Oct. 5, 2000 -- Ask a young woman why breast exams are necessary, and chances are, she will know the answer. Ask a young man why testicular exams are needed, and chances are, he won't know.
According to a study published in the Sept. issue of the Journal of Urology, young men are drastically unaware that testicular exams are necessary. Further, note the authors of this survey, national guidelines offer very little guidance for male self-health care.
"Young males are grossly unaware of many aspects of their self-health. Despite higher risks of testicular torsion, cancer, and varicocele (varicose veins in the testicles) than most other age groups, our population was universally unaware of any of these as a reason for genital examination," writes Phillip Nasrallah, MD, and colleagues from the Children's Hospital Medical Center and Northeastern Ohio Universities College of Medicine in Akron, Ohio.
They surveyed over 300 male athletes aged 12 to 18 years with a five-item anonymous survey given before a sports physical exam. Almost half of these boys incorrectly answered question one, "Why does the sports physical exam include a genital exam for males?" Correct answers included hernias, testicular abnormalities, tumors, or cancer. Only about half even answered "hernia."
Question two stated, "What type of protection for your testicles do you wear during sports?" Correct responses included athletic supporter or cup, and had to be appropriate for the sport the boys played. Almost half of the boys did not wear the appropriate protection, and a quarter wore no protection when playing football and other collision sports. Tight underwear or compression shorts were worn as protection by only 5% of the boys.
The remaining questions also pointed out either the teens' ignorance or misunderstanding of potential problems, and their vulnerability to problems. For instance, a full 87% of the boys wrongly chose older men as the only group at risk for testicular cancer. But in fact, although relatively rare, testicular cancer is the most common form of cancer among young men between the ages of 15 and 35, according to the National Cancer Institute.
Patrick Walsh, MD, director of the Brody Urological Institute at Johns Hopkins Hospital in Baltimore, is not surprised about this general ignorance of the part of young men. "What 17-year-old athlete is thinking of cancer or illness?" he tells WebMD. "The only thing a 17-year-old male who has to have someone examine their testes is probably thinking is that it's strange."
The authors suggest other reasons for young mens' lack of knowledge. Mothers, who are often in charge of child rearing, have limited knowledge on male health issues. While there are many female issues discussed on talk shows and magazines, the media primarily focuses on athletic and technical issues for males. And finally, Nasrallah writes, "In our opinion the opportunity for educating the young male within the health care system does not exist."
According to many experts, yearly testicular exams to check for cancer are important even in young boys. Both the American Medical Association (AMA) and the American Academy of Pediatrics recommend annual exams for teen-age boys. In addition, the AMA's Department of Adolescent Health has published the Guidelines for Adolescent Preventive Services, which states that all adolescents aged 11 to 21 should have annual preventive service visits to address the physical and psychosocial aspects of adolescent health.
Preeti Matkins, MD, a pediatrician at the Carolinas Medical Center in Charlotte, N.C., says that regular exams in adolescent boys are important but often forgotten. "Adolescents, like young adults, are generally healthy. So it takes some effort to make an appointment," he says. In addition, annual visits may also be hard because boys do not have the changes girls have, such as menstruation, to mark the beginning of adolescence.
And just as girls should be taught to perform periodic breast self-exams, boys should be taught how to perform testicular self-exams. "We teach boys to examine their testicles and make sure they don't have any lumps that may be a sign of cancer or something else that should be checked by a physician," Matkins says.
A self-examination is best done during or right after a shower or bath when the skin of the scrotum is relaxed. Each of the testicles should be held between the thumb and fingers of both hands and gently rolled to check for any abnormal lumps, which are usually painless and about the size of a pea.