A letter to adolescents about the male genital exam
Dear Adolescent Boys,
Whenever I tell you that a genital exam is part of your annual well child check, your eyeballs fall out of your head in complete horror. The expression on your face makes me feel like my office is a haunted house, and you just saw a goblin for the first time ever. In other words, you act like you had ABSOLUTELY NO IDEA WHAT YOU WERE IN FOR.
I have a hard time deciphering this behavior. I’m not sure if you’re putting on a show to get out of the exam, or if you really are that mentally unprepared and completely clueless as to what would happen at your “well child check”.
First, let’s get the terminology out of the way, because the word “child” is a little off-putting. A well child check is the politically correct terminology for your annual physical exam. It is technically called a “well child exam” until you reach the age of 18. I’m sorry we call you a child. I know, the term makes you hate the pediatrician even more because you already feel too big and too grown up to visit a waiting room full of crying babies and kiddie toys. We should really call your yearly physical exams, “well adolescent checks” or “well adolescent exams”. Unfortunately, whatever term we choose to use, we’ll always be dorky to you because you’re a cool cat now — you have your driver’s license, you have a girlfriend, and you’re the drummer in a band.
I recommend that you get a routine physical exam once a year, for every year of your life! This includes every year up until you turn 18 and then one at age 19, 20, 21, etc.
It is standard for your well adolescent check to include a genital exam. Your doctor should ask for your consent before doing it. Most of the time, you say no anyways. But sometimes you say yes.
You should know why physicians do a male genital exam on adolescents. There are four main reasons:
- To make sure you don’t have testicular cancer. Testicular cancer can occur at any age.
- To make sure you don’t have an inguinal hernia. This is where your guts come out of your abdomen in all the wrong places.
- To do a sexual maturity rating (SMR). This is where we make sure your sexual development is on par with your age.
- To make sure everything is normal.
It’s true that routine male genital exams are controversial. In other words, some physicians think that it is unnecessary to do them on a regular basis. The USPSTF (a fancy acronym for an organization that sets the standards for health prevention & screening) actually recommends against testicular exams as a means to screen for testicular cancer in adolescent men. Some argue that routine hernia exams aren’t even necessary. A concerning inguinal hernia will most likely cause symptoms. A hernia found on exam without symptoms is usually a “watch and wait” situation.
If you feel uncomfortable about your genital exam, the best thing you can do is voice that discomfort to your physician. Have a conversation about the exam beforehand. Discuss specifically why you don’t want to get it done. The ability to have these conversations with your doctor helps to develop the skill set you need to comfortably talk about sex and your genitals with your peers. If you can’t talk about your genitals with your physician, how will you be able to discuss them with your future partner?
One last thing all guys everywhere need to know. When a physician checks for hernias, he or she will say the classic phrase associated with the male genital exam. Say it with me now:
“Turn your head and cough.”
This is NOT to distract you from the discomfort of the exam. The cough adds force to any guts that may be protruding in the wrong place, so that your physician can more easily detect them. In other words, the cough increases intra-abdominal pressure to accentuate the hernia to aid in diagnosis. The reason we ask you to turn your head is so that you don’t cough all over us. Brilliant, right?
Some physicians actually require a chaperone to be present during the genital exam. They do this for not only your protection and safety but also for legal purposes. In my practice, I require a parent to be in the room during the male genital exam, but the parent doesn’t have to watch directly.
Lastly, please note that some guys do incidentally get an erection during the male genital exam. It happens and there’s not much you can do about it.
K, so promise me, that the next time it’s your turn for a male genital exam, and you feel awkward and weird, that you’ll talk to your doctor about how you feel about the exam rather than acting like you had ABSOLUTELY NO IDEA WHAT YOU WERE IN FOR. Because now you know.