How Does a Urologist Examine You? 👨⚕️🩺

 

Table of Contents

Introduction

Overview of Urology Exams

Reasons for a Urology Exam

  - Urinary tract infections

  - Kidney stones

  - Enlarged prostate

  - Erectile dysfunction

  - Incontinence

  - Cancer screening

What to Expect During a Urology Appointment

  - Patient History Discussion

  - Physical Exam

    - Abdominal Exam

    - Genital Exam

      - Male patients

      - Female patients

    - Rectal Exam

  - Diagnostic Tests

    - Urine tests

    - Blood tests

    - Imaging tests

    - Cystoscopy

- The Physical Exam Step-by-Step

  - Abdominal Exam

  - Genital Exam

    - Male patients

    - Female patients

  - Rectal Exam

- Tips for an Effective Urology Visit

  - Ask questions

  - Speak up about discomfort

  - Follow pre-appointment instructions

  - Relax

  - Communicate

- Conclusion

- FAQs

 

Introduction

 

Visiting a urologist for examination is very common, with millions of appointments made every year. However, the idea of having your private areas and functions evaluated can make many people feel vulnerable or anxious. Understanding what exactly a urologist does during an exam and how they conduct their inspection is key to feeling prepared and at ease when your appointment day arrives. This comprehensive guide will walk through the typical components of urological exams for both men and women, so you know what to expect. We will also discuss the reasons you may need to see a urologist, tests that may be ordered, tips for an effective visit, and what is considered normal versus abnormal during these check-ups. Being informed about how urologists examine their patients can help eliminate fear and uncertainty before your own urological evaluation.

 

Overview of Urology Exams

 

Urologists are medical doctors who specialize in treating conditions related to the urinary tract and male reproductive organs. This includes common issues like incontinence, infections, kidney stones, cancers, erectile dysfunction, and more. When seeing a patient with concerns possibly related to the urological system, the urologist will perform an examination to check for any abnormalities and help determine an accurate diagnosis.

 

The exams performed by a urologist focus on the abdominal area, genitals, and rectum. These areas allow the urologist access to feel, see, or evaluate the condition of structures like the bladder, urethra, prostate, testicles, and pelvic muscles and organs. The exam may involve visual inspection, feeling with the hands (palpating), tapping (percussion), advanced imaging tests, and insertion of instruments like a speculum or cystoscope. While urology exams involve sensitive areas, the entire process is professional and clinical. The urologist has performed these exams countless times before and understands how to conduct them efficiently and respectfully.

 

Though urology exams require exposure and touch of private regions, there should be no more than mild discomfort at most. Significant pain is not normal, so speak up if an exam hurts. The urologist relies on your feedback to provide appropriate, timely care. Keeping communication open before, during, and after the exam results in the most effective urological evaluation. If you know what types of techniques to expect, relaxation methods to use, and how to participate, you can get the most out of your urologist visit.

 

Reasons for a Urology Exam

 

There are many common urological conditions that may prompt a visit to a urologist for examination. Being seen by a urologist does not necessarily mean you have a serious problem. However, it is the best way to get appropriate testing and treatment to resolve or manage the issue. Some examples of symptoms that could cause your primary doctor to refer you to a urologist include:

 

-         Urinary Tract Infections

 

Recurring or complicated urinary tract infections (UTIs) are a common reason for referral to a urologist. They will perform a thorough history and examination to check for any anatomical or functional issues that may be predisposing you to frequent UTIs. This could include obstruction, urinary retention, or trouble fully emptying the bladder that allows bacteria to grow. They can also order urine tests and imaging that better evaluate the urinary tract for signs ofdamage that could make you prone to infection.

 

-         Kidney Stones

 

Agonizing kidney stones may bring you to a urology clinic seeking relief. The urologist will discuss your history of stones to understand possible causes, such as diet or hereditary factors. The physical examination focuses on the abdomen, where the urologist feels for any tenderness or masses along the paths stones take through the urinary tract. Imaging tests are also used to look for current stones in the kidneys or ureters. Blood and urine testing help assess any worrisome metabolic factors contributing to frequent stone development.

 

-         Enlarged Prostate

 

As men age, they may experience urinary symptoms like reduced flow, difficulty initiating urination, frequent urination, and urgency. These are often caused by noncancerous prostate enlargement common in older males. A urologist can evaluate whether symptoms are due to prostate growth rather than other conditions like UTIs. The rectal exam allows the urologist to check if the prostate feels enlarged or irregular. They may also order bloodwork to measure PSA levels and urine flow studies to assess the impact of prostate changes on urinary function.

 

-         Erectile Dysfunction

 

Difficulty obtaining or maintaining erections adequate for sexual activity is known as erectile dysfunction or ED. This sexual concern can stem from prostate issues, vascular disease, diabetes, or psychological factors. A male embarrassed about ED may see their primary care doctor first, and get referred to a urologist for specialized testing. The urologist will perform a thorough medical history and exam, sometimes include penile and testicular evaluation. Additional testing can also be done to pinpoint the cause, such as vascular imaging or labwork.

 

-         Incontinence

 

Leaking urine when laughing, sneezing, or doing activities is called incontinence. Both men and women can experience this common condition. A urologist assesses incontinence through methods like a bladder scan to see how much urine remains after you urinate. A rectal exam can check for descended pelvic organs that may contribute to leaks. Additional tests like post-void residual measurement, urodynamics, cystoscopy, and imaging provide data to diagnose the type of incontinence.

 

-         Cancer Screening

 

Urologists play a key role in screening for and treating cancers of the bladder, kidneys, prostate, testicles and penis. Even if you have no suspicious symptoms, regular screening exams based on your age and risk factors are crucial for early cancer detection. A digital rectal exam and PSA blood test can screen for prostate cancer. Physical examination helps check the testicles for lumps or swelling that could indicate testicular cancer. Urine tests and cystoscopy are used to monitor for bladder cancer.

 

No matter the specific complaint that takes you to the urology office, the attempted diagnosis begins with a detailed history and physical exam. Understanding why you need to see the urologist and what they will look for during your visit can make the experience less intimidating.

 

What to Expect During a Urology Appointment

 

The thought of having your private parts examined can feel embarrassing or cause performance anxiety. However, there is a logical flow and sequence to a typical urology visit. Knowing the usual progression ahead of time allows you to mentally prepare. The key components of a standard urology appointment involve:

 

-         Patient History Discussion

 

The visit starts with the urologist getting your full health history and details about your specific urinary symptoms or concerns. Be ready to describe your issues, including when they started, what makes them better or worse, impact on quality of life, and any other relevant details. Bring a list of your current medications and supplements. Honest, thorough responses to their questions will aid diagnosis. Don't leave out information due to modesty; the urologist needs complete data to select appropriate tests. Let them know if you have any pain, discomfort, anxieties, or questions during this discussion.

 

-         Physical Examination

 

After the verbal history portion, it is time for the physical inspection. This allows the urologist to actually look at and feel the body structures involved with your urinary or reproductive symptoms. A standard urological physical exam includes inspection and palpation of the:

 

Abdominal Exam

 

For the abdominal portion, you will lie flat as the urologist visually inspects and then palpates all areas of the stomach/flank region. They check for any areas of swelling, tenderness, bulges, or pain that could indicate issues with organs like the kidneys, bladder, prostate, ovaries, and uterus. Let them know if any spots hurt when touched. This abdominal assessment gives key clues through tactile feedback.

 

Genital Exam

 

The external genitals are crucial to evaluate for any visible or palpable abnormalities that could contribute to urinary/reproductive issues. Examination techniques vary slightly between males and females.

 

= Male Patients

 

* Visually inspect penis - The urologist looks at the penis shaft, foreskin, and urethral opening for any discharge, rashes, lesions, or deformities.

 

* Palpate penis - They will gently feel along the penile shaft to check for hardness, plaques, nodules, or other concerns. Let them know if any area is painful when touched.

 

* Inspect testicles - Visual examination of the testicles checks for swelling, redness, or lumps. One testicle may hang lower than the other naturally.

 

* Palpate testicles - The urologist will gently feel each testicle between fingers to detect any bumps, hardness, or pain. Again, speak up about discomfort immediately.

 

* Inguinal check - The lymph nodes in the groin/inguinal area may be felt for any enlargement if infection is suspected.

 

= Female Patients

 

* External genital exam - Visual inspection of the external vulva, labia, clitoris, and urethral opening note any inflammation, lesions, prolapse, or other visible abnormalities.

 

* Palpation - The urologist may gently examine the labia, clitoris, and around the vaginal opening for any unusual bumps, cysts, swelling, or pain. Let them know what hurts.

 

* Pelvic floor tone - You may be asked to bear down or cough while fingers are inserted in the vagina to check pelvic floor tone and signs of prolapse.

 

* Bimanual palpation - Palpation of the cervix, uterus, and ovaries is done by inserting two fingers in the vagina and pressing down on the abdomen simultaneously to feel between the hands. Any tenderness, irregularities, mobility, or masses can be detected this way.

 

Though sensitive, the genital exam should not cause pain and only mild embarrassment. Take slow deep breaths and communicate any discomfort immediately to your urologist during the process.

 

Rectal Exam

 

Examination of the rectum allows internal assessment of critical structures like the prostate gland or bladder. A lubricated, gloved finger is gently inserted into the anus to feel the prostate, sphincter tone, or any rectal masses. Though awkward, this should not be painful. Breathe slowly and relax the sphincter muscles as much as possible. Let the urologist know if you feel any pain or burning during insertion, examination, or removal of the finger. Hemorrhoids or anal fissures could contribute to discomfort in some cases. This portion only lasts a minute or two.

 

While the prospect of these personal examinations may seem daunting initially, try to approach it clinically as the urologist does. Remind yourself this is a professional medical process rather than anything sexual. The entire physical exam is typically completed within 10-15 minutes. Relaxation and open communication ensure you obtain the necessary evaluation while maintaining dignity.

 

-         Diagnostic Tests

 

After the history and physical examination, the urologist may order additional laboratory or imaging tests to supplement their findings. Common diagnostic tests a urologist might utilize include:

 

Urine Tests

 

Sampling the urine can provide loads of information through simple tests:

 

* **Urinalysis** - This basic urine dipstick test can detect signs of infection like leukocytes and nitrites. It also picks up blood, protein, glucose, ketones, and other chemical indicators of conditions. Microscopic urinalysis visually inspects the urine sample for cells, crystals, bacteria, and casts.

 

* **Urine culture** - If infection is suspected, a urine culture isolates the bacterial organisms that grew allowing for proper antibiotic selection to treat the UTI.

 

* **Urine cytology** - Microscopic analysis of urine cell samples helps screen for cancers of the bladder, kidneys, or ureters. Abnormal appearing cellular shapes and clusters may prompt further testing.

 

Blood Tests

 

Bloodwork ordered by your urologist could include:

 

* **Complete blood count (CBC)** - The CBC measures your levels of white blood cells, red blood cells, and platelets. Elevated white cells indicates infection. Low red blood cells could reflect internal bleeding from the urinary tract if present.

 

* **Electrolyte panel** - Electrolytes like sodium, potassium, chloride, and carbon dioxide in the blood impact kidney functioning and hydration status. Imbalances may contribute to certain urinary symptoms.

 

* **Prostate specific antigen (PSA)** - This blood marker can be elevated in men with prostate cancer, prompting further testing like a biopsy if concerning levels are detected.

 

* **Testosterone** - Checking male hormone levels helps assess disorders like hypogonadism or erectile dysfunction. Low testosterone reduces sexual functioning.

 

Imaging Tests

 

Specialized imaging allows the urologic structures to be visualized for abnormalities:

 

* **KUB X-ray** - Plain abdomen X-ray detects kidney stones and some urinary blockages.

 

* **CT scan** - Cross-sectional CT imaging provides detailed views of the kidneys, ureters, bladder, prostate, and urinary tract. Masses, stones, enlargement, and anatomical detail is visible.

 

* **MRI** - Magnetic resonance imaging captures high contrast images throughout the pelvis without radiation. It excels at viewing soft tissue changes in organs and muscles.

 

* **Ultrasound** - Using soundwaves, ultrasounds check the kidneys, bladder, prostate, uterus, and ovaries for any masses, blockages, enlargement, or other pathology.

 

* **Intravenous pyelogram** - Contrast dye is injected into the bloodstream and excreted on the urine to highlight the kidneys, ureters and bladder on X-ray images. Helps detect urinary obstruction or reflux.

 

Cystoscopy

 

One common in-office procedure conducted by urologists is cystoscopy:

 

* This involves insertion of a thin cystoscope tube with a camera on the end into the urethra. The urethra and bladder can be inspected on a video screen for any masses, lesions, obstructions, stones, or coloring changes that could indicate cancer. Biopsies can also be taken through the scope. Though uncomfortable, cystoscopy should not be extremely painful. Let your urologist know immediately if you experience intense pain or difficulty urinating after the procedure. Some temporary mild burning with urination can occur.

 

Understanding the basics of these diagnostic exams takes the mystery and fear out of the equation. Ask your urologist questions if any test concerns you or you need clarification on why it was ordered. The testing provides objective data to direct appropriate treatment options.

 

The Physical Exam Step-by-Step

 

While the thought of disrobing for examinations can feel intimidating, having an idea of exactly how the urologist will proceed can ease anxieties. Here is a detailed step-by-step walkthrough of techniques during the physical inspection portion:

 

-         Abdominal Exam

 

* You will lie flat on an exam table, ideally with your head slightly raised on a pillow for comfort.

* The urologist will first visually inspect your exposed abdomen, looking at the contours and skin appearance. Let them know if you have any rashes, swelling, surgical scars, or other areas of concern.

* They will then palpate the abdomen using their hands. They will press gently at first superficial, then deeper in all quadrants feeling for any abnormalities.

* As they palpate, speak up immediately if any area elicits pain or discomfort when pressed.

* Pay attention if any part of your abdomen feels firmer, swollen, or odd to you when compared to the same area on the other side. Report this.

* The urologist will likely palpate central areas where organs like the bladder, uterus, and prostate reside to feel for enlargement or masses.

* They will also check the flanks or sides where the kidneys sit. Pain when these areas are pressed may signal kidney infection or stones.

* Areas of hernias may be examined for any protrusions, bulges, or weaknesses.

* The examination should not cause pain when the urologist presses on the abdomen. Feeling mild pressure is normal. If any area hurts significantly, speak up immediately so they can modify their technique.

* Let the urologist know if you feel any burning, stinging, or aching during or after the abdominal portion of the exam.

 

-         Genital Exam

 

The external genitals will be visually inspected first, then palpated for any abnormalities. Technique varies slightly for males and females:

 

Male Patient External Genital Exam

 

* Typically performed in the standing position, the urologist will first inspect the penis and testicle appearance for any lesions, discharge, asymmetry, or swelling. You may be asked to retract the foreskin if present.

* Palpation of the shaft of the penis checks for any nodules, plaques, or masses under the skin indicative of disease.

* The testicles are then palpated gently between fingers for any lumps, bumps, swelling or pain. A varicocele feels like a “bag of worms”.

* The inguinal lymph nodes in the groin may be palpated for swelling or hardness if infection is suspected.

 

Female Patient External Genital Exam

 

- You will lie on your back on an exam table with your knees bent and legs parted. Drapes will be used to protect modesty.

 

- The urologist starts by visually inspecting the vulva, labia, clitoris, and urethral opening for any inflammation, lesions, cysts, prolapse, or other visible abnormalities.

 

- Palpation involves gently feeling the labia, clitoris, and tissues around the vaginal opening for any unusual bumps, swelling, or pain. Communicate any discomfort.

 

- To check pelvic floor tone, you may be asked to bear down or cough while fingers are inserted in the vagina to ensure the muscles support pelvic organs properly.

 

- Bimanual palpation is done by inserting two gloved, lubricated fingers into the vagina while the other hand presses down on the abdomen. This allows the uterus, ovaries, and structures between the hands to be felt for any masses or irregularities.

 

- Though intimate, keep breathing slowly and let your urologist know immediately if any part of the exam hurts so they can adjust pressure and technique.

 

-         Rectal Exam

 

- For this portion, you will lie on your side with your knees pulled up towards your chest.

 

- As the lubricated, gloved finger is inserted into the rectum, do your best to relax the sphincter muscles and breathe slowly. Bearing down gently, as if passing stool, can help relax the area as well.

 

- The urologist will feel along the rectal wall for any masses, swelling, or blockages. In men, the prostate will also be examined for enlargement, nodules, and firmness.

 

- Women's posterior pelvic organs can be felt through the rectal wall for any pain, cysts, or enlargement.

 

- Though only lasting about a minute, let the urologist know if you feel significant pain or a burning sensation during the rectal exam so they can modify technique.

 

- When the finger is removed, coughing gently can help relax the muscles. Breathe slowly and relax the area once the exam is complete. Report any lingering pain.

 

- Some pressure is expected, but pain should be minimal. Communicate any worries before or during the process so steps can be taken to maximize comfort and care.

 

Remember, these techniques are used to provide the urologist with crucial information, not to cause embarrassment or harm. Being an active participant by relaxing, breathing slowly, and communicating concerns facilitates an efficient, thorough urological evaluation.

 

Tips for an Effective Urology Visit

 

To help make sure your urology exam goes smoothly, here are some tips to keep in mind:

 

-         Ask Questions

 

Never be shy about asking questions before, during or after your urology appointment. Voicing your concerns and seeking clarification leads to better care. If you don't understand something the urologist says or want more detail on a test, procedure, or diagnosis - speak up. Urologists want you to feel informed and empowered.

 

-         Speak Up About Discomfort

 

Discomfort during the exam should never reach the level of significant pain. Notify your urologist immediately if any portion of the physical exam hurts so that they can adjust techniques. Do not tolerate unnecessary pain out of politeness.

 

-         Follow Pre-Appointment Instructions

 

If your urologist's office provides specific directions to prepare for your visit (like not urinating beforehand or stopping certain medications), be sure to follow those fully. This allows for the most accurate tests.

 

-         Relax During the Exam

 

Do your best to relax your muscles, use slow breathing, and try to maintain calm during the exam. Tensing up often worsens discomfort. Let your urologist know if you need a moment at any time. Staying relaxed facilitates the exam.

 

-         Maintain Open Communication

 

Keep an honest, open dialogue with your urologist. Discuss any concerns or questions. Report all symptoms accurately. Honesty and transparency ensure you get the best possible care from your visit.

 

Putting these tips into practice can help you feel less anxious and more in control during your urological exam. An informative, attentive urologist also plays a key role in making patients feel comfortable. Don't be afraid to ask questions or select another provider if you do not feel your concerns are being adequately addressed.

 

Conclusion

 

Undergoing examination by a urologist does not need to be a source of dread or embarrassment. Knowledge of what is entailed in the exam, why it is performed, potential tests conducted, and tips for an optimal visit help eliminate fear of the unknown. Urologists are medical professionals who conduct these personal exams regularly and efficiently, just as a dentist looks at sensitive oral areas. Approaching your appointment as a opportunity to gain valuable insight into your urinary or reproductive health is key. The information gleaned during your urological evaluation allows proper treatment to manage any issues found, giving you peace of mind. With the right urologist, open communication, and a clinical mindset, your urology visit can be a thoroughly informative, reassuring experience rather than something to fear.

 

FAQs

 

What is a normal male genital exam by a urologist like?

 

A standard male genital exam by a urologist is very quick and focused. They will first visually inspect the penis, noting if there are any sores, lesions or discharge present. The penis is palpated along the shaft feeling for any nodules or irregularities under the skin. The urethral opening will be examined as well for any inflammation or discharge. The testicles are then inspected for any swelling or lumps, followed by light palpation between the fingers to check for any masses or fluid. This is not painful - speak up if you have discomfort. The inguinal lymph nodes may also be pressed to check for swelling if infection is suspected. Overall, the external genital exam takes only a minute or two and should not hurt, though you may feel mild pressure during palpation. Let your urologist know if any aspect is painful.

 

What happens if a male gets an erection during a urology exam?

 

It is perfectly normal and somewhat common for a male to get an erection involuntarily during a urologic physical exam, especially when the genitals are being manipulated or touched. The urologist is aware this can occur simply as a reflex, despite lack of sexual arousal. They will not be concerned and understand it is not intentional. They will pause the exam briefly until the erection subsides, often within a minute or two, before continuing the genital inspection. Do not feel embarrassed - this is a normal occurrence they have seen many times before. Try to stay relaxed, breathe deeply, and refrain from stimulating the penis further as this may prolong the erection unnecessarily. Report any pain as the erection goes away.

 

Do female urology exams hurt?

 

A female urology physical examination should never be painful, though portions of it may cause some mild temporary discomfort. Communicate with your urologist so they can help minimize any discomfort, but significant pain is not normal. Examples of parts that may cause some mild sensation include:

 

- Insertion of a speculum for visualizing the urethra or cervix

 

- Palpating the abdomen to feel the bladder and kidneys

 

- During the bimanual and pelvic floor strength assessment

 

- During a Pap smear if one is collected

 

Let your urologist know if you experience pain during any part of the exam so they can adjust techniques. Being vocal ensures your comfort is prioritized and the exam goes smoothly.

 

What is checked during a female urology physical exam?

 

A standard urological physical exam for a female patient evaluates the abdominal area, external genitalia, and internal pelvic organs related to urinary system function. Your urologist will:

 

- Palpate and feel the abdomen for bladder or kidney swelling, masses, or pain

 

- Visually inspect and examine the external genitals including labia, clitoris, urethra

 

- Assess pelvic floor muscle tone by having you cough or bear down during an internal exam

 

- Check organs like the uterus, ovaries, bladder and cervix during the bimanual exam

 

- Examine for signs of prolapse during coughing or straining

 

- Perform a rectovaginal exam to palpate between the rectum and vagina

 

Let your provider know if any aspect is painful so they can modify pressure. Open communication ensures your optimal comfort.

 

What is a normal rectal exam by a urologist like?

 

A standard rectal examination performed by a urologist involves insertion of a lubricated, gloved finger into the anus to feel the prostate and/or posterior pelvic organs. For men, the doctor feels the prostate for any nodules, firmness, or enlargement. The female rectal exam checks pelvic architecture and masses between the vagina and rectum. The exam should only take about 15-30 seconds. You may feel some pressure and need to relax the sphincter muscles. Mild discomfort can occur but significant pain is unusual. Let your urologist know if you feel any burning or pain during insertion, exam, or removal of the finger so they can improve their technique. Communicate any lingering discomfort after the rectal exam as well.

 

What kinds of diagnostic tests do urologists perform?

 

Some diagnostic tests a urologist may use to evaluate urinary concerns include:

 

- Urine tests like urinalysis and urine culture to check for infection, blood, chemicals

 

- Bloodwork to assess kidney function, electrolyte levels, prostate cancer markers, testosterone 

 

- Cystoscopy to view the inside of the urethra and bladder using a thin camera scope

 

- Imaging like CT scans, ultrasounds, and MRIs to visualize the kidneys, bladder, prostate, etc.

 

- X-rays such as KUBs to detect kidney stones or urinary blockages

 

- Urodynamic testing to look at bladder pressure and function

 

- Prostate biopsies if cancer is suspected based on rectal exam or PSA level

 

Discuss your questions about any diagnostic testing with your urologist. Understanding the purpose facilitates the process and allays anxieties.

 

How can you make the most of your urology exam appointment?

 

To optimize your urological exam:

 

- Communicate openly with your provider before, during and after the visit

 

- Speak up right away about any discomfort or concerns

 

- Relax your body and breathe slowly throughout the examination

 

- Ask any questions you have to improve understanding

 

- Provide complete, accurate information during your medical history

 

- Follow any instructions for preparatory steps like not voiding

 

- Keep follow-up appointments for test results and treatment steps

 

Being an engaged, participatory patient helps ensure you get the most out of the urological evaluation and continue any needed care afterwards.