The skin

■ The prepuce (foreskin). If it is present, retract it or ask the patient to retract it. This step is essential for the detection of many chancres and carcinomas. Smegma, a cheesy, whitish material, may accumulate normally under the foreskin.

■ Theglans. Look for any ulcers, scars, nodules, or signs of inflammation.

Check the skin around the base of the penis for excoriations or inflammation. Look for nits or lice at the bases of the pubic hairs.

Note the location of the urethral meatus.

Compress the glans gently between your index finger above and your thumb below. This maneuver should open the urethral meatus and allow you to inspect it for discharge. Normally there is none.

Meatus Penis

See Table 10-1, Abnormalities of the Penis (p. 378).

Phimosis is a tight prepuce that cannot be retracted over the glans. Paraphimosis is a tight prepuce that, once retracted, cannot be returned. Edema ensues.

Balanitis (inflammation of the glans); balanoposthitis (inflammation of the glans and prepuce)

Pubic or genital excoriations suggest the possibility of lice (crabs) or sometimes scabies.

Hypospadias is a congenital, ventral displacement of the meatus on the penis (p. 378).

Profuse yellow discharge in gonococcal urethritis; scanty white or clear discharge in nongonococcal urethritis. Definitive diagnosis requires Gram stain and culture.

If the patient has reported a discharge but you do not see any, ask him to strip, or milk, the shaft of the penis from its base to the glans. Alternatively, do it yourself. This maneuver may bring some discharge out of the urethral meatus for appropriate examination. Have a glass slide and culture materials ready.

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