Early And Late Childhood

Inspect the penis. The size in prepubertal children has little significance unless it is abnormally large. In obese boys, the fat pad over the symphysis pubis may obscure the penis.

There is an art to palpation of the young boy's scrotum and testes because many have an extremely active cremasteric reflex that may cause the testis to retract upwards into the inguinal canal and thereby appear to be unde-scended. Examine the child when he is relaxed, because anxiety stimulates the cremasteric reflex. With warm hands, palpate the lower abdomen, working your way downward toward the scrotum along the inguinal canal. This will minimize retraction of the testes into the canal.

In precocious puberty, the penis and testes are enlarged, with signs of pubertal changes. This is caused by a variety of conditions associated with excess androgens, including adrenal or pituitary tumors. Other pubertal changes also occur.

A useful technique is to have the boy sit cross-legged on the examining table, as shown here. You can also give him a balloon to inflate or an object to lift to increase intra-abdominal pressure. If you can detect the testis in the scrotum, it is descended even if it spends much time in the inguinal canal.

The cremasteric reflex can be tested by scratching the medial aspect of the thigh. The testes will move upward.

Cryptorchidism may be noted at this age. It requires surgical correction. It should be differentiated from a retractible testis.

A painful testicle requires rapid treatment; common causes include infection such as epi-didymitis or orchitis, torsion of the testicle, or torsion of the appendix testis.

Examine the inguinal canal as you would for adults, noting any swelling that may reflect an inguinal hernia.

Inguinal hernias in older boys present as they do in adult men, with swelling in the inguinal canal, particularly following a Valsalva maneuver.

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