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PHYSICAL EXAMINATION IN SEXUAL MEDICINE CASE TAKING Nutrition : Good/Fair/Poor Built : Good /Fair/Poor Weight: Kg Height : Cms B.P : mm Hg. Pulse : per min Lymph nodes : palpable/ not palpable C.N.S. : Reflexes Autonomic N.S. : Valsalva maneuver: Take the pulse rate at rest Blow through the B.P. apparatus tube to raise the mercury upto 40mm and maintain for 15sec. Take the pulse rate again. Take the ratio of the two readings. Normal : ratio > 1.5 Neuropathy : if the ratio is <1.1 Postural hypotension: Take systolic B.P.in sleeping position (after rest for 15 min) After standing for 3 min, take systolic B.P. again Normally B.P. falls by about 10 mm In Neuropathy , B.P. falls by about 30mm Pupillary reaction to light: Normally, pupils react to light In Neuropathy , pupils do no react to light. Other signs No sweating, Constipation R.S. : A.S. : P.R. Exam U.G.S. : Secondary sex characters : Genital development, Hair Male: change in voice nocturnal emissions Female : Breast development, Menstruation Genital Exam : Male : scrotum; Testes- size, consistency Penis- skin, Urethral meatus, Prepuce- phimosis? Glans- ulcer, smegma, Consistency of corpora, chordee? Pulsation of dorsal arteries(?) Cremastric & Bulbocavernosus reflexes Penile B.P. Female : mons, clitoris, labia majora & minora Urethral meatus, Vaginal opening, Hymen P.V.-1 or 2 fingers dilatation Vaginismus?