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Do doctors still do testicular exam?


The testicular exam, also known as the testicular self-exam or TSE, is a simple procedure where a man checks his testicles for any lumps, bumps, or changes. It used to be a standard part of a routine physical exam performed by doctors, but has become less common in recent years. There are a few key questions around whether doctors still perform testicular exams:

Do all doctors do testicular exams?

Not all doctors routinely perform testicular exams anymore. The testicular exam was once a standard part of a physical examination, but over the past few decades it has become less of a priority in general/family medicine. Some of the reasons doctors do not always perform testicular exams include:

  • Lack of evidence – There is conflicting evidence on whether routine testicular exams significantly improve early detection of testicular cancer in men with no symptoms.
  • Low incidence of testicular cancer – Testicular cancer is rare, accounting for only about 1% of cancers in men.
  • Time constraints – With limited time to perform a complete history and physical, testicular exams may get overlooked by busy providers.
  • Patient embarrassment/discomfort – Some patients may find testicular exams awkward or embarrassing which can deter doctors from routinely performing them.

While it is still considered an important screening tool, whether or not a testicular exam is performed often comes down to provider preference and scenario.

Are testicular exams part of routine adult male physicals?

While there are no definitive medical guidelines, most major medical organizations still recommend that doctors perform testicular exams, especially for adult male physicals. Some examples include:

  • The American Cancer Society recommends men have an exam as part of a routine cancer-related checkup.
  • The American Academy of Family Physicians recommends a testicular exam as part of an adult male’s periodic health examination.
  • The American Urological Association states that although evidence for the exam’s efficacy is limited, it supports physicians performing testicular exams.

So while not universally adopted, most major medical groups still advise that a testicular exam be incorporated into routine care for adult men. However, patients may need to specifically request it if their doctor does not perform a testicular exam routinely.

At what age should doctors start performing testicular exams?

There are no definitive guidelines for when testicular exam screening should start, but most recommendations are:

  • Age 15-16 – Some medical groups advise doctors start performing testicular exam screening around this age range.
  • Age 18 – When a teenager transitions to an adult provider, testicular exams should be incorporated into their checkups.
  • Age 50-70 – Guidelines vary on when screening can be discontinued, but most recommend doctors continue performing exams at least through a man’s 50s to 70s.

The primary goal is to screen for testicular cancer in younger men who are at highest risk. Catching it early greatly improves prognosis if cancer is detected.

When would a doctor perform a testicular exam?

There are a few instances when a physician may perform a testicular exam:

Part of a routine physical exam

As noted above, testicular exams may be part of a wellness checkup for adult men, though not always. Patients may need to ask for it specifically if the doctor doesn’t offer to perform one.

If testicular problems are suspected

If a patient is experiencing symptoms like testicular pain, swelling, lumps, or discomfort, a doctor will very likely perform a hands-on exam to investigate these issues. They may also order an ultrasound for further evaluation.

Follow-up cancer screening

For men with a history of testicular cancer, doctors will do periodic exams to monitor for potential recurrence. This screening may be done every few months for the first few years after treatment.

Part of a fertility evaluation

When a man has fertility problems, testicular exam is standard to check for any abnormalities like varicocele veins or atrophy. The doctor may also order a semen analysis and hormone testing.

Sports physical requirement

Testicular exam may be included as part of a sports physical if required by the school district or sports league. Requirements vary.

What does the exam entail?

When a doctor performs a testicular exam, they will follow these steps:

  1. Visually inspect the scrotum for any swelling, discoloration, or abnormal findings.
  2. Palpate each testicle gently with fingers to feel for lumps or areas of hardness. The doctor may use two hands to cradle each testicle.
  3. Assess testicular size and anatomy. The doctor confirms each testicle feels normal in shape and consistency.
  4. Check for pain or discomfort as the patient’s testicles are handled. Soreness may indicate issues.
  5. Examine the epididymis on the back side of each testicle. This is a common site of testicular cancer.
  6. Inspect the spermatic cord for any bumps or swelling. This cord carries sperm from the testicle.

The exam is quick and only takes a minute or two. Doctors are trained to handle the testicles gently to minimize discomfort.

When should men perform self-exams?

Testicular self-exams are an important complement to professional screening. All men can benefit from regularly performing self-exams. Guidelines for frequency include:

  • Monthly self-exams once a boy hits puberty or age 15.
  • Continue monthly exams throughout adulthood to monitor for any testicle changes.
  • Special attention if any prior testicle conditions or injuries. Exam healthy side for comparison of size/shape.
  • Self-exams can be discontinued if both testicles are removed later in life.

Men at average risk should make self-exams part of their regular routine. Those with risk factors like prior testicular issues or history of undescended testicle may benefit from more frequent self-checks.

How to perform a self-exam

Men can perform a simple monthly self-exam by following these steps:

  1. Stand in front of a mirror and visibly inspect the scrotum for any swelling or oddities.
  2. Gently palpate each testicle with fingers using a rolling motion between the thumbs and index fingers of both hands.
  3. Feel for any lumps, bumps, or areas of hardness. Compare sides for symmetry.
  4. Use a body temperature shower to relax the scrotum and make exam easier. Warm skin aids palpation.
  5. Repeat self-exams monthly. Contact a doctor if any testicle changes are found.

Examining the testicles regularly helps men detect any abnormalities early when treatment is most effective.

Are self-exams as effective as doctor exams?

Routine testicular self-exams are beneficial, but they aren’t considered as effective as having a doctor perform periodic testicular screening exams. Reasons professional exams are still advised include:

  • Thoroughness – Doctors are trained on proper palpation technique and know what abnormal tissue feels like.
  • Two sets of hands – A doctor can cradle each testicle in two hands simultaneously.
  • Objectivity – Men doing self-exams may miss subtle changes a doctor would notice.
  • Spot checks – Annual or periodic doctor visits provide important check-ins versus sporadic self-checks.
  • Early intervention – Doctors can order imaging tests if abnormalities are found.

While self-exams help men tune into their body, medical expertise adds an invaluable layer of screening. Both self and professional exams play an important role in early testicular cancer detection.

What is the positive predictive value of a testicular exam?

Positive predictive value (PPV) refers to the probability that a positive test result reflects the underlying condition being tested for. In the case of testicular exam, the PPV would indicate how likely a suspicious lump found on exam turns out to be cancer.

Studies on PPV of testicular self-exam have shown:

  • PPV of 46% when performed by physicians (nearly half of positive exams are cancer)
  • PPV of 39% for positive self-exams

So while not a definitive diagnostic test, an abnormal lump on self or doctor testicular exam has a moderately high PPV for testicular cancer. Any positive finding warrants immediate medical follow up.

Predictive value compared to other cancer screening exams

To compare, here are positive predictive values for other common cancer screening tests:

Cancer Screening Exam Positive Predictive Value
Mammography for breast cancer 4-6% PPV
PSA test for prostate cancer 25-40% PPV
Pap smear for cervical cancer 5-20% PPV
Testicular exam for testicular cancer 39-46% PPV

So while not definitive, the testicular exam’s PPV indicates it is a relatively good screening tool compared to other common cancer screening tests.

What is the role of testicular ultrasound?

If a doctor’s exam or self-exam reveals a suspicious lump or mass, the next step is usually a testicular ultrasound. This imaging test uses sound waves to examine the testicles and provides valuable information:

  • Confirm presence and location of a mass
  • Assess shape, size, and internal echogenicity of the mass
  • Help distinguish between fluid-filled cysts vs solid tumors
  • Evaluate nearby structures like the epididymis
  • Look for potential lymph node involvement
  • Compare contralateral testicle

Ultrasound is the primary mode of imaging used in evaluating testicular masses. It is non-invasive and does not use ionizing radiation. Results can help determine whether a tumor is likely malignant versus benign.

Benefits of ultrasound over other imaging tests

Benefits of testicular ultrasound include:

  • No radiation exposure as with CT scans
  • Less expensive than MRI imaging
  • High resolution images of the testicular parenchyma
  • Allow dynamic assessment via real-time scanning
  • Non-invasive quick procedure

These advantages make ultrasound the ideal first-line imaging test for evaluating testicular concerns found on exam. It provides key information to guide next steps in diagnosis and treatment.

What conditions are doctors looking for with testicular exams?

Doctors who perform testicular exams are screening for several potential conditions, both benign and malignant:

Testicular cancer

The most important reason doctors monitor the testicles is to screen for testicular cancer. Testicular cancer has a peak incidence in men age 15-40. The two main cell types are seminomas and nonseminomas. Risk factors include undescended testes, family history, and race (higher rates in white men). Testicular cancer usually presents as a unilateral painless mass. While relatively rare overall, it is the #1 cancer in younger males. Early detection on exam leads to very high cure rates.

Hydrocele

A hydrocele causes fluid buildup around the testicle, feeling like a painless soft swelling on exam. While usually benign, hydroceles can grow and cause discomfort.

Varicocele

Varicoceles are enlarged veins in the scrotum, often described as feeling like a “bag of worms.” They are the most common abnormality found on testicular exams in men age 15-35. Varicoceles can impair fertility but are otherwise benign.

Epididymitis

Inflammation of the epididymis causes this tender testicular swelling. It is often due to infections. STD screening may be warranted if epididymitis is suspected from exam.

Testicular torsion

Testicular torsion is twisting of the spermatic cord cutting off blood flow. This very painful condition is a medical emergency requiring urgent surgery to save the testicle. The classic presentation is sudden unilateral testicular pain with an elevated positioning of the affected testicle.

Hernias

Inguinal hernias protrude through the groin area near the scrotum and may be detected on exam. Patients may notice an intermittent bulge with straining.

Conclusion

While no longer standard practice across all fields, many primary care doctors still routinely perform testicular exams, especially for male wellness visits. Screening for testicular cancer remains an important reason for periodic checks. The exam only takes a minute and although self-exams are beneficial, the clinical perspective of a physician can detect subtle changes that warrant evaluation. An abnormal finding will usually lead to a testicular ultrasound. Beyond cancer, conditions like hydroceles, varicoceles, and epididymitis may also be discovered on routine testicular screening. Patients are advised to discuss testicular health with their doctor and not hesitate to request a screening exam if it is not offered. Catching problems early leads to the best outcomes.