Underwear down or all the way off for physicals?

My primary care physician of the last 12 years follows the same routine with every exam. Meets me fully clothed for questions, steps out while I undress to underwear, nurse enters to take vitals, doctor returns for exam. After all the above-the-waist procedures are done he says, “remove your underwear and we’ll finish up.”

I stand in front of him, he is seated, genitals are checked, I cough for the hernia check, then bend over the exam table for rectal/prostate exam. He does not rush so I am nude for about five minutes. He places a box of tissues on the exam table and says I can get dressed. He remains in the room removing gloves and washing his hands while I wipe and dress.

At the last exam he told me upfront the prostate exam is no longer required by the guidelines based on my low PSA levels but given my family history he recommends it. I follow his recommendation.

@jeff35253 Does the nurse remain for your exam, or does she leave after taking your vitals?

The last time I had a real physical was five years ago. (All the doctors and PAs since then just ask questions.) The elderly doctor performing that full physical began the exam by telling me to take off all my clothes. I was surprised and said, "Everything?" He replied, "You can keep your underwear on for now, if you want."

After a thorough abdominal exam, with lots of deep palpating, he pulled up on my boxers' elastics with his left hand and just scooped his right hand inside, to cup and stretch my penis and scrotum. He took his time doing this, too.

He didn't pull down my boxers entirely until it was time for my digital rectal exam. Then, without preamble, he just stripped them down to my ankles and started dabbing my anus with jelly.