VOLUME 114, ISSUE 3, P483
Mark Sigman, M.D.
The standard paradigm for the evaluation of patients has been the collection of history, the performance of a physical examination (exam), followed by laboratory testing if needed. The recent rapid move toward telemedicine has brought to the front the question of the value or necessity of the physical exam. With modern tests and technology, is this time-tested practice necessary? If it provides information of use to help direct patient management, it is likely of value. For the male exam, the 2 primary components are the visual exam and palpation of structures/organs. Some of the exam can be obtained through video, for example, to determine whether the patient is normally androgenized, whether 2 testes are present, whether hypospadias is present. However, some of the most valuable exam components still rely on palpation. Assessment of the size of testes remains a vital part of the algorithm to evaluate males with azoospermia. Smaller testes suggest (but do not prove) impaired spermatogenesis. Are they tender or do they have a mass suggesting testicular cancer? Are they abnormally soft or firm? These questions still require the physical exam.