Why the Doctor Grabs Your Balls at the Sports Physical

The ten-second exam, in order. What's being checked, the real numbers behind it, and exactly what you're allowed to say.

10 min read · Updated September 2026

Every August and September, a few million guys sit on a paper-covered table, get told to lower their shorts, feel a gloved finger push up into their groin, and hear the words "turn your head and cough." Almost nobody explains why. Here's the whole thing: what the doctor is checking, how often it finds anything, what's normal, and the part nobody tells you — the exam is a conversation you're allowed to steer.

27%

of men will have an inguinal hernia repaired in their lifetime (vs 3% of women)

~15%

of guys aged 15–19 have a varicocele — most never notice

5–9%

of high school athletes had a genital or hernia finding in one screening study

<60 sec

how long the genital part of a sports physical normally takes

The exam, in order

The genital section of a preparticipation physical (the official name for a sports physical) is short, standardized, and basically the same in every clinic in the country. It's recommended by six medical organizations — the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, and three sports-medicine societies — in the shared guideline every doctor uses, the Preparticipation Physical Evaluation monograph.^[1] Here is what it actually consists of.

Before anything is touched

They tell you what's about to happen

This isn't a courtesy — it's policy. The American Academy of Pediatrics says clinicians should explain the scope and purpose of any sensitive exam in advance, and offer a chaperone as a routine, opt-out thing.^[2] If the doctor skips this step, you can ask. More on that below.

About 5 seconds

A quick look

Gloves on. The doctor glances at the penis and scrotum for anything obviously off: a rash, swelling, a testicle that isn't where it should be. Nobody is evaluating size. They see dozens of these a week and are thinking about hernias, not you.

About 10–15 seconds

Each testicle, rolled between two fingers

They're feeling for the basics: smooth, oval, freely moving, roughly the same size as the other one. The soft, rope-like ridge on the back of each testicle is the epididymis — normal equipment, not a lump. One testicle hanging lower than the other (usually the left) is also normal and is literally how the anatomy is designed.

About 10 seconds per side

"Turn your head and cough"

The doctor slides a fingertip up along the loose skin of the scrotum, toward the crease where your leg meets your body, until it rests at the external inguinal ring — the opening where the cord running to each testicle passes through your abdominal wall. Then you cough. Coughing spikes the pressure inside your abdomen; if there's a weakness there, a small bulge of tissue pushes down and taps the fingertip. That tap is what they're waiting for. Turning your head does nothing medically — it just points your cough away from the doctor's face.

Done

Shorts up. That's it.

If nothing tapped and nothing felt strange, the box gets checked and the visit moves on to your knees and your blood pressure. Total time under a minute.

What they're actually looking for

1. A hernia (the main event)

An inguinal hernia is a spot where the abdominal wall is weak enough that a bit of intestine or fat can push through into the groin or the scrotum. This is not a rare, old-man problem. The definitive population study — 30,675 hernia repairs tracked across an entire region of England over a decade — put the lifetime chance of needing one repaired at 27% for men versus 3% for women.^[3] Roughly one guy in four, over a lifetime. The rate in men aged 16 to 24 is about 11 new cases per 10,000 per year, then climbs steadily with age.^[4]

The reason sports medicine cares: heavy lifting, straining, and collision can enlarge a hernia, and a small percentage get trapped ("incarcerated"), which becomes an emergency. Finding one early means a planned, routine surgery instead of a 2 a.m. one. And the fingertip exam earns its keep here — in a classic community survey, more than half of the men found to have a hernia had no visible bulge at all; the only way to detect it was a doctor's finger feeling the cough impulse.^[5]

Not the same thing: "sports hernia"

You'll hear athletes talk about a "sports hernia" (athletic pubalgia). Despite the name, it isn't a hernia at all — it's a strain of the muscles and tendons in the lower abdomen and groin, and the cough test does not find it. If you have groin pain that gets worse with sprinting, cutting, or sit-ups and the sports physical came back clean, that's a separate conversation to have with a doctor or athletic trainer.

2. A varicocele (the one you might have and not know)

A varicocele is a cluster of enlarged veins above the testicle — think varicose veins, but in the scrotum. It almost always shows up on the left side, because of how the left testicular vein plumbs into the body at a sharp angle. It develops at puberty, and it is common. In a study of 4,052 Turkish boys, the rate was under 1% before age 10, 7.8% at ages 11–14, and 14.1% at ages 15–19.^[6] A European study of 7,035 young men (median age 19) found one in 15.7%.^[7]

Most varicoceles never cause a problem. The doctor is checking because a minority of them are associated with the left testicle growing smaller than the right, which can affect sperm production down the road. If one is found, the usual plan is to measure and watch — not surgery. We have a full breakdown in our varicocele guide; the short version is that a "bag of worms" feeling above your left testicle is worth mentioning, not worth panicking over.

3. Where the testicles are

The doctor confirms both testicles are actually in the scrotum. An undescended testicle is usually caught in infancy, but not always, and a testicle that's up in the groin is at higher risk of injury and other problems. A screening study of 3,205 boys found retractile testicles in about 1.2%, undescended in 1.1%, and fluid collections (hydroceles) in just under 1%.^[8]

"Retractile" deserves a note: in teens it's usually just an overactive cremaster muscle — the one that yanks your testicles up when you're cold, scared, or in an exam room with the air conditioning on. That's a reflex, it's normal, and the doctor can coax the testicle back down in two seconds.

4. Lumps — with an honest caveat

While they're in there, the doctor will notice a firm lump if one exists. But here's a piece of context most people don't get: the U.S. Preventive Services Task Force actually recommends against routine testicular cancer screening in guys with no symptoms, because the cancer is rare, it's usually caught when a guy notices a change himself, and outcomes are excellent either way.^[9] So the sports physical isn't a cancer screening, and you shouldn't treat a clean one as a permanent all-clear. Knowing what your own testicles feel like — our three-minute self-exam guide — is what catches things between physicals.

5. Sometimes: a maturity note

Some older forms include a "Tanner stage" — a 1-to-5 rating of how far through puberty a body is. It isn't required to clear you for sports, it isn't a grade, and a lot of clinicians skip it. It exists because, occasionally, it helps match a still-developing athlete to a safer sport or position.^[10] If you're curious where you are on it, our growth timeline lays the stages out — including why finishing later than your friends is normal and not a sentence.

Does it actually change anything?

The evidence here is thinner than the tradition

We tell you when the data is weak, and this is one of those times. A formal evidence review in the Journal of Family Practice concluded there is insufficient evidence to recommend for or against genital exams during sports physicals. The exam's one clear payoff is catching hernias; six professional bodies recommend it anyway on expert opinion, because it's quick, low-risk, and occasionally finds something that matters.^[11]

How often is "occasionally"? In one of the only studies to count, a Georgia high school screened its juniors and seniors two years running: 48 of 562 students (9.1%) one year and 34 of 706 (4.8%) the next had a genital finding or hernia noted.^[12] Most of those were minor. Almost none of them changed whether the kid could play.

So the truthful framing is this: the exam is a low-yield formality that nonetheless catches a real condition in a real fraction of guys, costs you sixty awkward seconds, and — this is the part we'd underline — puts a trained expert in front of your anatomy for free, at exactly the age when most guys have a question they've never asked anyone. That last part is the actual value, and it's the part you control.

The cold-room problem (and the other one)

Exam rooms are cold, you're nervous, and you've been sitting on crinkly paper waiting. Your cremaster and dartos muscles respond to all three by pulling everything up tight. Every doctor who does sports physicals sees this a few hundred times a season and does not register it. Your flaccid size in that room is not your flaccid size anywhere else, and it is definitely not being assessed, ranked, or remembered. (We've written about why your own perspective is the least reliable view of your size — the exam room is that problem plus air conditioning.)

The other one: an erection during the exam. It's uncommon, but it happens, and it's a spinal reflex to touch — it does not mean anything about you, your attraction to the doctor, or anything else. Doctors are trained to ignore it or briefly pause. You're allowed to say "sorry, give me a second." Nobody involved will think about it again.

Things that are not a problem (so you don't waste worry on them)

One testicle hanging lower than the other — it's how they're supposed to hang
One testicle slightly bigger than the other — small asymmetry is standard issue
The soft, cord-like ridge on the back of each testicle — that's the epididymis, it belongs there
Everything shrinking up in a cold room — reflex, temporary, ignored
A reflex erection — same category
Being nervous — the doctor expects it and it doesn't affect the result

You're allowed to…

Ask what they're checking for — before it starts, in the middle, or after. Explaining the exam is the clinician's job, not a favor.
Have a chaperone — or not. Current AAP policy says the chaperone should be offered as routine and you can decline; if you want one, you get a say in whether that's a parent or a staff member.
Ask your parent to step out for this part. Plenty of teens do. Plenty of parents are relieved.
Ask for a male or female clinician. Clinics can't always accommodate it, but asking is normal and nobody is offended.
Keep everything else covered. Only the area being examined needs to be uncovered, and only for as long as the exam takes.
Say "stop" or "that hurts." A hernia check should feel like pressure, not pain.
Bring up the thing you've been wondering about. This is a free consult with someone who has seen ten thousand of these. Use it.
Tell someone if anything felt wrong. Comments about your size, extra "checks" that aren't explained, photos, an exam with the door open — none of that is standard, and telling a parent, coach, or athletic trainer is the right move, not an overreaction.

Chaperone and explanation standards: American Academy of Pediatrics policy statement, Pediatrics, June 2025.^[2]

What to say (word for word, if you want it)

Five lines that work

"What are you checking for?"Any doctor will answer this in one breath. If they don't, that tells you something.

"Can we do this part with just you and me?" — or — "Can my dad stay for this part?"Either is a normal request. Say whichever one is true for you.

"One of mine hangs lower than the other — is that normal?"Yes. But you'll hear it from a doctor instead of a website, which counts for more.

"I felt something like a bundle of veins on the left — can you check?"That's the varicocele question. Asking it is the whole reason the exam exists.

"It hurts when I ___." / "There's a curve when I'm hard — is that a problem?"Pain, curvature, foreskin that won't retract, a lump: all fair game. Nothing you say will be new to them.

The ten seconds you control

The exam is going to happen either way. The difference between a guy who gets nothing out of it and a guy who walks out with an answer he's carried around for two years is one sentence, asked while the expert is standing right there. That sentence is the most useful thing in this article.

If they find something

Finding	What usually happens next	Can you still play?
Hernia	Referral to a surgeon. Small, painless ones may be watched; most get a routine outpatient repair.	Usually yes until the repair, with restrictions the surgeon sets. Full return after recovery.
Varicocele	Measure both testicles, often with a quick ultrasound. Re-check yearly. Surgery only if the left testicle lags in growth or there's pain.	Yes. No restriction for the vast majority.
One testicle (absent or undescended)	Evaluation of the missing one if it hasn't been done. Counseling about protecting the one you have.	Yes — the AAP clears athletes with a single testicle for sports; some sport bodies require a protective cup for contact play.^[13]
Lump or firm area	Ultrasound, usually within days. Most lumps are cysts, fluid, or the epididymis being mistaken for something else.	Yes while it's being worked up, unless a doctor says otherwise.
Retractile testicle	Doctor confirms it comes down easily. Sometimes a re-check in a year.	Yes.

Notice the pattern in the last column. The genital exam almost never keeps anyone off the field. Its job is to find the things that are easier to fix now than later — and, if you use it, to answer the question you brought in with you.

The bottom line

The doctor grabs your balls at the sports physical to check for a hernia (which one in four men will eventually deal with), a varicocele (which about one in seven guys your age has), and to make sure both testicles are where they belong. It takes under a minute, it's done the same way everywhere, and the data says it's a modest-yield exam that occasionally matters a lot. Nobody is grading you. Nothing about the cold room, the nerves, or a reflex is being noted.

What you should take from this isn't "the exam is no big deal," although it isn't. It's that you're not a passenger in it. You can ask what's happening, decide who's in the room, and get a straight answer from a professional about the thing you've been quietly Googling. Guys who know that walk in differently. Now you're one of them.

If you're reading this at 15, 16, 17

Everything in this article is normal stuff to ask a doctor, and asking it is a sign of taking care of yourself, not a sign that something is wrong with you. If anything about a medical visit ever felt off — a comment, a touch that wasn't explained, being made to feel embarrassed on purpose — that's worth telling a parent, a school nurse, a coach, or an athletic trainer. You won't be in trouble, and you'll be believed.

And if the exam turned up something you're worried about, or you found something yourself, the next step is a doctor, not a search engine. Bring an adult you trust. It goes faster and easier than you think.

Sources

American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine. Preparticipation Physical Evaluation, 5th edition. Bernhardt DT, Roberts WO, eds. AAP, 2019. Genitourinary examination (hernia, testicular exam) recommended for male athletes.
American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine and Committee on Adolescence. "Use of Chaperones for the Pediatric and Adolescent Encounter: Policy Statement." Pediatrics 2025;155(6):e2025071810. Opt-out chaperone offer; explanation of scope and purpose in advance; shared decision-making with adolescents on whether a parent or staff member serves as chaperone.
Primatesta P, Goldacre MJ. "Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality." International Journal of Epidemiology 1996;25(4):835–839. Oxford Record Linkage Study, 30,675 repairs, 1976–1986; estimated lifetime risk of repair 27% for men, 3% for women.
Jenkins JT, O'Dwyer PJ. "Inguinal hernias." BMJ 2008;336(7638):269–272. Review; incidence in men rising from 11 per 10,000 person-years at ages 16–24 to 200 per 10,000 at 75+.
Abramson JH, et al. "The epidemiology of inguinal hernia: a survey in western Jerusalem." Journal of Epidemiology and Community Health 1978;32:59–67. Community survey; 18.3% overall prevalence in men, of which 10.7 percentage points were detectable only as a palpable cough impulse on examination.
Akbay E, Cayan S, Doruk E, Duce MN, Bozlu M. "The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents." BJU International 2000;86(4):490–493. n = 4,052 boys aged 2–19; prevalence <1% under age 10, 7.8% at 11–14, 14.1% at 15–19.
Damsgaard J, et al. "Varicocele is associated with impaired semen quality and reproductive hormone levels: a study of 7,035 healthy young men from six European countries." European Urology 2016;70(6):1019–1029. Varicocele prevalence 15.7%; median age 19.
Screening study of 3,205 boys aged 6–12 (western Iran), as summarized in the Journal of Family Practice Clinical Inquiry cited below: inguinal hernia and penoscrotal abnormalities 6.6% overall; retractile testes 1.22%, undescended testes 1.12%, hydrocele 0.87%.
U.S. Preventive Services Task Force. "Screening for Testicular Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement." Annals of Internal Medicine 2011;154(7):483–486. Grade D: recommends against routine screening of asymptomatic adolescent and adult males.
Sports Participation Evaluation. StatPearls [Internet]. StatPearls Publishing; updated 2024. Genitourinary component of the PPE; solitary testis and protective cup; note on Tanner staging as an aid to sport selection rather than a clearance requirement.
"How useful are genital exams during boys' sports physicals?" Clinical Inquiries, Journal of Family Practice 2010;59(7) (Family Physicians Inquiries Network). Evidence review: insufficient evidence for or against screening genital exams; hernia detection the primary yield; testicular cancer screening not supported (strength of recommendation C, expert opinion).
Linder CW, DuRant RH, Seklecki RM, Strong WB. "Preparticipation health screening of young athletes: results of 1,268 examinations." American Journal of Sports Medicine 1981;9(3):187–193. Richmond County, Georgia high school screening across two years: 48 of 562 (9.1%) and 34 of 706 (4.8%) students with a genital finding or hernia.
Rice SG; American Academy of Pediatrics Council on Sports Medicine and Fitness. "Medical Conditions Affecting Sports Participation." Pediatrics 2008;121(4):841–848. Athletes with a single testicle may participate; some sport governing bodies require a protective cup for contact/collision sports.

Medical disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Any new lump, swelling, pain, or change in your testicles or groin should be evaluated by a healthcare provider. Sudden, severe testicular pain is an emergency — go to the ER.