Question about digital rectal exam guidelines/ possible abuse situation

Jenifer Hermes · May 19, 2005

PS In case you were wondering, the exam in question was performed by a physician, not by a nurse, and there was no nurse or other observer present during the procedure.

Jenifer

Hi, all!
I`m not a nurse, but of course I am your big fan!! I am a university teacher here in Japan and recently a young man confided in me about a digital rectal exam procedure that he had undergone in the US that sounded to me like it probably did not follow established guidelines. He said that he felt that he had been abused, and the other details raised real red flags with me. My questions (and if I`m not asking the right ones, feel free to add) are:
1) What are the established guidelines for digital rectal examinations? What type of consent is required? What procedures should be followed? Is this an exam that is normally part of an annual checkup for a healthy teen?
2) If I suspect that there was in fact abuse, what next steps should I recommend to this young man, who is eager to ensure that no other patients have to face this situation?
Please note that although I live in Japan, this happened in the US
Thank you for reading, and I appreciate any help or advice.
Sincerely,
Jenifer Hermes
Tokyo, Japan

redwinggirlie · May 20, 2005

Not really enough information. Why did he go to the doctor? Why is he telling you? Just wondering....

leslie :-D · May 20, 2005

my almost 15 yo just went for his physical and he got a digital exam to check his prostate....same for my 12 yo.

other than checking the prostate gland, the only other reason i could think of is to see if someone is impacted and/or if there's blood in their underwear, you would do a digital to see if it's coming from the rectum.

leslie

Jenifer Hermes · May 20, 2005

Sorry for the lack of info. Why did he go to the doctor? Apparently for a routine physical before changing to another form of insurance coverage.

Why did he confide in me? Heck, I don`t know. I`m a teacher...people tell me stuff all the time, and then I try to help them if I can. This is a bit outside my field, so I was hoping you all could help me to give him some relevant info.

When I say "procedure", what I mean is things like- without gloves is standard? Without lubrication? Without explanation or prior consent? With no other person present? I have had DRE exams as part of routine GYN care, but my experience has been far different from what I heard described. If that had happened to me, I would surely have felt violated/ abused, but I am 39 and a professional person myself, so can kind of "smell" unprofessional behavior in others, even if they are authority figures. I would not be so trusting, but he was very shocked and hurt, physically and emotionally. If you nurses think that there is something wrong here, I would like to encourage him to take steps so that this will not happen to a young person who might not be even aware enough to recognize that there is something wrong or that they are not to blame.

Jenifer

KRVRN, BSN, RN · May 20, 2005

It is definitely standard to use gloves and lubrication. Were they not used? It IS standard to give an explanation beforehand, but perhaps the doctor said something to the effect of "I'm going to check your prostrate" -- a non medical person might not know that that meant a rectal exam. It is not necessarily standard to have a 2nd person present if the examiner is the same sex as the pt. Even with a different sex examiner, it is usual, but not always the case for there to be another person present. Other than answering those few questions, I can't really comment on what happened unless you give more specifics.

suzanne4, RN · May 20, 2005

A rectal exam should always be done with gloves on, as well as lubicant.

If the patient feels that it was abuse, then it was. Has he notified his parents?

A report should be made with the medical licensing authority in that state. And this should be done by his parents, if at all possible. Since you are a teacher, then you can also do the reporting....

GingerSue · May 20, 2005

The examiner is to wear a glove and use lubricant. When examining a school-age child or adolescent the perianal region is inspected. Internal palpation is not performed routinely. In a child, palpation is omitted unless the history or symptoms warrant.

Jenifer Hermes · May 20, 2005

Thank you all for your help.

Jenifer

mommatrauma, RN · May 20, 2005

For our rectal exams gloves and lube always used...For adult males we do not have a chaperone in the room. Females if it is a male doctor a female nurse will go in...If it is a minor, either the parent or a nurse would be present. If anyone requests someone in the room, we will always have a second person. There is always a brief explanation about what is going to happen...although I don't know how much anyone can really be prepared for a finger in the butt... :uhoh21:

Jenifer Hermes · May 20, 2005

For our rectal exams gloves and lube always used...For adult males we do not have a chaperone in the room. Females if it is a male doctor a female nurse will go in...If it is a minor, either the parent or a nurse would be present. If anyone requests someone in the room, we will always have a second person. There is always a brief explanation about what is going to happen...although I don't know how much anyone can really be prepared for a finger in the butt... :uhoh21:

Thank you for your post. No doubt that was PART of the problem, but not all, I think.

Jenifer