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

Specialties NP

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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?

If the boy is at least 10 years old, I gently check, stopping if there's even slight resistance. I wouldn't even try to retract gently if the boy is any younger than that.

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I don't fault the NP's who are doing their job as best they can while trying to minimize the embarrassment of their teenage boy patients, but I am at a loss as to what their parents are thinking in sending them to have such an exam by women. Do they not realize how embarrassing it is for these boys, embarrassment that would be greatly lessened if they sent the boys to a male provider for physicals post-puberty?

My kids had a male pediatrician but when our daughter hit puberty we switched her over to a female NP for her physicals and routine care so as to spare her the embarrassment of being examined by a man during those sensitive years. It astounds me that parents don't think of their son's embarrassment.

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Specializes in Community, OB, Nursery.
I don't fault the NP's who are doing their job as best they can while trying to minimize the embarrassment of their teenage boy patients, but I am at a loss as to what their parents are thinking in sending them to have such an exam by women. Do they not realize how embarrassing it is for these boys, embarrassment that would be greatly lessened if they sent the boys to a male provider for physicals post-puberty?

My kids had a male pediatrician but when our daughter hit puberty we switched her over to a female NP for her physicals and routine care so as to spare her the embarrassment of being examined by a man during those sensitive years. It astounds me that parents don't think of their son's embarrassment.

Fair point.

My son, for his part, prefers a female provider. When he started hitting puberty I asked him if he wanted me to take him to a guy instead, and he said no. He likes/trusts his NP and for him that seems to be more important than her XX chromosomes. Ditto when he started having mental health issues (puberty + coming out to us = bumpy couple of years) - asked if he wanted to see a male or a female counselor and he said wanted to see a female. No hesitation.

Some things are not going to be easy no matter who's doing them. I am female and have a female NP do my yearly stuff and it's still no fun, despite 20+ years of having them and birthing 2 kids.

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Elvish, you did it the way I would hope all parents would handle it. You gave your son a choice, and he chose what he was comfortable with. Our daughter was very shy and my wife just knew moving her to a female NP was the way to go. Our son was also shy and though he stayed with the male pediatrician he was still pretty embarrassed on account the doctor had a female in the room assisting during a physical I brought him to. Puberty can be a tough time for kids.

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Totally depends. I rarely see boys in clinic who have foreskin. The younger ones that do usually have some smegma. The older ones not so much. Thats all. I don't do anything to cause embarrassment; but I have found that most of them are not embarrassed at all. In fact, they typically freely volunteer information as long as their parent is not in the room.

I ask if they have any difficulty with urinating or any itching or burning. I don't retract. I've never had reason to. I ask them if they have any issues doing so. All that I really look for is scrotal development and the secondary developmental characteristics so I can document the Tanner stuff.

I do ask blunt questions about sexual activity if they are teens because I've sometimes heard shocking stories that have led me to do STD testing on them.

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Wow, I forget all about this post.

So, I asked a friend of mine (who's a pediatric urologist, and probably the smartest woman I know) about this topic, and she said that she recommends retraction should be regularly checked during physicals, BUT not until the boy is 12 years old, and even then, the retraction should be incredibly gentle. Following this advice, I've actually discovered foreskin and/or hygiene problems in several patients that they either were too embarrassed to mention, or didn't even know they had.

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Specializes in Community, OB, Nursery.

The AAP doesn't recommend retracting at all until the foreskin is fully retractable, and even then only gently. Physicians in countries where circumcision is not the norm- who are used to dealing with foreskin every day all day - don't retract at all, ever, unless there is a problem.

If there is a foreskin issue that is bad enough to need intervention, they will be apparent without retraction far more often than not. The number needed to treat on foreskin retraction is not low enough to justify it routinely.

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Specializes in Transitional Nursing.

Don't touch it, it isn't meant to be retracted until puberty or later. Its attached, or it should be until it becomes separated later in life.

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As a male I prefer my FNP over the males I have had in the past, she is way more professional and upfront with me and there are no supersizes. I hope she never moves or retires!

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Specializes in PACU.
On 6/3/2016 at 9:04 PM, CamilliaJGP said:

I'm curious to hear what some of the other approaches are, but here's how me and the other NP at the clinic I work at do for boys from 8 to 18:

1. With one hand, pull down the front of the boy's waistband.

2. Make a mental note of the tanner stage of their genital development and pubic hair growth.

3. With the hand not holding the waist band, quickly feel each testicle (to make sure they've descended in younger boys and to make sure there are no masses in older boys).

4. If the boy is there for a sports physical, do a hernia check.

5. If the boy is uncircumcised, test how far their foreskin can retract VERY GENTLY (so it isn't harmed if it can't retract)

6. Release waistband.

This should take less then 5 seconds (10, if you have to check for hernia/phimosis). As a female NP, no matter what you do, the boy is going to get embarrassed, so you just have to do things in a way that minimizes embarrassment. If you ask them a bunch of questions and spend time talking about their genitals before you actually do the exam, they are going to get infinitely more embarrassed than if you finish examining member/testicles before they even realize what you're doing and just treat it like any other part of their body.

Don't just ask him if he has any foreskin problems, if he does, there's a pretty good chance he either doesn't know or is too embarrassed to say something.

The biggest problem is mothers bringing their son's to be checked by a Female NP. Most boys are embarrassed and will be upset but will not say anything about it. Why do you not suggest that boys see a male MD or NP?

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42 minutes ago, RNMikeMiller said:

The biggest problem is mothers bringing their son's to be checked by a Female NP. Most boys are embarrassed and will be upset but will not say anything about it. Why do you not suggest that boys see a male MD or NP?

Why are you crusading on these topics?

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Specializes in Occupational Health.
On 11/9/2018 at 6:07 PM, Albert D said:

she is way more professional and upfront with me and there are no supersizes.

LOL...too funny...Freud would be proud!

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