Men get ultrasounds all the time, for dozens of reasons that have nothing to do with pregnancy. Ultrasound works by bouncing high-frequency sound waves off soft tissues to create real-time images, and that technology is just as useful for evaluating a man’s testicles, prostate, blood vessels, liver, or heart as it is for monitoring a developing fetus. Because it uses sound waves rather than ionizing radiation, it is safe, painless in most applications, and relatively cheap compared to CT or MRI.1PubMed Central. The art and science of ultrasound imaging: medical applications of ultrasound in diagnosis and therapy and its impact on patient care If your doctor has ordered one, you are not an unusual case.
Testicular and Scrotal Ultrasound
This is probably the most common male-specific ultrasound. If you show up at a clinic or emergency room with scrotal pain, swelling, or a lump you can feel, a scrotal ultrasound is almost always the first imaging test ordered. The transducer (a small handheld wand) is placed directly on the skin of the scrotum after warm gel is applied. Images take only a few minutes to capture, and you stay awake and clothed from the waist up the entire time.
One of the most urgent reasons for a scrotal ultrasound is ruling out testicular torsion, a condition where the spermatic cord twists and cuts off blood flow. This is a surgical emergency, and ultrasound with color Doppler can show whether blood is reaching the testicle. Research has found that certain epididymal findings on ultrasound, such as abnormal location and flow patterns, are highly specific for identifying torsion and distinguishing it from less urgent conditions like epididymitis.2Nephro-Urology Monthly. Epididymal or Testicular Ultrasonic Findings: Which One is More Reliable for Differentiation of Testicular Torsion from Epididymitis?
Beyond emergencies, scrotal ultrasound is routinely used to evaluate lumps or masses. It can tell whether a mass is solid or fluid-filled (a cyst), and whether it sits inside or outside the testicle itself. That distinction matters because intratesticular masses carry a higher concern for cancer. That said, ultrasound has a well-known limitation here: while it can detect a focal lesion, it is not always able to determine whether that lesion is benign or malignant.3PubMed. Differential diagnosis of scrotal masses by ultrasound When a mass looks suspicious, further workup or surgery usually follows. Scrotal trauma is another common reason for the scan. After an injury, ultrasound is considered the first-choice imaging tool for assessing damage and deciding whether surgery is needed.4PubMed. Imaging of traumatic injuries to the scrotum and penis
Fertility Evaluation and Varicocele
When a couple has trouble conceiving, the male partner’s evaluation often includes a scrotal ultrasound with Doppler. The scan checks testicular size (smaller-than-expected testicles can signal reduced sperm production), looks for structural abnormalities, and most importantly screens for varicocele. A varicocele is an enlargement of the veins that drain the testicle, similar to a varicose vein in the leg. It is extremely common: a large European study of healthy, fertile men detected varicoceles on color Doppler ultrasound in roughly 37% of participants.5PubMed. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics That same study found no association between varicocele and sperm or hormone levels in those fertile men, which underscores that having a varicocele does not automatically mean you have a fertility problem.
The picture changes when you are already struggling with fertility. In that setting, treating a varicocele can improve sperm parameters. Doppler ultrasound is especially valuable for catching smaller (grade 1) varicoceles that a physical exam might miss, and for identifying bilateral varicoceles that affect both sides. Diagnosing these subtler cases allows earlier intervention, which may help avoid unnecessary delays in fertility treatment.6Urology Herald. Comparative evaluation of visual-palpatory findings with scrotal Doppler ultrasound data for varicocele diagnosis
Penile Doppler Ultrasound
Erectile dysfunction affects a large share of men at some point in their lives, and figuring out why is not always straightforward. Penile Doppler ultrasound is the go-to tool for distinguishing vascular causes (problems with blood flowing into or staying in the penis) from other causes like nerve damage or psychological factors.7PubMed. Penile Doppler Ultrasound for Erectile Dysfunction: Technique and Interpretation The exam can show blood flow changes in real time using color Doppler, which makes it particularly useful for understanding the mechanics of what is going wrong.8PubMed Central. Penile Doppler ultrasonography revisited
The procedure is more involved than a standard ultrasound. After applying gel and taking baseline measurements, the clinician injects a small dose of a medication called alprostadil directly into the base of the penis to stimulate an erection. Blood flow velocities are then measured at intervals. The peak systolic velocity (how fast blood rushes in) and end-diastolic velocity (how fast it leaks back out) help pinpoint whether the issue is an arterial supply problem, a venous leak, or both.9PubMed. The penile duplex ultrasound: How and when to perform it? The injection can cause a brief sting, and some men feel self-conscious about the setting, but the exam itself is over in about 20 to 30 minutes.
Penile ultrasound is also the primary imaging method for Peyronie’s disease, a condition where scar tissue (plaque) forms inside the penis and causes curvature, pain, or both. Ultrasound can identify and measure both calcified and soft plaques, including smaller ones that are not detectable by touch alone.10PubMed Central. US Imaging in Peyronie’s Disease This information helps guide treatment decisions, whether that means medication, injections into the plaque, or surgery.
Prostate Imaging
Transrectal ultrasound, commonly called TRUS, has been a cornerstone of prostate evaluation for decades. During a TRUS exam, a specially shaped transducer is inserted into the rectum so the probe sits right next to the prostate gland, producing detailed images. The exam measures prostate volume and can guide a biopsy, during which multiple tissue samples are taken from different zones of the gland.11PubMed Central. Transrectal ultrasound biopsy of the prostate: does it still have a role in prostate cancer diagnosis?
If you have been told you need a TRUS biopsy, you will typically receive local anesthesia (a nerve block injected through the rectal wall) and possibly antibiotics beforehand. The procedure is uncomfortable but usually tolerable, lasting around 10 to 15 minutes. Research has consistently shown that men report high levels of anxiety before the procedure and meaningful discomfort during it, though the pain is usually short-lived. Afterward, you might see blood in your urine or semen for a few days, which is normal.
It is worth knowing that the role of TRUS-guided biopsy has evolved. MRI of the prostate has become increasingly important in recent years, and many centers now use MRI to identify suspicious areas before using ultrasound (or MRI-ultrasound fusion) to guide the biopsy needle more precisely. TRUS alone does not disappear from the picture, but it is now often paired with MRI data rather than used as the sole targeting method.
Abdominal Aortic Aneurysm Screening
This one is a straightforward preventive health measure aimed squarely at older men. An abdominal aortic aneurysm (AAA) is a dangerous bulge in the body’s largest artery as it passes through the abdomen. If it ruptures, the mortality rate is extremely high. Ultrasound is a safe and effective screening tool for detecting these aneurysms before they become life-threatening.12PubMed Central. Ultrasound screening for abdominal aortic aneurysm: current practice, challenges and controversies In the United States, Medicare covers a one-time screening ultrasound for men aged 65 to 75 who have ever smoked. The UK runs a similar national program.
The exam is completely painless: you lie on your back while a technician moves the transducer across your abdomen, measuring the diameter of the aorta. The whole thing takes about 10 minutes. A study of men with cardiovascular risk factors found aneurysms in about 1.8% of those screened, and every single man diagnosed with an aneurysm had a smoking history.13PubMed Central. Abdominal aortic aneurysm ultrasound screening in men with risk factors in Primary Care Screening reduces aneurysm-related deaths because small aneurysms can be monitored over time with periodic follow-up scans, and larger ones can be repaired surgically before they rupture.14PubMed. Evaluation Of Handheld Point-of-Care-Ultrasound (POCUS) in Screening for Abdominal Aortic Aneurysm in Men: A Comparative, Cohort Study Newer handheld ultrasound devices (essentially a probe connected to a tablet) have shown promising accuracy for this purpose, which could make screening even more accessible in primary care offices that lack a full ultrasound cart.
Groin Hernias
Inguinal hernias, where abdominal tissue pushes through a weak spot in the groin, are far more common in men than in women. When the bulge is obvious and easy to feel, a clinical exam is enough for diagnosis. But in cases where the hernia is small, intermittent, or hidden (an “occult” hernia), ultrasound becomes invaluable. It has emerged as the most convenient imaging tool for the groin because it is portable, radiation-free, and can be done in real time while the patient is asked to cough or bear down, which makes a small hernia pop into view.15PubMed Central. Ultrasound imaging for inguinal hernia: a pictorial review
That coughing or straining part (called a Valsalva maneuver) is a key element of the technique. The examiner watches the screen while you bear down, looking for tissue sliding through the inguinal canal. The scan also helps distinguish between direct and indirect hernias and can identify other conditions that mimic a hernia, such as enlarged lymph nodes or fluid collections.16PubMed. Ultrasound of the Groin: Techniques, Pathology, and Pitfalls In one study, ultrasound achieved 100% sensitivity and 100% specificity for diagnosing groin hernias when compared against surgical findings.17PubMed Central. The groin hernia – an ultrasound diagnosis?
Liver, Bladder, and Other Abdominal Scans
Plenty of ultrasound exams ordered for men are the same ones ordered for women, because organs like the liver, kidneys, gallbladder, and bladder work the same way regardless of sex. If your blood tests show elevated liver enzymes, an abdominal ultrasound is a standard first step. It can detect fatty liver disease, gallstones, liver masses, and signs of cirrhosis. One well-known limitation is that ultrasound cannot pick up small amounts of fat in the liver and cannot determine whether fatty liver has progressed to inflammation or scarring.18PubMed. Abdominal ultrasound for diagnosis of nonalcoholic fatty liver disease (NAFLD) For that, additional testing such as elastography (a specialized ultrasound mode that measures tissue stiffness) or biopsy may be needed.
Bladder ultrasound is commonly used in men with urinary symptoms like a weak stream, frequent urination at night, or difficulty emptying the bladder, all of which can be linked to an enlarged prostate. The scan measures how much urine remains after you void (postvoid residual volume), which helps determine how well the bladder is functioning. Ultrasound can also estimate prostate volume and measure the thickness of the bladder wall, both of which give clues about the degree of obstruction.19PubMed. Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume You typically drink water beforehand so the bladder is full for the first set of images, then empty your bladder and return for a second quick scan.
Male Breast Imaging
Men can and do develop breast tissue problems, including gynecomastia (benign breast tissue enlargement), cysts, and in rarer cases, breast cancer. While male breast cancer accounts for a small fraction of all breast cancer diagnoses, it does happen, and the lump in a man’s chest that brings him to the doctor needs to be evaluated. Ultrasound plays a specific and complementary role here. In a study comparing imaging methods for male breast disease, mammography was the most sensitive for detecting cancer (catching about 95% of malignant cases), while ultrasound was the most specific (correctly identifying about 95% of non-cancerous cases).20PubMed. Mammography and ultrasound in the evaluation of male breast disease In practice, the two tests are often used together. If you notice a lump, tenderness, or nipple discharge, an ultrasound of the chest area is a reasonable and common part of the workup.
Cardiac Ultrasound
An echocardiogram is an ultrasound of the heart, and it is one of the most frequently performed imaging studies in medicine for both men and women. The transducer is pressed against different spots on the chest wall to visualize the heart’s chambers, valves, and blood flow in real time. Your doctor might order one if you have a heart murmur, unexplained shortness of breath, chest pain, or abnormal results on an EKG or stress test. A standard transthoracic echocardiogram (the external kind) is completely painless and takes about 30 to 45 minutes. In some situations, a transesophageal echocardiogram (where a thin probe goes down your throat for a closer look) may be needed, which requires sedation and is less comfortable but provides superior images of certain structures.
Undescended Testes in Boys
Ultrasound has a complicated reputation when it comes to evaluating boys with undescended testes (cryptorchidism). If the testicle can be felt during a physical exam, ultrasound is not usually necessary because the surgeon already knows where it is. The harder scenario involves a nonpalpable testis, where the testicle cannot be felt at all and might be located in the abdomen, in the inguinal canal, or might be absent entirely.
Here, ultrasound performs poorly. A systematic review and meta-analysis found that ultrasound has a sensitivity of only about 45% and a specificity of about 78% for localizing a nonpalpable testis.21Pediatrics. Diagnostic Performance of Ultrasound in Nonpalpable Cryptorchidism: A Systematic Review and Meta-analysis A positive ultrasound result only nudges the probability that the testis is intra-abdominal from about 55% to 64%, which is not clinically useful enough to change management.22PubMed Central. Diagnostic Imaging in Cryptorchidism: Utility, Indications, and Effectiveness Surgical exploration (usually laparoscopy) remains the gold standard for finding a missing testis. Despite this, ultrasound is still commonly ordered before referral to a surgeon, adding cost without changing the treatment plan.23PubMed Central. Unnecessary diagnostic imaging: a review of the literature on preoperative imaging for boys with undescended testes If your child’s pediatrician orders an ultrasound for an undescended testicle, it is reasonable to ask whether the result would actually change the next step.
What the Procedure Feels Like
For the majority of male ultrasounds, the experience is uneventful. Here is a rough guide to what to expect, grouped by exam type:
- External scans (scrotal, abdominal, groin, cardiac, bladder): warm gel is applied to the skin, and the transducer is pressed and moved across the area. You might feel mild pressure but no pain. Scrotal exams can feel awkward, but the technician has done this hundreds of times. Most external scans take 15 to 30 minutes.
- Penile Doppler: involves an injection of medication into the penis to induce erection. Expect a brief pinch from the needle and some self-consciousness about the setting. The imaging itself is painless. The entire appointment runs about 20 to 30 minutes, plus waiting time for the medication to wear off.
- Transrectal (TRUS): a lubricated probe is inserted into the rectum, which causes pressure and discomfort. If a biopsy is performed at the same time, you will feel a series of quick, sharp sensations as the needle fires. Local anesthesia reduces but does not eliminate the discomfort. Plan for some soreness afterward and minor bleeding for a few days.
For abdominal and bladder ultrasounds, you are usually asked to fast for several hours or to arrive with a full bladder, depending on which organs need to be visualized. For scrotal, groin, and penile exams, there is typically no special preparation. Your technician or doctor’s office will give you specific instructions ahead of time.
When Ultrasound Is Not Enough
Ultrasound has real strengths: it is fast, safe, repeatable, and gives real-time images. But it has blind spots that matter for men’s health. As noted earlier, scrotal ultrasound cannot always tell benign from malignant testicular masses, and it performs poorly for localizing nonpalpable undescended testes. Abdominal ultrasound misses early-stage fatty liver disease. Image quality can also be limited by body habitus; in men with significant abdominal fat, sound waves may not penetrate deeply enough to give clear images of structures like the aorta or kidneys.
For many of these gaps, MRI or CT fills in. MRI has become particularly important for prostate evaluation, where it can detect suspicious lesions that TRUS alone would miss, and for characterizing complex testicular masses. CT is the primary tool for acute abdominal pain when ultrasound findings are unclear, and for staging cancers. The trend in imaging is not toward replacing ultrasound but toward using it as the accessible first step, with more advanced imaging reserved for cases where the ultrasound raises a question it cannot answer on its own. If you are told you need a follow-up MRI or CT after an ultrasound, that does not mean the ultrasound failed. It means it did its job of identifying something that warrants a closer look.