as the prostate exam) might not be necessary for younger patients. For convenience and simplicity we have divided the components of the exam based upon patient position. A full video of the exam can be found here. Some exam components are also covered on the page dedicated to the abdominal exam.

Exam sections: based upon the position of the patient

  1. Sitting position
  2. Supine position
  3. Standing position
  4. Bending over table (prostate exam)

*Make sure the patient has been able to void there bladder/bowels prior to examination to limit discomfort


Costovertebral (CVA) tenderness: Also a component of the abdominal physical exam, testing for CVA/flank tenderness can be done easily when the patient is sitting upright. This test is performed by using one’s fist to lightly percuss on the patient’s back (over the area where the kidneys reside). The presence of CVA tenderness can be suggestive of an issue with the kidney, such as infection (pyelonephritis).

Clinical test for CVA/flank tenderness (source)

Bladder percussion: also a component of the abdominal physical exam, while the patient is laying on their back, percussion of the bladder can be done. If the patient has recently voided, there should no dullness (caused by fluid) heard over this area. If patients are not able to completely void their bladder this can be suggested by this exam (although this can be confirmed my ultrasound).

Location for bladder percussion (source)
Location for bladder percussion (source)


Inguinal Lymph Node Palpation: feel these lymph nodes on both sides in order to assess for any lymphadenopathy.

Location of inguinal lymph nodes (source)
Location of inguinal lymph nodes (source)

Visual inspection of pubic area: check the skin for any abnormal findings (ulcers, lesions, infections, scars, nodules, etc). Also appreciate the hair distribution and if it is appropriate for the patients age.

Palpation of the penis: feel the shaft of the penis including the corpora cavernous and corpus spongiosum. Certain birth defects can be found in this region.

Anatomy of the penis (source)
Anatomy of the penis (source)

Move on to inspecting the glans penis (retracting foreskin as needed). Spread the urethral meatus (to observe inside the urethra for discharge.

Inspection and palpation of the scrotum: visually inspect the scrotum as you did the other areas of the genital anatomy. Palpate the scrotum and its contents. First isolate each testis and feel for:

  1. Epididymis: palpate and check for pain, swelling, any abnormalities
  2. Spermatic cord (which includes vas deferens): palpate each cord along its full length (tests to superficial inguinal ring).
Location of structures to palpate in the scrotum (source)
Location of structures to palpate in the scrotum (source)

Check for a hernia: put one of your fingers through the inguinal canal, and have patient cough/bear down. Feel for any structural weakness or the presence of bowels.

Examination of hernia (source)

Prostate exam: below is a step by step guide to performing a digital rectal exam (DRE)

  1. Prepare tissues for the patient (who will use these to clean up any extra lubricant left over), and have them close to the patient.
  2. Have the patient lower pants, widen stance, face away from you, and rest their elbows on the examination table.
  3. With your lubricant ready (apply generously to your finger) use your other hand to spread the patient’s cheeks in order to visualize the external sprinter.
  4. Apply lubricant to the area (above and below the sphincter as well)
  5. Insert your  index finger SLOWLY (pain receptors are only on the outside of then sphincter) with your palm facing towards the ceiling.
  6. Once inside rotate your finger so you are able to feel for the left, and right loves of the prostate
  7. Palpate the remaining surfaces of the anus as well
  8. Retract finger slowly and then perform guac test on any stool for occult blood.
Anatomy of the digital rectal exam (source)
Anatomy of the digital rectal exam (source)
Page Updated: 01.30.2016