Physical examination should include a complete evaluation of physical state of infertile man. Any factor can be responsible for abnormalities in sperm production. Thus, the physical examination should be complete and careful, especially it concerns the genitalia area.
1. Body Habitus
Presence of some signs of inadequately virilization (androgen-deficiency) such as decreased body hair, gynecomastia, eunuchoid proportions, etc., hints on the delayed maturation due to an endocrine abnormality diagnosis.
Penile curvature or angulation should be assessed for presence of hypospadias. Irregularity can cause an improper placement of the ejaculate within the vaginal vault.
The scrotal contents are examined by fingers while the patient is standing. The doctor should pay attention to testicular size and consistency and estimate the volume of the testis either with an orchidometer or by measuring the long and wide diameter of the testes to the nearest millimeter. It has been proved that a decrease in testicular size often indicates impaired spermatogenesis. Normally the length of the testis should be greater than 40 mm and the volume greater than 20 ml.
The doctor should also examine the peritesticular area for epididymal induration, irregularity, cystic changes, the presence of the vas deferens and any nodularity along its course. As a varicocele can cause abnormalities of gonadal function engorgement of the pampiniform plexus should be identified.
The most truthful results are gotten if the patient is examined in a warm room after standing for several minutes.
4. Digital Rectal Examination (DRE)
DRE is used for assessing prostatic size and examination for presence of prostatic and/or seminal vesicular induration, masses, or cysts.