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

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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?

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 Short Term/Skilled.

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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Again, why are we resurrecting two year old threads? You're new to these forums as of a month ago. But every post you've made has been regarding gender diversity and personal issues with seeing the opposite sex.

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Specializes in ICU, LTACH, Internal Medicine.

I never do it unless there are relevant complains/other relevant indications. Too many individual variables and too little chance to find something warranting any further action if there is no other stuff going on, therefore it doesn't worth my time and trouble. For the remaining cases like STD check, Paget's, RA, etc, most adult or teenaged males are perfectly able to pull it themselves if asked to do so.

Theoretically, breast exam on females should include nipples palpation and attempt to extract fluid, and PE on males should also include careful palpation of breasts. Honestly, how many of us do that outside of specialty practice?

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3 hours ago, KatieMI said:

I never do it unless there are relevant complains/other relevant indications. Too many individual variables and too little chance to find something warranting any further action if there is no other stuff going on, therefore it doesn't worth my time and trouble. For the remaining cases like STD check, Paget's, RA, etc, most adult or teenaged males are perfectly able to pull it themselves if asked to do so.

Theoretically, breast exam on females should include nipples palpation and attempt to extract fluid, and PE on males should also include careful palpation of breasts. Honestly, how many of us do that outside of specialty practice?

Well woman exams 25 and over per ACOG guidelines should have a breast exam offered every 1 to 3 years. Breast exams are pretty standard of practice in my clinic and one of my precept locations were sticklers on them. And that’s primary care. I’ll admit male exams aren’t to the same scale or consideration unless there’s a specific complaint. But I’m unaware of any recommendations for that specifically.

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Specializes in ICU, LTACH, Internal Medicine.
1 hour ago, djmatte said:

Well woman exams 25 and over per ACOG guidelines should have a breast exam offered every 1 to 3 years. Breast exams are pretty standard of practice in my clinic and one of my precept locations were sticklers on them. And that’s primary care. I’ll admit male exams aren’t to the same scale or consideration unless there’s a specific complaint. But I’m unaware of any recommendations for that specifically.

The evidence of usefulness of manual breast exam is controversial, whatever ACOG wanna say:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974039/

(this is far from the only one)

Better to spend time educating patients about importance of screening studies and doing what can be done to improve access for them, IMHO

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1 hour ago, KatieMI said:

The evidence of usefulness of manual breast exam is controversial, whatever ACOG wanna say:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974039/

(this is far from the only one)

Better to spend time educating patients about importance of screening studies and doing what can be done to improve access for them, IMHO

Did you actually read the conclusion?

“A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbehad more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram.“

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