Genitourinary Physical Exam

What do these examinations assess?

During the genitourinary physical examination, a healthcare professional will typically begin by taking a comprehensive medical history and discussing any relevant symptoms or concerns. The physical examination involves a thorough inspection, palpation, and sometimes specialized tests to evaluate the condition of the genitals and surrounding structures. Additionally, the urinary system is assessed by examining the kidneys and bladder.

How to use this physical exam template

Step One. Patient details

The first step is to enter your patient's information in the spaces provided. This includes their name, date of birth, and ID. These details are essential to confirm with the patient during your introduction portion of the examination.

Step Two. Patient history (subjective information)

The next section is the subjective information section, which those of you familiar with the SOAP note format will be familiar with! This section includes their genitourinary history, which should include a thorough history and their presenting genital or urinary symptoms.

Step Three. Fill in findings for each body part (objective information)

Next is the physical examination portion of the template. Check off each of the body parts as you assess them. If all findings are normal, add your findings in the comments section provided.

Step Four. Assess the findings

Once you have assessed all the body systems that apply to your patient, it's time to synthesize all the information- both subjective and objective- to form an assessment of your patient's condition.

Step Five. Plan for the next steps

The next steps for your patient may include further examination, diagnostic imaging to confirm a diagnosis, lab testing, referral to a specialist, medication prescription, or another treatment to address their symptoms.

Understanding the results

Abnormal findings in the genitourinary physical exam generally warrant further examination or testing to confirm any underlying pathology. While "normal" results are widespread, some other "abnormal" results that could potentially be found during a physical exam include:

Prostate gland

Physical examination of the prostate is completed via digital rectal examination, which can detect features such as size, asymmetry, firmness, or nodules, which may be indicative of prostate cancer. Upon an abnormal result from this part of the examination, a PSA test or biopsy is generally ordered to rule out prostate cancer.

Testes

During a physical exam, the testes are examined for size, shape, and any palpable lumps or abnormalities. This part of the examination can detect masses or changes in the testis' shape or texture, which may indicate conditions such as testicular cancer or other reproductive health issues.

Penis

Examination of the penis generally aims to detect signs of infection, abnormal or tender areas upon palpation, or abnormal urethral discharge.

Vagina and vulva

During a pelvic exam, the vagina and vulva are inspected for signs of infection, lesions, or other abnormalities. Common abnormalities that might be detected include inflammation, abnormal discharge, or changes in the vulva's appearance, which could indicate conditions like infections or precancerous lesions.

Kidney

Abnormalities such as pain in the flanks, tenderness, or abnormal masses may indicate kidney conditions, including infections, stones, or tumors.

Treatment and next steps

The next steps for the patient following the genitourinary examination depend on the examination results, the patient's chief complaint, and medical history. Here are a few common "next steps" following the genitourinary exam.

Laboratory tests

A common next step following a physical examination is laboratory testing. In these tests, a sample is collected from the patient, such as from a pap smear, and is sent to a lab to check if any abnormal cells are present. If physical examination shows abnormal results, one way to confirm or further investigate these is to take blood or another type of sample from the patient and conduct lab tests.

Imaging referral

Diagnostic imaging may be able to find things that a physical exam alone can't detect, so a common next step following abnormal findings might include requesting imaging, such as ultrasound, for further information.

Specialist referral

In some cases, the findings of a physical exam may warrant referral to a more specialized physician who can better treat the patient's condition. For example, suppose the digital rectal examination of the prostate yields abnormal results. In that case, the patient may be referred to a urologist for a biopsy and further testing to confirm if there is any underlying disease, such as prostate cancer, causing the findings.

Treatment prescription

In some cases, physical examination along with the patient's medical history alone may be able to confirm a diagnosis. For example, if a physical exam shows clear signs of a urinary tract infection, the physician may prescribe antibiotics immediately to quickly get on top of the disease. Often, a sample is still collected to test and confirm this diagnosis.

References

Meng, M. V., & Tanagho, E. A. (n.d.). Chapter 4: Physical Examination of the Genitourinary Tract.

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