Are you supposed to check a boy's foreskin during a physical?

  1. I just started work at a family clinic and I've had to do some physicals for kids and teens. Obviously, if you're giving a boy a physical you have to check for TC and a hernia, but if the boy is uncircumsized, should I also check if his foreskin moves freely? I've yet to have a patient that wasn't snipped but on the off-chance I do what's routine procedure?
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  2. 55 Comments

  3. by   SydneyKidney
    I'm a NP (meaning I can do physicals), and the standard physical form I've seen from schools and camps has a "Genitourinary (Males Only)" box.

    And I live in (and went to school in) an area with a very high circ rate, so I don't remember it ever being covered.
  4. by   RiskManager
    Your free risk management advice of the day: especially with teenage males, be sure to explain why and how you will be doing that part of the exam before you do it, or ask them to do it as you observe. This will really cut down on the complaints about inappropriate touching, as for example I receive on male providers as they reposition a breast during a physical exam. If the patient knows why you are doing it, they are generally fine with it. If the parent/guardian/anyone else is in the exam room during the exam, be sure to chart it, in case we ever need to have a witness to deal with these complaints.
  5. by   Here.I.Stand
    Not sure what age you're talking about, but my boys are 11 and almost 3, and nobody has ever touched their foreskin. Nobody will either, except for my boys themselves. Not risking injury from a provider retracting one that doesn't yet retract. Basically their exams have consisted of looking at the area, and checking for hernias. (So far I have stayed in the rm with 11 yr old, but turn my back during this part of the exam. Looking and hernia check is all I've heard the MD explain to him.) Oh and of course as newborns checking to make sure both testes have decended.

    Do you look ar every crevice of a female's vulva? Or is is more of a general look and a vag exam/Pap smear?
  6. by   traumaRUs
    Moved to NP forum
  7. by   Psychcns
    Maybe np's can share how they do an genital urinary exam on a boy or man in a routine physical. I bet there are a variety of
    Approaches. What are the criteria if any for pulling back forskin .
  8. by   SydneyKidney
    Quote from Psychcns
    Maybe np's can share how they do an genital urinary exam on a boy or man in a routine physical. I bet there are a variety of approaches. What are the criteria if any for pulling back foreskin .
    That's exactly what I'm looking for.
  9. by   BSN16
    I just asked my boyfriend his thoughts (We are both in NP school), and he said that he wouldn't actually examine it. Maybe ask if they were having any problems with it. I mean yes you are technically supposed to is what youre taught in school but i think many providers pick and choose on some of the smaller things or uncomfortable things. I guess it depends on how thorough you want your examination to be.

    But like i said we are both only students
  10. by   pro-student
    For a normal physical, I wouldn't. The likelihood that there's a problem that hasn't been detected is very low (boys are pretty aware if something is not right with their penis). If you did need to however, I would ask the patient to do it himself and maybe use it as a teaching moment about hygiene.
  11. by   mmc51264
    Both male and female genitalia are assessed as necessary in my inpatient unit by nurses. I worked on an urololy unit and no am ortho where we have a lot of Foleys or I&Os for post anesthesia urinary retention. We chart normal abnormal. I have also seen urethral fistulas that leak stool and penile erosions from long term foley use. We have to chart the abnormals, and do wound care (?)
  12. by   ElvishDNP
    AAP says do not retract. Foreskins can separate anywhere between infancy and adolescence; as long as they're peeing ok there is no rush for it to separate. Matter of fact, premature retraction can cause injury/adhesions/infections which you do not want to be the cause of. My son's NP is great about this and doesn't touch if my son doesn't allow her to.

    I'm in a part of the country where it's about 50/50 intact vs. circed. Unless there is a specific GU complaint a quick visual check is all you have to do for an intact penis. Infants I make sure the testes are descended; adolescents I palpate the scrotum/testes and teach them about TSEs. Is it uncomfortable, maybe a little, but if they save their own life down the road it's worth it.

    Anyway, back to foreskin. Leave it alone.
    Last edit by ElvishDNP on Jun 3, '16
  13. by   Glycerine82
    foreskin should never be retracted by anyone but the patient. It doesn't retract until puberty or later in many boys which is normal.
  14. by   traumaRUs
    This thread got off to a rough start due to some miscommunication. I've deleted a few posts to keep it on topic.

    The OP is an NP and it is within her scope of practice to do this exam.

    As an APN myself, this question isn't outside the realm of being imaginable.

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