Does your doctor perform testicular exams?

July 31, 2005 8:47 PM

Does your doctor perform testicular exams?

I had a physical this morning and my (female) doctor asked me if I was alright to do my own testicular exam or if I would prefer she do it for me. The last time I had a physical - about 10 years ago with a different doctor (again, female) - she simply informed me I would have to do that part of the physical myself, full stop. My recollection going back another 10 years or so to when I had a male doctor is that this was just another routine part of the physical. So I'm just wondering if this is a new way of doing physicals in general, or largely specific to female doctors, or is there some other reason for this? More to the point, has anyone else noticed a similar change in the way physicals are performed?

posted by anonymous to Health & Fitness (17 answers total)

While we don't want to neglect important parts of health care, we also don't want to get sued for inappropriate touching. Neurologists occasionally have use to test the function of the cremasteric reflex, which involves watching the testicle rise up when the inner thigh is sharply stroked - but you can be damn sure I'll be explaining exactly why, to the man involved, before I begin.

Another reflex that tests the same set of nerves is the pubococcygeus reflex. To test this, insert one finger in the rectum, past the anal sphincter. Tug gently on the penis. The anal sphincter should gently contract. In women, apparently the same reflex can be evoked by tapping on the clitoris.

The pubococcygeus reflex is just about the only fact I learned in medical school that I put into the 'NEVER USE THIS' mental file cabinet.
posted by ikkyu2 at 9:32 PM on July 31, 2005

I've never heard of a doctor refusing to do this. I've had it done by young and old, male and female. If a doctor ever suggested I do it myself I'd say, "Sure - I'll pay myself for doing your job too, shall I?"

The idea that one would do so because of the risk of "inappropriate touching" ... please tell me you're joking. A doctor? What next? Are they going to get sued for sexual assault for carrying out a prostate poke? Jesus... what insanity.

America, right? This has to be in America.
posted by Decani at 9:39 PM on July 31, 2005

I've never heard of a female doctor hesitating to do testicular exams, but as male medical students, when we do breast, rectal, or genital exams on women we have to have a female "chaperone" in the room.
posted by gramcracker at 10:03 PM on July 31, 2005

Wow, that's pretty crazy. Regardless of whether I inspect myself or not, there's always the (pretty likely) possibility I'm doing it wrong.

For the record: I've had male doctors do the inspection, and don't remember a female ever telling me I "had to do it myself". Can't really remember past that. Maybe I should get my brain inspected too.
posted by trevyn at 10:15 PM on July 31, 2005

2 residents were fired from Harlem Hospital's internal medicine program last year for something to do with breast exams. The official story was "not indicated" breast exams, but in a place like Harlem where all-cause, all-ages mortality exceeds that of Bangladesh, I can't see that a physician trying to protect a woman from breast cancer is ever unindicated.

I don't know what the two residents were doing that was wrong; goodness knows HH gets its share of last-in-class foreign medical graduates. I do know the practical result:

a) A bunch of us attendings wore black armbands for a year whenever we were practicing, as a protest.

b) I never examined a woman with her top off without a nurse in the room after that.

c) Most residents quit doing breast exams.

And yes, doctors do get sued for inappropriate touching, even when it's inadvertent. That's why - in America - a smart doctor will ask before touching a patient. Seems like common sense to me, actually, but then again I have a well-developed sense of my personal space and its violation.
posted by ikkyu2 at 11:13 PM on July 31, 2005

On a useful side note, what exactly is the proper way to do a self-check for testicular cancer?
posted by sic at 1:09 AM on August 1, 2005

Well, it isn't really rocket science. Get to know your little buddies, how big they are, and how they feel. Roll 'em around gently. But do not get the cord or whatever it is called twisted up as that is supposedly VERY PAINFUL. See how your boys are nice and regularly shaped? If one ever changes size or feels different (like having a lump), bring your buddies to the doctor. Take care of your testicles and they'll take care of you!
posted by Justinian at 1:56 AM on August 1, 2005

My female doctor performed the exam, but she had a nurse come in as a monitor.
posted by fletchmuy at 4:48 AM on August 1, 2005

My female GP does it during regular checkups. It's just part of the exam.
posted by ursus_comiter at 5:23 AM on August 1, 2005

I get all my testicle facts from the Scrotal Safety Commission
posted by cosmicbandito at 6:38 AM on August 1, 2005

Or you could take Rachel's advice. Mildy NSFW.
posted by blag at 7:11 AM on August 1, 2005

My female GP always asks first, and I tell her to go ahead. I prefer to have the professional do the job.

And since my vasectomy there are knots and odd bumps to deal with (which I'm told are normal). Why take a risk?
posted by cptnrandy at 7:12 AM on August 1, 2005

I just had a physical this morning and my female GP did mine. She did announce what she was looking for as she went through the exam ("checking this side for hernia, checking this side for cancer") but there was no nurse present or anything.
posted by Kosh at 7:55 AM on August 1, 2005

Thanks for the details, ikkyu2. I believe my GP does what Justinian describes, but --- every doctor I've had always does the thing where he says "turn your head and cough" while holding onto the scrotum. What's that all about? (I knew insecure guys growing up who'd refuse to go back to any doctor performing this test.)
posted by Rash at 10:57 AM on August 1, 2005

Regarding "turn your head and cough" - the doctor is checking for hernias, and coughing just exerts internal pressure so a hernia is more evident. I believe the turning of the head is just so the poor doc isn't coughed on all day!
posted by sgarst at 12:32 PM on August 1, 2005

Too Much Info alert: I had a scrotal hernia. You didn't need to be a doctor to find that baby. It was like a giant third testicle... except it was a loop of intestine hanging down. You think getting kicked in the nads hurts? Take a blow to a loop of intestine sometime.
posted by Justinian at 2:05 PM on August 1, 2005

Just FYI, there's no conclusive evidence that screening for testicular cancers during routine physical examinations has any benefit as far as early detection or mortality or morbidity. It's a relatively rare cancer, especially outside a particular age group. Any doctor should be willing to perform a routine exam if a patient asks or voices concern, but those who don't include testicular exams in routine physicals aren't necessarily practicing bad medicine.

That said, it can't hurt (unless your doc is on the rough side), and monthly self-exams are definitely a good idea.
posted by drpynchon at 7:56 PM on August 1, 2005