Thursday, February 10, 2011

You've Gotta Go Deeper

A few weeks ago I posted my recount of the female pelvic exam. So last Thursday I walked over to the urology clinic with other med students to do the male genitourinary exam. This is what you've all been waiting for, lol. But . . . it was rather anticlimactic.

So we walk over to the urology clinic, which is (curiously) in the lower level of the hospital. We were to examine a male standardized patient in groups of 4-5 with a resident or an attending physician. My group got this really nice and laid back resident. I especially love his preface with something like, "You know, urology is great. I never thought that I'd be doing what I'm doing, but I love it. As long as you can explain to your kids why you're not a pervert, and explain to their parents why you're not a pervert, then you're good to go. And within medicine, it's a highly highly respected field."

Some more chatter to relieve the inevitable tension of the situation (though less tension than for the pelvic!), and then we enter the tiny exam room. Sitting in our room was a guy in one of those hospital gowns. As soon as he lifted his gown, we noticed all his tattoos and he looked like your stereotypical biker guy (beard and all!). He later told us that he uses the money from doing these things to get more tattoos, lol.
So as with all exams, it begins with inspection. Some things to note: circumcised or uncircumcised, symmetry, and anything "weird" (lumps, bumps, sores, etc). This part is so important that the resident told us that if we were to ever consult urology after doing a male exam and didn't note whether the guy is circumcised/uncircumcised, then they think we didn't really do a male exam. Our guy was circumcised (unlike the prototypical picture above, and unlike 70-80% of guys on the planet - but still pretty common in the US).

Next was palpation. So basically, just feel along the penile shaft for any lumps/bumps that can't be seen, and gently open the meatus of the urethra (pee hole) to make sure nothing's wrong there. Note that it's "patent."

Then examine the testicles. There's a particular technique to "trap" the testicles between the fingers so it's easier to feel without causing (much) discomfort. Feel for lumps/bumps, find the epididymis, the spermatic cord, etc. Ask them to cough and then feel for any varicoceles.

And finally, do a hernia exam. This was actually a tad tricky, because you have to follow the spermatic cord back into where it goes into the body (and it's not as easy as it'd necessarily seem) and then ask them to cough. Our guy had to constantly tell us whether or not we were in the right area. Often he'd say something like, "You've gotta go up and you've gotta go deeper." Yeah, that was a bit odd, lol.

We didn't do a prostate exam on him. Instead, everyone did a prostate exam on a plastic model. Eh, chances are I'll never really need to do one anyway (in peds), so whatever.

And that's that. Clinical, short, easy. Like I said, rather anticlimactic and not very exciting. Our guy could've used some lotion on his penis, it looked rather dry to me (especially the glans). ::Shrugs::


fan of casey said...

OK, I somehow thought this was going to be a bit more exciting since we're talking about the male sex organ but it was very clinical, so you did a professional job explaining things without too many side comments.

Uncutplus said...

I'm curious -- when you students did the female and male sexual organ exams, did you students separate into male and female groups or did you remain a mixed group?

I realize it was clinical, but different students may also be in various stages of their own sexual exploration.

Did the women students ask more questions when the exam was on a male and vice-versa? One tends to know somewhat more about one's own sex organs, I would think.

Anonymous said...

Well yeehaw. I'm glad the attending patient was such a good sport. :) I'd guess you'd have to be, lol.

As for hernia exams.... All I have to say is: >_>

Ron said...

My medical school is just starting to develop a male clinical teaching associates program (there's a well-established female one already for pelvics and pap smears etc).

So I haven't had the opportunity to learn first-hand how to perform a male genital exam. We know the fundamental basics but haven't put it into practice just yet.

A friend of mine keeps telling me I should go into urology. Not sure why?


- Ron

Aek said...

fan of casey: Yup, professionalism is key. :-P

Uncutplus: No, students weren't separated into male and female groups. I don't think either sex asked any more about the opposite sex. There are things, uncomfortable things, that we must simply get over. And of all the uncomfortable things out there, the male/female exams aren't that bad.

James: Haha. Hernias aren't pleasant.

Ron: Your school doesn't have a male exam training session?! That's just weird. I hear that urologists are the happiest, most laid back, and have the best humor among the surgeons. I think it's largely true.

xl pharmacy said...

I have to go to the urologist because I've been having some problems and I'm really scared, I hope it not being something bad,