Which sequence best describes steps of manual penile examination?

• A. Retract foreskin if present; compress glands A/P to open meatus and urethra for inspection; palpate penis for tenderness or induration; if there are urethral symptoms, strip or milk the ventral penis from base to glans to collect a drop
• B. Strip or milk ventral penis; retract foreskin; compress glands A/P; palpate
• C. Retract foreskin if present; compress glands A/P to open meatus and urethra for inspection; palpate penis for tenderness or induration; if there are urethral symptoms, strip or milk the ventral penis from base to glans to collect a drop
• D. Compress glands A/P to open meatus; retract foreskin; strip ventral penis

Answer: (C)

The main idea is to expose and inspect the urethral opening first, then assess the surrounding tissues, and only then collect any discharge if symptoms are present. Retracting the foreskin if present exposes the glans and meatus so you can inspect for abnormalities. Gently compressing the glands in an anterior-posterior direction helps open the urethral meatus and urethra, making inspection more reliable. Palpating the penis for tenderness or induration follows to detect signs of infection, inflammation, or a mass that might not be evident on visual inspection alone. If there are urethral symptoms, stripping or milking the ventral penis from base to glans to obtain a drop targets the area most likely to yield discharge for testing. This order ensures proper exposure, clear visualization, thorough examination, and appropriate specimen collection when indicated.