As promised, here is the recap of yesterday's sports exam at our local high school.
My group practice volunteers to perform sports physicals at our local high school. We rotate the Doctors through each season, so each of us gives on average one afternoon a year to examine either the boys teams, or the girls teams for one season. We always assign a female Doctor for the girl's teams, because state law requires a female nurse to be present if a male examines a female in my state. We have more female Doctors in my practice than males, so while I usually draw female teams, sometimes we have two female doctors on the same rotation, as this year, and I got the boys. The methodology is designed to be as efficient as possible, and is not a full medical exam. The school board requires a full exam from each student before their freshman year. This exam is to insure that the students are physically able to participate in interscholastic sports.
I sit in the training room, the coach sits in an adjacent office. The door is open between the two rooms, however the coach is out of direct line sight of the table where the exam is performed. the boys line up in the locker room, shirtless and barefoot, but with their gym shorts and underwear on. Each has a medical form with name, age, sport. Rather than bore you with the total procedure, I'll cut to the chase, the last 30 seconds.
The boy stands, I ask him to lower his shorts and underwear, and I explain that I will be checking for any lumps in their testes, and for hernia. As I exam their testicles, I explain the importance of self exam, as testicular cancer is actually a higher risk in young males than in older males. (each gets a handout explaining how to perform a self exam.) I do a quick visual exam of the penis, to make sure there are no problems, then the hernia exam, and we're done. On average, the entire exam takes less than 5 minutes, the genitals about 30 seconds.
I realize that most of you aren't here to read about acne, or tendon issues, so I'll skip right to my observations during the genital exams. There were a total of 83 boys ages 14-18. Approximately 2/3 circumcised. 3 erections, 2 freshmen, one senior. Both freshmen were erect when they dropped their shorts, the senior became erect while I was examining his testicles. All three expressed regret, and I reassured them that they werent the first or last of the day to have a 'natural reaction' to being touched. One of the freshman with an erection appeared to have Phimosis (a condition where the foreskin does not retract fully). We discussed it, and strongly urged him to see a urologist for further evaluation. All three boys with erections were of average size and girth.
The entire gamut of puberty was represented by the group. Boys with minimal pubic hair, all the way to fully developed boys with full chest hair. While I'm happy to report all 166 testicles appeared healthy, I did see 8 cases of Varicocele. This is not unusual in young men, occuring in about 15% of males bewtween 14 and 25. The spermatic cord leads upwards from the scrotum which carries sperm to the penis, and also has veins and arteries. The veins of the spermatic cord can become swollen, elongated and looped, and tender to the touch. In moderate cases, it does not need attention, as were all of these cases, but each boy was advised to be aware of any increased swelling, or discomfort, and to see a Doctor if they perceived any change. (As is usually always the case, all 8 involved the left testicle.) Two boys appeared to have gynecomastia, which is nipple enlargement, or 'nipple buds' due to excess hormonal production during puberty. In most cases, this is a temporary condition that abates within a short time. It is however a condition that can cause embarrassment in boys. Naturally, the majority of the boys were somewhat embarrassed to expose themselves to me, which I try to ease by turning away from them and signing the paperwork when I asked them to drop their shorts, then quickly turn back and perform the exam. As is also usual a small minority seem to take great joy in exposing themselves, one even placing his hands on his hips like Superman, and stating 'nice one huh doctor', I must say it did illicit a chortle from me, and I assured him that he appeared perfectly healthy and normal. I observed the full array of penises and testicles, ranging from small to large, thick to narrow, light colored to dark colored, loose scrotum to tight scrotum. One thing I have learned over the years, is there is no prediction to size when the shorts come down. In fact, the largest flaccid penis yesterday belonged to a small thin Freshman cross country runner, and was at least 6' in length. Ironically, the smallest belonged to the strapping Senior Quarterback, and wasnt much longer than a half inch (flaccid). There was one freshman with what appeared to be a relatively serious case of Peyronie's Disease, which is a severe curvature of the penis. This boy's flaccid penis was about 4' in length, and curved approximately 30 degrees to the left. This can create issues later during intercourse. (Also suggested he consult a urologist).
Finally, as discussed in my earlier post, I observed five penises with obvious abrasions. This can be a very delicate discussion with a teen, as discussion of masturbation technique with a middle age female is last little 'chat' a boy wants to have. My standard statement, after the shorts come back up, is: 'I noticed skin abrasions, which is very common when men do not use a lubricant. There are a number of products, such as (and in deference to the site editor, this time I won't mention a brand name) available at drug and grocery stores to prevent that, and keep your skin healthy. It is important to use a lubricant specifically developed for genital use, as many creams and lotions contain additives that can irritate you'. That usually gets the message across.
Lastly, based on the comments of my last post, I'll anticipate the question 'Was there anyone you saw that you found sexually stimulating'
Yes. The Cross Country coach. Wouldn't mind seeing him naked!