Clinical Inquiries

How useful are genital exams during boys’ sports physicals?

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EXAMINATION MAY BE USEFUL to identify hernia but not testicular cancer. Insufficient evidence exists to recommend for or against screening genital exams for boys playing sports. Given the low risk of harm, screening for hernias as a part of a preparticipation physical evaluation (PPE) is recommended by several specialty organizations (strength of recommendation [SOR]: C, expert opinion).

Screening for testicular cancer doesn’t benefit asymptomatic adolescents and adults. Because clinical outcomes are excellent without cancer screening, routine screening isn’t recommended (SOR: C, expert opinion).

Evidence summary

No patient-centered studies have evaluated the effectiveness of male genital examinations during a PPE. Examination is performed mainly to identify an inguinal hernia. The incidence of infantile inguinal hernia is 0.8% to 4.4%, with a male-to-female ratio of 6 to 1.1 About 4% of the population will develop an inguinal hernia, but its incidence among adolescents and young adults isn’t known.1 The natural history of inguinal hernias is poorly understood.

Screening turns up hernia more often than other genital problems
In a study involving juniors and seniors attending a Richmond County, Georgia high school, 48 of 562 students (9.1%) and 34 of 706 students (4.8%) were found to have genital problems or a hernia during examinations conducted in 2 consecutive years of preparticipation physicals.2 No data were available to differentiate the type or severity of the genitourinary problems identified.

A study of 3205 elementary school boys 6 to 12 years of age in western Iran found that 213 (6.64%) had inguinal hernia and penoscrotal abnormalities. The most common abnormality was indirect inguinal hernia (2.4%).3 The rates of other external genital abnormalities, such as retractile testes (1.22%), undescended testes (1.12%), hydrocele (0.87%), and hypospadias (0.78%), were lower.

Students’ attitudes toward screening aren’t known
Students’ knowledge of, and attitude toward, genital screening during PPE are unknown. In 1 study, 50% of junior high school, high school, and college athletes in northeastern Ohio didn’t know why a genital examination is performed during the PPE.4

Sensitivity and specificity of physical examination for hernia
The sensitivity and specificity of physical examination hasn’t been well studied. One study, assessing the accuracy of methods of diagnosing inguinal hernia in 55 laparoscopically documented cases, found that the sensitivity and specificity were 74.5% and 96.3%, respectively, for physical examination; 92.7% and 81.5% for ultrasound; and 94.5% and 96.3% for MRI.5 The patients were symptomatic, however, which makes it likely that the accuracy of these diagnostic methods in screening asymptomatic patients would be overestimated.

Evidence-based answers from the Family Physicians Inquiries Network

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