Don’t Let Exam Fear Keep You From The Doctor
Sunday, January 1, 2012
By Robert C. Robinson III, MD
“Ok sir, could you please drop your shorts?”  As a man visiting your healthcare provider these are the words that we dread most during our visit. You might be wondering, “Do I really need to have someone examine what’s “under the hood”?  Or you might be thinking, “Do you absolutely have to put your finger up there?!!” Here we will explain why it’s necessary to have these uncomfortable, and often times invasive examinations performed to ensure you’re in good health.
The “Cough Test”
Ok, so you’re in the doctor’s office and your healthcare provider instructs you to drop your pants.  Upon doing so he or she then proceeds to tell you to turn your head to either side, and cough all while they “examine” your testicles.  You may be thinking, “What in the world is going on?!!” “What does coughing have to do with you examining my groin and testicles?” The purpose of this test is to evaluate for the presence of a hernia sac.
So what is a hernia sac and why do I need to know about this?
A hernia is formed when the lining of the abdominal cavity (peritoneum) passes through a hole, or weak area in the fascia (the strong layer of the abdominal wall that surrounds the muscle).  In men the most common form of hernia is an inguinal hernia.  In this type of hernia, the hernia sac can then bulge all the way down into the scrotum (sounds like a problem doesn’t it).  Mostoften hernias have no symptoms and may not require any immediate intervention.  
However, in some cases the hernia sac may become incarcerated and strangulate, meaning the bulging tissue gets stuck in the hole and its blood supply has been cut off.  This usually results in significant pain and requires urgent surgery.  Occasionally, hernias may be present at birth but are not noticed until later in life, which is why it is important to have this exam performed regularly.  Additionally, hernias can develop as a result of any medical condition or activity that increases pressure on the abdominal wall and tissues including:
•     heavy lifting
•      coughing (hence the turn and cough test)
•     excessive body weight
•     smoking
•     overexertion
• chronic constipation,  straining to have bowel movements
•     enlarged prostate, straining to urinate
How is a hernia treated?
The only treatment to permanently fix a hernia is surgery.  If the hernia can be easily pushed back into the abdomen, your healthcare provider may recommend that simple observation. In this case they may suggest doing nothing and not intervening until it is absolutely unavoidable.   
If you have a hernia and watchful waiting was suggested it is important to make note of any pain or discomfort that you experience in your groin or abdominal region, as this may be a sign of incarceration or strangulation as described above.
The Testicular Exam
The testicular exam is performed to evaluate for abnormalities of the testicles and the tubes that carry semen from the prostate to the urethra.  When performing a testicular exam, the clinician is looking for evidence of masses or growths that may be indicative of cancerous growths.  
Men aged 18-35 are at particularly high risk for testicular cancer and that’s why it is essential that a testicular exam be performed on a consistent basis.
The physician will examine each testicle including the size, texture (whether there are lumps and bumps), and consistency (firm or spongy).   All of these characteristics can be clues to disease of the testicles.  Just as important as having a testicular examination with your primary care provider is performing a self examination.  Be sure to make note of any changes in smoothness, size or consistency to your healthcare provider to ensure appropriate evaluation and testing.
The Rectal Exam
“Sir, could you please bend over?” Ok, so you’ve gotten past the turn and cough test and the testicular exam, but now you’re being asked to allow someone to violate you in a way that you are completely uncomfortable with.  So what’s up with the dreaded prostate exam, and does it really require that a finger be inserted “up there”?!!
Well, the short answer is “Yes”.  The purpose of a prostate examination is to identify abnormalities in the gland that may be representative of cancer.  Unfortunately, the only way to effectively evaluate the prostate is to physically “examine” it.  This requires manual palpation of the gland or ultrasound examination.
Routine prostate examination is recommended for all men beginning at age 50.  However, due to the higher death rates and more aggressive cancers typically seen, in Black men it is recommended that screening begin at age 40.  Additionally, if there is a family history of prostate cancer then you should begin routine screenings 10 years earlier than the age of diagnosis of the relative who had/has prostate cancer.
This means if your father was diagnosed with prostate cancer at age 40 you should begin with screenings at age 30.  Once a “bump” or “lump” is identified, this may prompt further testing such as a biopsy.  It is important to realize that not all lumps or bumps are necessarily cancerous however it is still important to have these identified to ensure that there aren’t cancer cells present.
As men, we often assume that because everything is “working” that there are no health concerns that we need to be aware of.  However, this mentality is a dangerous one to have and it is important for us to realize that not all health issues have obvious symptoms.  
The importance of preventive health visits and screenings can’t be stressed enough, especially amongst men.   Please see your healthcare provider on a consistent basis and inquire about the tests described above.
This was printed in the January 1, 2012 - January 14, 2012 Edition

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