How I Perform Penis Exams

The entire physical is a build up to the genital exam as the grand finale. Ideally, the patient is stripped completely except for his undershorts for the entire exam. This allows any embarrassment the patient may feel over having his body exposed to the examiner to be fully realized. The less sensitive body parts are examined initially as the examiner gets to more and more sensitive body parts, moving closer and closer to the realization that possible body parts to examine are eliminated one by none until there is nothing left except what lies beneath the undershorts. Ideally, the abdominal exam is done with the patient lying supine on the exam table, including a very thorough auscultation and palpation, immediately precedes the examination of his genitalia. I prefer to have the examiner give a lot of very specific and condescending instructions to the patient. I would go from standing over the patient doing the abdominal to step back a bit from the table--this should give a knowledgable patient a good clue as to what is about to happen--and start the instructions. "Let's go ahead and sit up." Now the examiner moves over and gets a pair of exam gloves, sits on the rolling stool, gloves up, and rolls over closer to the patient and says "I want you to stand up right here next to the table and face toward me." The examiner is now sitting directly in front of the patient and says "slip your shorts down for me." As the examiner, you want the patient's shorts down to upper or mid thigh so that the penis and scrotum are hanging free and not bound up or resting on the waistband. If the patient has failed to drop them adequately, tell him to drop them farther down. Another maneuver the examiner can use is to adjust the position of the shorts himself, regardless of whether the patient has lowered them adequately to facilitate the exam. He could just take the waist band on the lateral side of each thigh and just move them down ever so slightly. This will emphasize to the patient that the examiner is in charge of the experience and is in charge of how far the shorts are lowered. Then take a few seconds and just get a look at the penis and scrotum. This will let the patient know you are sizing him up compared to others you have seen. If he is circumcised, take the shaft in the left hand and use the right hand to grasp the tip of the head and spread the meatus, then pull and skin he has rolled behind the corona and push it toward the base to get a good look at the corona, them lift the penis up and check the frenulum. If he is uncircumcised, say "since you are not circumcised, I need to retract your foreskin." Use one hand to fully retract the foreskin, not just exposing the head but pulling the skin as far back as it will go so that you have a good look at the entire inside of the foreskin. Tile the penis to give you a good look at the frenulum, then use one hand to spread the meatus. Then move to the testes and hernia.