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Female Genitalia Examination

TABLE 10-2 ■ Abnormalities of the Male Genitalia (Continued)

Tuberculosis EpididymisTransilluminate Testicle

Acute Epididymitis

An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testis. The scrotum may be reddened, and the vas deferens inflamed. It occurs chiefly in adults. Coexisting urinary tract infection or prostatitis supports the diagnosis.

Varicocele

Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft "bag of worms" separate from the testis, and slowly collapses when the scrotum is elevated in the supine patient. Infertility may be associated.

Spermatocele and Cyst of the Epididymis

A painless, movable cystic mass just above the testis suggests a spermatocele or an epididymal cyst. Both transilluminate. The former contains sperm and the latter does not, but they are clinically indistinguishable.

Tuberculous Epididymitis

The chronic inflammation of tuberculosis produces a firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens.

Torsion of the Spermatic Cord

Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection. Torsion, most common in adolescents, is a surgical emergency because of obstructed circulation.

Epidermoid Cysts

These are firm, yellowish, nontender, cutaneous cysts up to about 1 cm in diameter. They are common and frequently multiple.

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