Scrotum and Contents The spermatic cord is also examined with the patient in the standing position. A varicocele is a dilated, tortuous spermatic vein that becomes more obvious as the patient performs a Valsalva maneuver. The epididymis can again be palpated as a ridge of tissue running longitudinally, posterior to each testis. The testis should be palpated again between the fingers of both hands

To examine for a hernia, the physician's index finger should be inserted gently into the scrotum and invaginated into the external inguinal ring

Abnormal Physical Examination Findings—Scrotum and Contents 1.Testicular Cancer The most common physical finding in the testis is a mass. A useful guideline is that most masses arising from the testis are malignant, whereas almost all masses arising from the spermatic cord structures are benign Testicular tumors usually present as painless, firm, irregular masses on the surface of the testicle. Testicular tumors can be readily distinguished from benign masses arising from the spermatic cord by transillumination and scrotal ultrasound.

2.Torsion Torsion occurs most commonly between the ages of 12 and 20 years, although it does occur less frequently during the first year of life. Age is the most useful criterion in distinguishing torsion from epididymitis, because torsion usually occurs around puberty whereas epididymitis more often occurs in sexually active males, usually after age 20 years.

3.Hydrocele A hydrocele is a collection of fluid between the tunica vaginalis and the testis. Physical examination reveals smooth, symmetrical enlargement of one side of the scrotum in which it is very difficult to feel the testis. The diagnosis is made by transillumination of the scrotum. However, because about 10% of testicular tumors present with an associated reactive hydrocele, it is important to be sure that the hydrocele transilluminates completely and, if there is any doubt, to confirm the diagnosis with a subsequent scrotal ultrasound.

4.Varicocele A varicocele is an enlarged, tortuous spermatic vein above the testicle that almost always occurs on the left side. The patient presents with a soft mass or swelling above the testicle noted when he stands or strains. This has been described as a "bag of worms." Varicoceles typically decrease in size and may disappear when the patient is supine. Patients with the sudden onset of a varicocele, a right-sided varicocele, or a varicocele that does not reduce in size in the supine position should be suspected of having a retroperitoneal neoplasm