ABSTRACT
Start the examination with your patient standing up exposing the groin and scrotum. If on general inspection there is an obvious swelling, describe it to the examiner. To examine the scrotum, first observe the anterior aspect for skin changes and the presence of a scrotal swelling. Then observe the posterior aspect before moving on to palpation. If there is a scrotal swelling, define its characteristics and determine whether you can get above the swelling, i.e. is it an indirect inguinal hernia or a swelling originating in the scrotum? Ascertain also whether the swelling is separate from the testis – if so, it is likely to be an epididymal cyst or a spermatocele; if not, it is likely to be a testicular tumour or a hydrocele. There is a simple way to determine whether an inguinal hernia is direct or indirect – ask the patient to reduce the hernia when he is lying down and place your two fingers over the deep inguinal ring, then ask him to cough. An indirect inguinal hernia will be controlled by pressure over the deep inguinal ring, and a direct inguinal hernia will not.
