"Uncircumsized male; prepuce easily retractible. No penile discharge Suspicious for testicular carcinoma, or lesions. No scrotal swelling or discoloration. Testes descended the most common form of cancer bilaterally; right testicle smooth; 1 x 1 cm firm nodule on left lateral in men between the ages of 15

testicle. It is fixed and nontender. Epididymis nontender. No inguinal or and 35 femoral hernias."

Many students feel uneasy about examining a man's genitalia. "How will the patient react?" "Will he have an erection?" "Will he let me examine him?" It may be reassuring to explain each step of the examination so the patient knows what to expect. A male patient may occasionally have an erection. If so, you should explain that this is a normal response, finish your examination, and proceed with an unruffled demeanor. If the man refuses to be examined, you should respect his wishes.

A good genital examination can be done with the patient either standing or supine. To check for hernias or varicoceles, however, the patient should stand, and you should sit comfortably on a chair or stool. A gown conveniently covers the patient's chest and abdomen. Wear gloves throughout the examination. Expose the genitalia and inguinal areas. For younger patients, review the sexual maturity ratings on p. 707.

M The Penis_

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