From the Guidelines
In Texas, there are no specific rules prohibiting an Internal Medicine doctor from performing a testicular exam on a minor when medically necessary, but such exams should be performed with appropriate clinical indication, parental consent, and ideally with a chaperone present. Internal Medicine physicians are trained to perform complete physical examinations, including genital exams when medically indicated. For pediatric patients, it's standard practice to have a parent or guardian provide informed consent before the examination and to have them or another healthcare professional present during the exam, as noted by the American Academy of Pediatrics 1. This approach protects both the patient and the physician. The examination should be conducted professionally, with clear explanation of its medical necessity, and documented thoroughly in the medical record. While pediatricians or urologists might more commonly perform such exams in minors, an Internal Medicine physician may need to conduct a testicular exam if symptoms warrant it, such as pain, swelling, or concerns about development. It's also important to consider the recommendations against routine screening for testicular cancer in asymptomatic adolescent and adult males by the American Academy of Family Physicians and the American Cancer Society 1.
Key Considerations
- The USPSTF recommends against screening adolescent or adult males for testicular cancer by clinician examination or patient self-examination 1.
- The benefits of screening for testicular cancer are small to none, and potential harms include false-positive results, anxiety, and harms from diagnostic tests or procedures 1.
- The examination should be conducted with appropriate clinical indication, parental consent, and ideally with a chaperone present.
- Internal Medicine physicians should be aware of the recommendations against routine screening for testicular cancer and only perform exams when medically necessary.
Best Practices
- Obtain informed consent from a parent or guardian before performing a testicular exam on a minor.
- Have a chaperone present during the exam, if possible.
- Conduct the exam professionally and explain its medical necessity to the patient and their parent or guardian.
- Document the exam thoroughly in the medical record.
From the Research
Restrictions on Internal Medicine Physicians Performing Testicular Examinations on Minors in Texas
- There are no specific studies provided that directly address the restrictions on internal medicine physicians performing testicular examinations on minors in Texas.
- The studies provided focus on the importance of physical examination in detecting testicular tumors and other scrotal pathologies 2, 3, 4.
- They also discuss the challenges of performing scrotal ultrasound examinations in infants and toddlers 5 and the epidemiology of testicular and paratesticular pathology in children 4.
- Additionally, a study reviews testicular germ cell tumors, which are the most common solid malignancy among males aged 15 to 40 years in the US 6.
- However, none of these studies provide information on the specific regulations or restrictions in Texas regarding internal medicine physicians performing testicular examinations on minors.