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

SnowShoeRN · Jun 8, 2016

This is exactly what I do. The MD's and Do's in my practice do the same. I'll have to mention the AAP to them and get their opinions.

SydneyKidney · Jun 8, 2016

This is exactly what I do. The MD's and Do's in my practice do the same. I'll have to mention the AAP to them and get their opinions.

What CamilliaJGP does?

SnowShoeRN · Jun 9, 2016

What CamilliaJGP does?

Yes. I meant to quote her comment. Sorry 'bout that.

SydneyKidney · Jun 9, 2016

Yes. I meant to quote her comment. Sorry 'bout that.

Is Camillia right? Does doing it that way (fast and without warning) reduce embarrassment? Also, have you encountered any problems with retracting the foreskin routinely? Because a lot of people here seem to be against it.

SnowShoeRN · Jun 10, 2016

Is Camillia right? Does doing it that way (fast and without warning) reduce embarrassment? Also, have you encountered any problems with retracting the foreskin routinely? Because a lot of people here seem to be against it.

Where does she say she does it "fast and without warning?" I would never retract the foreskin fast and without warning. And I would never NOT tell the patient what I was doing and then allofasudden put my hand down his pants.

I agree that having a long discussion on genitals isn't going to help any comfort level, but explaining what I'm doing and why I'm doing it and doing it as quickly and effectively as possible minimizes discomfort. Perhaps this is what you meant.

However, it's also important to note that just because we're doing it doesn't mean it's considered best-practice. Anecdotal reasoning is all very well and good, but our behavior should be based on evidence based practice and if there is some physiological reason as to why we shouldn't be retracting to check for phimosis or hypospadia or any other condition then we should be aware and take that into our practice.

I want to look into this more and discuss it with my colleagues before providing any more input.

RiskManager · Jun 10, 2016

Where does she say she does it "fast and without warning?" I would never retract the foreskin fast and without warning. And I would never NOT tell the patient what I was doing and then allofasudden put my hand down his pants.

Doing this sort of exam by surprise is an excellent way for the provider to end up talking to me, as I am figuring out how we are going to respond to the complaint made by the patient or parent.

SydneyKidney · Jun 10, 2016

Doing this sort of exam by surprise is an excellent way for the provider to end up talking to me, as I am figuring out how we are going to respond to the complaint made by the patient or parent.

Fast and without warning was a very poor choice of words. Gently and efficiently with no unnecessary conversation in order to minimize embarrassment was what I meant.

Elvish, BSN, DNP, RN, NP · Jun 22, 2016

I am seriously questioning where the MS school nurses manual got the evidence that says a school nurse should be retracting a child's foreskin. If the kid can pee alright it is not a big deal that the foreskin doesn't retract. If it does, the kid is old enough to retract it himself.

Dany102 · Jun 23, 2016

I'm not sure if I can make a meaningful contribution here but, speaking from experience as an uncircumcised male, every physical examination I have had in which I allowed my genitals to be assessed involved retracting my foreskin. And for the most part, I was not asked before hand. Nor was I told to do it myself. I have always assumed that pulling back the foreskin was standard and part of the assessment.

As far as I can remember, only one care provider ever "warned" me before doing so. The same goes for when I was a kid /teenager.

That being said, I have always dealt with doctors; never had a physical done by a nurse or PA. I can't imagine this would make a difference.

Dany

Elvish, BSN, DNP, RN, NP · Jun 23, 2016

I'm not sure if I can make a meaningful contribution here but, speaking from experience as an uncircumcised male, every physical examination I have had in which I allowed my genitals to be assessed involved retracting my foreskin. And for the most part, I was not asked before hand. Nor was I told to do it myself. I have always assumed that pulling back the foreskin was standard and part of the assessment.
As far as I can remember, only one care provider ever "warned" me before doing so. The same goes for when I was a kid /teenager.
That being said, I have always dealt with doctors; never had a physical done by a nurse or PA. I can't imagine this would make a difference.
Dany

Not cool. Not cool at all. I warn my female patients before I touch their genitals. I do the same for my male patients. That just feels like common courtesy. And the last male patient (18yo, cc STI check) I examined I had him retract his own foreskin. He knew what he was doing and I saw what I needed to see. Very sorry about your experiences.

Dany102 · Jun 23, 2016

Not cool. Not cool at all. I warn my female patients before I touch their genitals. I do the same for my male patients. That just feels like common courtesy. And the last male patient (18yo, cc STI check) I examined I had him retract his own foreskin. He knew what he was doing and I saw what I needed to see. Very sorry about your experiences.

Thank you for your comments (and concerns), Elvish. It's hard to feel slighted or wronged when you lack the proper context to refer to. As I said, I've always assumed it was part of a "normal" assessment. Not that I allow it very often, but that's an entire different ball of yarn.

This thread certainly provided me with a different point of view. I'll make sure to keep that in mind next time I see a doctor.

Dany

sammiesmom · Jun 25, 2016

Very interesting post. I'm in FNP school and appreciate all the good responses here. However, uptodate is probably what I will use first before asking this forum. Geez some people are rude here!