Do You Need a Well-Male Exam?

Unfortunately, nearly one in three men don't have a primary care physician.

Posted May 20, 2012

A few weeks ago, my wife was counseling her aunt about the value of a well-woman exam. Apparently, her aunt, who is 55-years-old, hadn’t seen a physician in more than 10 years. Like many other Americans, my wife's aunt lacks insurance and is waiting for Medicare to kick in—another 10 years of no preventive care! My wife, who works at a community clinic, told her aunt that she can receive a free screening at her clinic. After my wife’s aunt finally agreed to make an appointment at the clinic and receive a pap smear and breast exam, her husband, a 60-year-old man, flippantly remarked that he hadn’t seen a physician ever since he broke his arm 15 years ago.

Whenever most people think about screening and preventive health, women and children may come to mind. But the reality is that more men fail to receive check-ups than women do. In fact, nearly one in three men don’t have a primary care physician compared with one in five women. And men need well-examinations just as much as women do.

Recently, I was thumbing through an issue of American Family Physician and read an article titled “The Adult Well Male Examination.” Remembering the conversation that my wife had with her relatives, I figured the well-male exam would make for a good blog posting.

• Although men should always be asked alcohol and tobacco use, there is insufficient evidence to screen for illicit drug use.

• Men should be asked about risk factors for sexually transmitted infections. Men who are at increased risk for sexually transmitted infections should receive group counseling that spans several sessions. All men who are served in high-risk clinical settings like homeless shelters, sexually transmitted infection clinics and correctional facilities should receive HIV screening despite prevalence of risk factors.

• All men should have their blood pressure taken and BMI calculated. In men with waist circumferences greater than 40 inches and BMIs between 25 and 34.9, there is evidence suggesting an increased risk of hypertension, dyslipidemia, diabetes, and cardiovascular disease. Interestingly, in Asian and black men, waist circumference may be a better indicator of cardiovascular disease than BMI is an indicator of cardiovascular disease.

• Men should be screened for type 2 diabetes, a cardiovascular risk equivalent. Men 20- to 34-years-old with hypertension or men older than 35 with cardiovascular risk factors should be screened for dyslipidemia, too.

• The U.S. Preventive Services Task Force (USPSTF) recommends that all men aged 65- to 75-years-old who have a history of smoking receive a one-time ultrasound screening for an abdominal aortic aneurysm. (The biggest risk factor associated with abdominal aortic aneurysm is smoking.) Furthermore, a ruptured abdominal aortic aneurysms is oftentimes deadly. Even if a man with a ruptured abdominal aortic aneurysm reaches the hospital, he has only about a 20 percent chance for survival—50 percent if he receives emergent surgical repair.

• The USPSTF found insufficient evidence to recommend osteoporosis screening in men.

• The USPSTF recommends against screening for chronic obstructive pulmonary disease like emphysema or bronchities using spirometery.

• The USPSTF recommends against screening for testicular cancer in adolescents or adult men. Of note, even if testicular cancer is caught late, treatment is oftentimes very effective.

• Screening for prostate cancer is controversial. The USPSTF recommends against screening using prostate-specific antigen (PSA) serologic assay. The American Urological Association recommends that if a PSA is performed then it should be accompanied by a digital rectal exam.

• The USPSTF suggests that men be screened for colorectal cancer beginning at 50-years-old.

• All adults should receive an annual influenza vaccine.