nudity during physical exam

[AdamFin]

• Consistent with the Wajefirest study:
  
  
  
  Carlos Nuñez Mora · MD Anderson Cancer Center Madrid
  In our series near of 2% of patients were diagnosed of having prostate cancer due to the DRE with PSA below 2.5 ng/ml
  Dec 16, 2013 ·

 

[Max_Polo]

• Consistent with the Wajefirest study:
  
  
  
  Carlos Nuñez Mora · MD Anderson Cancer Center Madrid
  In our series near of 2% of patients were diagnosed of having prostate cancer due to the DRE with PSA below 2.5 ng/ml
  Dec 16, 2013 ·

BUt what about outcome data?

 

[AdamFin]

"Clinically significant" diagnosis is evidence enough the test is useful. It is simple and costs basically nothing.

I'd love to see a study on outcomes in this group too. Frankly one that looks at much, much more than mortality.

Perhaps the big money trying to save billions on PSA testing isn't interested in looking at this group. And as index fingers have no lobby to fund studies I doubt we will see one.

But to humor you, between 1985 and 2000, there was a very sharp decline in prostate mortality as a percent of the general population. Many things happened in that time and since to push the disease to the historically low rates of mortality today, and among those things was the PSA emerging in late 80s coupled with DRE. You can literally see a spike in diagnosis correspond with a rapid decline in mortality. Now the annual diagnosis number is declining (I think as a result of less testing not less disease in the population), and in no time I predict higher percentage of later stage diagnosis and notwithstanding better drugs and target radiation, an uptick in, your favorite word, mortality. And a lot more people LIVING with advanced disease.

You cannot early-detect aggressive disease without catching up a lot of redolent disease in the diagnostic net.

Problems of clinicians navigating patients through nuanced treatment decisions needed in prostate cancer should not translate into desire to "dis"improve diagnosis.

Retreating to "Opportunistic" screening (I love that bullshit word) will in time be proven folly. Many doctors know it and that's why they are not heeding the popular advice.

Not for nothing, absent PSA (falling out of favor) the DRE (even more out of favor) is all you have. And inasmuch as it helps find prostate cancer, it also: detects benign enlargement (good to know as a baseline even it treatment not needed) and certain lesions, hemorrhoids and often does double duty as means of collecting fecal specimen for instant occult test. In a physical exam, it is hard to consider it less appropriate than a skin check, a testicular exam in young men, a peek down the throat, a scope in the ear, or a shiny light looking into your eye.

 

[Max_Polo]

It is simple and costs basically nothing.

Perhaps the big money trying to save billions on PSA testing isn't interested in looking at this group.

Huh?

Retreating to "Opportunistic" screening (I love that bullshit word) will in time be proven folly. Many doctors know it and that's why they are not heeding the popular advice.

Agree - that's nonsense.

Not for nothing, absent PSA (falling out of favor) the DRE (even more out of favor) is all you have. And inasmuch as it helps find prostate cancer, it also: detects benign enlargement (good to know as a baseline even it treatment not needed) and certain lesions, hemorrhoids and often does double duty as means of collecting fecal specimen for instant occult test. In a physical exam, it is hard to consider it less appropriate than a skin check, a testicular exam in young men, a peek down the throat, a scope in the ear, or a shiny light looking into your eye.

There's no real downside to DRE but its utility in diagnosing prostate cancer is minimal at best (has never been shown to improve any outcome measure, let alone mortality). BPH is a symptomatic diagnosis and does not depend on DRE. Hemorrhoids are extremely common and only treated if symptomatic. And stool FOBT testing is so error-prone (both false negative and false-positive), depends on dietary restrictions, etc that it is entirely unhelpful, assuming that you are screening for colon cancer by some other means (we strongly recommend optical colonoscopy screening). There's a question about whether FOBT is better than no screening and it probably is, but not by much. I certainly wouldn't let my life depend on it.

Which brings up an interesting point...my physician patients (including two gastroenterologists) decline DRE but do want annual PSA testing and none have opted for FOBT testing.

 

[AdamFin]

Dude, docs suck as patients.

I'm not a doctor, and don't play one on tv!

Look, if you don't get my points, so be it. Mark my predictions and let time tell. Meanwhile enjoy healthy margarine, oh sorry, butter. Or maybe neither. And eggs. Or maybe not. And all the fruits of statistically significant but abjectly stupid and wrong advice. I know you get my point.

My recent comments may imply I am a big over believer in the medical establishment. I am not. I am (as far as I know) a hyper healthy guy under 40 with a great BMI, healthy diet, exercise profile, strong, kids and spouse -- with a DNR. Because I do trust the simple stats that say positive outcomes after resuscitation big time suck.

I have a doctor who took a baseline PSA a few years ago but not since. Perfect call given my age. I have a physical every year, including a DRE. And he does the occult test without me asking if he gets a sample. My doc!

Outcome improvements grow out of accurate information-based decisions made by people using common sense analyzing many interlacing variables. Stats inform this but don't dictate this. They can't.

Not a doctor, but I definitely know flawed math. And too many medical studies (worse, by far, nutrition studies) use math irresponsibly. IMO. It is shocking really.

 

[Max_Polo]

Dude, docs suck as patients.

Some do, some don't. It is very interesting to look at what doctors want for themselves vs. what they do for patients.

There's a great book if you're curious, called How Doctors Think by Jerome Groopman.

 

[Number 51]

I don't think I've ever been nude for a physical exam. When I was younger, I'd be examined in my underwear, and the pediatrician would check my testicles and for hernias by sticking his hand in my underwear and feeling around (it felt ticklish and I'd involuntarily chuckle when he did that). The only time that I've had a physical recently that I even so much as took my shirt off was when the nurse practitioner wanted a baseline EKG run; otherwise, it's just basic stuff like blood pressure and heart rate. When I go to the dermatologist for skin exams, I'm given a pair of disposable shorts to put on, and the dermatologist checks over my body and finishes up with a quick peek down the shorts. I personally have nothing against DREs; I've had hemorrhoid issues in the past and have grown utterly used to someone shoving his finger up my butt.

As a followup, I just had my annual physical done. The nurse-practitioner said that at my age I needed a regular check for testicular and prostate cancer. I dropped my pants, she fondled my twig and two berries (unlike when I was younger, it didn't feel ticklish), then lubed up her gloved finger and shoved it up my butt. There was nothing out of the ordinary found, and it was all done most professionally. Frankly, I think that the stories you read about medical professionals getting excited at seeing a penis are just that, and if your doctor does react to your penis, you probably should switch to another doctor.

 

[RamblingCock]

Just went to a new dermatologist last week and was being examined for a couple of unusual (to me) dark spots on my skin. Underwear only. She checked me out, afterward telling me there was nothing nasty found, and she calmed me down about the dark spot, going over and explaining all of the various types of blemishes which can creep up over 50+ years. Towards the conclusion of the exam, accomplished while she had an assistant keeping notes (also female), she asked if there was anything else of concern. I paused, then remembered a hernia scar with a little black recurrent spot on it - kind of like a blackhead which forms a few times a year and varies in size. For obvious reasons I've never had a chance to get a good look at it myself.

I paused, and said "yeah..." kind of tentatively. She looked me straight in the eye and asked "your penis?"

I rapidly demurred and said it was a mark on an inguinal hernia scar. She leaned forward and pulled the front of my shorts away from my body, looking down towards the scar, having a clear view of Little Rambler and the boys. She knelt down, pulled the shorts down far enough to get a clear look at the scar, palpated a bit, told me there wasn't a problem, snapped the shorts back into place and stood up to wash her hands. The assistant jotted down the notes.

I have to say the doctor took me by surprise with assuming I was referencing my dick versus another part of the anatomy. She, frankly, is a VERY attractive woman and may have had this happen more than a few times with other patients. She told me after I'd redressed that she used to practice in Beverly Hills, which made me wonder a bit about what she must have been used to with patients up there.

 

[Clrwtrdlbud71-fl]

In my experience, the older I get the less I am asked to be naked or semi naked during a physical. It's probably an my imagination in the following but I feel even a dismissive attitude: "'the danger zone has passed' past the middle age, 'not a high concern anymore' type approach.

My last physical was with a female doctor (its an employer-provided physical through a physicians group, so you get whomever you get to perform it); I did feel a little awkward about her checking my balls because its been ages since a gal other than my wife has seen me naked. She told me that if next time I have and report to have checked myself consistently then they will have no need to drop tro and do it themselves lesson learned. I would feel no awkwardness if it was a guy Dr. She was pretty straight forward though: drop the trousers (they make one wear medical scrubs outfit), felt my balls, asked me to put them up again.

My last self-selected Dr. to give me a physical was male, I estimate my same age (early 30s then) : He only gave me a physical two years in a row, had me fully naked, it felt totally natural, like to buds hanging. The second time he did spend a lot time on my penis and balls, but specially on my penis, feeling girth from bottom to top and back down, squeezing the head, asking me about it, peeing, etc. He was very nonchalant about it, still for years I have recalled that exam and wondered if there had been something more going on given all the attention: I have since seen training videos (thank you YouTube!) on a thorough penile and testicular exam and so now I think he was doing it by the book and being thorough, nothing else.

 

[swimmersox]

That's basically the only fun part of a doctor visit, knowing that I'm statistically bigger than 9 of 10 guys s/he sees, and also considerably fitter than most.
If there's a prostate exam involved, all the better ...

 

[chrisrobin]

That's basically the only fun part of a doctor visit, knowing that I'm statistically bigger than 9 of 10 guys s/he sees, and also considerably fitter than most.
If there's a prostate exam involved, all the better ...

I agree, and the thought that the finger up the bum is smaller than most things I get up there....

 

[J32]

A few years ago I had to get a last minute physical exam for work. Not having insurance I was told that I could obtain one at certain Rite-Aid's that had these small clinics with a doctor.

So I went down there and figured it'd be one of those quick ones where they check your blood pressure, flash a light in your eyes and send you on your way. So I get in there and the doctor is this young blonde who must have been right out of college. I wouldn't say she was hot but definitely very cute and with a very nice ass that looked great in scrubs.

I waited my turn and when she came out with her previous patient she had a quick conversation with a female pharmacist that was nearby. They were only a few feet away from me so I could hear even though I pretended to be reading a magazine. They were talking about getting together for something and the doctor mentioned she had no one to take with her. The pharmacist asked about some type of boyfriend and the doctor said that person was out of the picture. So as I go into this exam I have the idea that this doctor is single and all sorts of filthy thoughts start going through my mind and I get hard.

During the exam I kept trying to think of the filthiest things because I wanted her to see my bulge. But then the unexpected happened. She asked me to drop my pants for a hernia exam. I was excited but also nervous she might be upset since I was fully hard. I dropped, she examined, never mentioned that I was hard, she just moved it out of the way, and then when she was done it was like nothing happened.

But on the way out she said said "Well, everything looks normal and you should be good to go" and I replied with a joke "oh, good I was afraid I was dying" and she said "nope...everything looks very nice" and opened up the door to let me out. I replayed that "very nice" in my head so many times and still can't figure out if she meant it that way.

 

[AdamFin]

The fucking night gown thing they give you is ridiculous. They want you nude in a gown they can reach under easily and for the finger up the ass it falls away. I don’t mind being naked but the gown embarrasses me cause it seems like I am hiding shit I am I fact not trying to hide. My doc does feel my balls (five seconds each) palpates my dick head to look at the meatus (zither seconds). And he puts his gloved finger in my ass to feel my prostrate (ten seconds max). I’d rather be nude than in the sissy gown they put ya in.

 

[RamblingCock]

I get that. I hate the gown and coverings. I noted that on my blog (and maybe here). I was in the urologist's office for a scoping - the doctor sends a catheter up your dick to look at the insides of your bladder - and the nurse started to cover my (already naked) lap with a paper covering. I laughed and said "really?" She realized how dumb it was and just tossed it aside, but said she was usually surprised that there were guys who needed the covering until the doctor removed it for the procedure.

Maybe it's just me, but that is the more questionable attitude. You're at a dick doctor, do you really think covering yourself is doing anything but BRING attention to your shyness?

 

[Max_Polo]

I get that. I hate the gown and coverings. I noted that on my blog (and maybe here). I was in the urologist's office for a scoping - the doctor sends a catheter up your dick to look at the insides of your bladder - and the nurse started to cover my (already naked) lap with a paper covering. I laughed and said "really?" She realized how dumb it was and just tossed it aside, but said she was usually surprised that there were guys who needed the covering until the doctor removed it for the procedure.

Maybe it's just me, but that is the more questionable attitude. You're at a dick doctor, do you really think covering yourself is doing anything but BRING attention to your shyness?

Covering a patient who is waiting for an examination, and covering any parts of the body that do not need to be exposed for a particular procedure are standard and appropriate. It's OK for a patient to not request that or even to decline it, but it's the most appropriate default professional approach.

 

[Hairylegs]

Going into a doctor's office is incredibly stressful. Hell, I go into a doctors office, and my normally desert dry armpits are soaked in mere minutes! My goal is to try to keep those stress levels to a minimum. I won't wear a white coat for that reason. The gowns are worthless, all parties know that, but you try to keep a modicum of modesty. My number one goal is establish a bond of trust and good faith. Without trust, absolutely nothing I say will be believed or acted upon. And I take the genital exam very seriously. Yes, I am going to spend more time palpating the testes of an older teen or a 20 something than I will some geezer over 70. Young guys get testicular cancer, and having made 1 diagnosis in my career, I never want to make, much less miss, another. Finger in the butt? Nope, not going there with a 20 year old without one hell of a good reason, but some old fart over 40? I had a run of colon cancers a few years back that would have been missed if I had slacked off. That fickle finger of fate save a number of lives, with a modicum of embarrassment and discomfort. As for foreskins, they might not be very common where I work, but when they do mysteriously appear, they always, always get pulled back, all the way, for a proper look. 2 advanced, pre cancerous penile lesions in one month is pretty humbling. Yep, they both needed circumcisions despite the best advise available here on this website, and both guys get to keep their organs and live another day. I love my job. It isn't prurient, it isn't lewd, it's stressful at times. And it is very rewarding. Bad things happen in the real world. I do my damnedest at my professional best to try to prevent those bad things from coming to pass! Questions?

 

[Clrwtrdlbud71-fl]

Hiya @Hairylegs , seeing we have a pro on the thread, I got a question: your opinion of finger vs PSA blood test? One, other, both?

Ty!

 

[Max_Polo]

Hiya @Hairylegs , seeing we have a pro on the thread, I got a question: your opinion of finger vs PSA blood test? One, other, both?

Ty!

There is no good answer unfortunately. Many professional societies now recommend against screening for prostate cance (using either method) in average risk men. At the same time, most physicians (myself included) disagree and continue to check PSA annually in some men (generally not younger than 40, 45, or 50 and hopefully no in men older than some age - not clearly defined).

 

[AdamFin]

Covering a patient who is waiting for an examination, and covering any parts of the body that do not need to be exposed for a particular procedure are standard and appropriate. It's OK for a patient to not request that or even to decline it, but it's the most appropriate default professional approach.

I agree. Presumably somebody wants it. But I still think the gown is ridiculous. It’s like being given a Halloween gag costume. In my opinion, leave a dude in underwear and, if he wants, a T shirt. I honestly would rather be naked the whole time than be put in the freaky thing. (But I do as I am told.)

 

[Max_Polo]

I agree. Presumably somebody wants it. But I still think the gown is ridiculous. It’s like being given a Halloween gag costume. In my opinion, leave a dude in underwear and, if he wants, a T shirt. I honestly would rather be naked the whole time than be put in the freaky thing. (But I do as I am told.)

The paper ones suck. We use cloth gowns more like in hospital. Still not like being dressed but better than paper ones.