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Urogenital Emergencies In Boys: An Evidence-Based Approach To Sensitive Issues

November 2004

Abstract

Boys frequently present to the ED with a wide variety of complaints about their external genitalia. These cases can be quite challenging. Given cultural sensitivities and general discomfort with talking about genitals, new parents may have difficulty discussing their questions or concerns with a physician. This may lead to a delay in seeking care. In some cases, families are simply unable to talk about genitals and use euphemisms to describe "down there." Older, school-aged children may notice problems and be too embarrassed to bring the problem to the attention of their parents. Sexually active adolescents may want to conceal their sexual activity from their parents and avoid asking to see a doctor. All of these issues can lead to delays in care and miscommunication among boys, parents, teachers, and health care providers. Although many physical conditions associated with the penis and scrotal contents in boys are quite benign and require little more than reassurance, some of these conditions require emergency intervention.The emergency physician must not add further delays to those already inherent in patient presentation. If not addressed properly and expeditiously, these clinical problems may have serious sequelae involving future reproductive potential and sexual function. Social and litigious ramifications of a missed diagnosis require the emergency physician to be vigilant in the care of these patients. However, it can be difficult to determine which patients require simple reassurance and which require a more extensive workup. Identify ing those children who require immediate and definitive care is perhaps the most important role of the emergency physician in the care of these children. In this issue of Pediatric Emergency Medicine PRACTICE, we will examine the evidence pertaining to complaints involving the male genitalia.
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