Shouldn't all pediatric physicals include breast and genital exams?

All of the threads discussing pediatric breast and genital exams seem to share the common theme that there is zero consensus among medical professionals whether to do these checks or not. People have shared experiences of getting detailed checks at every physical while others have shared they never got a breast or genital exam until adulthood.

I find it concerning that the breasts and genitals, the two major parts of the body that kids (or anyone really) would be least likely to tell a parent or doctor that something doesn't feel right, are the two parts of the body that seem to have no exam standards or consistency between doctors. It's even worse that avoiding embarrassment and fear of being accused of innappropriate behavior are fairly common cause for omitting these exams.

Furthermore, these are the parts of the body that kids are most self-conscience and concerned about. There is something comforting and relieving about getting reassurance about the parts of the body that are full of uncertainty. I would attribute a part of my positive body image during my adolescent years to getting genital exams every year during my physicals and being assured that everything was healthy and developing properly. I never had to go for a period of time just guessing if I was normal; I got that assurance in a quick and painless exam.

What does everyone think of my analysis? Does anyone have an argument against breast and genital exams as a standard part of every yearly physical exam?

Here is a treatise on what constitutes good care for the pediatric patient from the NIH. I defer to it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828229/

I think certainly a routine check up should include a genital exam (external only girls) as was my experience.

Once there is breast tissue it should be examined although nasty breast lumps in pediatrics is incredibly rare there are other benign breast lumps which may not be detected without a clinical breast exam or without teaching self exams.

We need to be less hung up on our bodies and genitals and see it from a medical point of view that it's just another body system.

If the patient declines that is fine but the exam should at the very least be offered.

Our pediatricain did this.

Thanks for the post Liquidsky.

Good point Charlotte... I think it would increase our acceptance and understanding of our bodies, and remove a lot of the shame and risk that arises.

I agree with Charlotte. A pediatric exam should definitely include a routine genital check. The childhood and adolescence is most important part in the development of the body and missed opportunities to diagnose and treat pathological deviations at this time often come at a price in later years. Furthermore it is true that shame can sometimes hinder a child to address issues in this area with their parents and the routine gential exam provides a quick and safe way to ensure that all children enjoy the same opportunity for a healthy development to adulthood.

Those are kinda important areas. Especially genital exams on males. People see faces, eyes, arms, legs, all the time, someone would notice if there was something wrong with those areas. Rarely does anyone else look at someone else's genitals. This is especially important during preteen and teen years during development and hormone surges.

Every one of my pediatrician exams included genitals. In fact, my adolescent exams were more thorough then my adult exams. As a teenager, the doctor would always palpate my testicles for lumps, plus examine my (erect) penis from base to head and open the meatus. As an adult, all too often it is either skipped or just a 5 second cough-cough with no palpation of the testes or penis.

Genital exam, absolutely. Breast exam, occasionally, but not regularly except for a female going through puberty.

Yes and they should include rectal exams too regardless of age or gender. More young people are getting and dying from colon cancer. Plus young people can have constipation, ibs, rectal bleeding hemmorhoids etc

When a certain age is reached these procedures should be a component of a pediatric physical examination. I would say around 11 or 12 boys should be given a genital examination in addition to being provided instruction on how to conduct self testicular exams. Both boys and girls should also receive breast exams as well. Breast cancer happens to guys ( Although it is rare ) too.

Should it be included, probably. Does the healthcare provider not do it due to the tendencies of our litigious society and practicing C.Y.A. (cover your ass) medicine? Yes. No parent is going to sift through and weigh the NIH database research articles, they are going to see google results page 1 with some forum of people saying they think it shouldn't be necessary then they will freak out.

When a certain age is reached these procedures should be a component of a pediatric physical examination. I would say around 11 or 12 boys should be given a genital examination in addition to being provided instruction on how to conduct self testicular exams. Both boys and girls should also receive breast exams as well. Breast cancer happens to guys ( Although it is rare ) too.

Why do you think males should start receiving genital exams at age 11 or 12 and not earlier and why just males?

I view a physical exam as an opportunity for body systems that aren't checked out normally to be reviewed and cleared by a medical professional. For example, a kid who appears perfectly healthy could have an underlying heart or lung anomaly that needs immediate attention. Or maybe a kid is starting to show signs of scoliosis which has gone undetected by both the parents and the child. Likewise, children may not be aware or just may be too embarrassed or scared to go to a parent with a concern regarding their breasts or genitals. A physical exam which is comprehensive would provide an opportunity to catch those issues and prevent them from turning into something bigger.

A less important benefit of receiving genital and breast exams as part of a physical exam when young is that I think they help remove a fear and mistrust of doctors that could arise in the later childhood years. I'm sure if I had never received a genital exam before in my life and then at age 12 I was suddenly told to stand and lower my pants to get my genitals examined I would have been completely humiliated and unhappy with my doctor. But by making it a component of no higher or lower importance than any other portion of my physical exams, I now have a healthy relationships with all my doctors and entrust them to perform procedures that might be slightly uncomfortable or embarrassing.

Probably because around that age the body starts going through puberty. Prior to that age the exam should be somewhat cursory and maybe not as detailed.

As far as the unpleasantness and embarrassment that is gonna happen whether you are age 4 or 14. You just gotta deal with it. A doctor who is kind, professional and respectful really can put the mind at ease.

Why do you think males should start receiving genital exams at age 11 or 12 and not earlier and why just males?

I think the importance of genital exams increases during the time of puberty as the sexual organs develope more rapidly and start to become active. Nonetheless, a genital exam should be a compulsory part even of earlier exams to ensure a healthy and proper development.

For boys genital exams make a lot more sense than for girls, especially in younger years, as the male genitalia are more easily examined and do not require special equipment,

I too think that a genital exam should be a standard procedure in pediatric exams. Genital exams can help to prevent or treat diseases in an area that many children will not openly talk to their parents about. I had a phimosis when I was 12 and talking about it to my mom was extremely embarrassing and uncomfortable. These days I am very glad I did talk to her about it, but I think no one should rely on kids being always so open about it with their parents. A regular genital check can maybe help to reduce shame in these matters and definitely raise the chances of abnormal developments being spotted early.

Should be part of a thorough physical exam.

For boys genital exams make a lot more sense than for girls, especially in younger years, as the male genitalia are more easily examined and do not require special equipment,

Sorry i know its an older reply but an external genital exam as a check requires no special equipment beyond drs knowledge of heathy appearance, separation of the labia and well lit room.

Males being easier to examine doesnt make it more important in fact the opposite as he can see his junk where girls often dont look unless taught to.

My parents took me and my brothers to a number of different doctors as kids and I don't think I ever had an actual physical that did not include a genital exam.

I think its important part of a physical, I wouldn't leave other parts of my anatomy out why would you leave out genitalia?

Our youngest has a condition LS and although it is essentially managed and cared for via a dermatologist at checkup its still briefly assessed to ensure she is ok.

So I disagree with being more important for one gender to the other, its important regardless what set of genitals you happen to be sporting.

I feel like they should be. Even if it's not an in depth exam, just a brief once over to make sure everything is normal. Especially for all the reasons mentioned in the original post. It's an age and an area that kids and teens aren't likely to say much about to their parents or guardians. So I do find it odd that there is no consensus on the topic, and that there is much of a debate about it at all.

I feel like they should be. Even if it's not an in depth exam, just a brief once over to make sure everything is normal. Especially for all the reasons mentioned in the original post. It's an age and an area that kids and teens aren't likely to say much about to their parents or guardians. So I do find it odd that there is no consensus on the topic, and that there is much of a debate about it at all.

I agree. It seems important for the pediatrician to assess the progress of puberty and the health of the penis and testes as well as absence of a hernia in active kids and teens. These functions require visual and palpation examination of the penis and testicles. Concerns about modesty is no reason to omit these parts of the examination.

They should. Gloves on, pants down, bits checked.

Yes it will be embarrassing, but so will taking off your shirt be for some. That’s no reason to skip anything!

Specifically regarding males: if a hernia check is already being done I see little sense in skipping feeling for lumps or checking foreskin. His testes are already in your hand! An extra few seconds of exbarasment doesn’t really matter. And as for the foreskin the male can be asked to retract himself if there are concerns over accidentally forcing back a tight foreskin, or even just being careful if the doctor retracts.

As a teen I had concerns about my genitals. The first time my boxers came down I only got 1/3rd reassured. I was only checked for a hernia, no lumps exam or foreskin retraction, 2/3rd “probably ok” but still 100% embarrassed.

I recall in my case as well as that of my girls, as soon as they were large enough to fit into an "A" cup the ladies were checked. The southern hemisphere for the girls, that was always a quick look at by 15 a heck of a lot more, much to their dismay, but with my approval. My son has always had his "stuff" checked.

All my medicals from primary school to graduating from college were done naked and my genitals were inspected in increasing complexity as I grew up. My breasts were palpated even before they began to swell.

The decision on what parts of the body are examined are made by senior medical personnel who have to answer to politicians and are influenced by big corporations selling medical equipment and accessories. This starts in medical school. One trainer in the local teaching hospital recently informed me that "a few seconds 'wasted' by performing genital and breast exams on young people add up to many 'lost' hours of a doctor's time."

The medical profession reinforces the "shame" aspect of the reproductive system by doing this. The older you get the more embarrassing it becomes and the less likely you are to see your physician.

The reality is that problems go unnoticed by not doing these checks until it may be too late to correct them at a later age.

In a word, "Yes," and it has been true of my girls since they began to wear a bra even a training bra. There is little point to having them remove all their clothing if the doctor has no intention of examining or looking! Once they turned 15, it was always a look and a probe.

I say they should since it makes it a complete physical with all your bits and pieces checked. I'd say it wouldn't be a thorough exam without that stuff since it needs to be done for obvious reasons (ie development etc.)

I agree that any general exam should include a proper breast and genital check at any age. It reassures both parents and child that everything is normal down there - or picks up a problem early if something is awry. Just as importantly it accustoms the subject to being examined so they're less likely to be anxious about it later in life and won't shy from the doctors if they think there is something wrong with them for fear of embarrassment. It also gives a chance to ask any questions one might have about something, an opportunity which might not crop up otherwise.

I agree that these body parts should be examined, as it's important to pick up problems in time and not too late, and also because (especially for girls) getting them examined will keep down the drama later.

That said, there is much to be said about the ways these examinations were sometimes conducted in the past (I mean, when I grew up). For instance, for males, forcing the retraction of the foreskin, if it resists, is painful and traumatic, and starting to discuss circumcision in these circumstances is traumatic as well. Better let nature take its course.

Regarding girls, do they check for imperforate hymen? As far as I know it's a rare condition but a huge problem when menstruation starts.

. . . . Regarding girls, do they check for imperforate hymen? As far as I know it's a rare condition but a huge problem when menstruation starts.

No, they do not.

I think it is very important especially during the start of puberty. I feel that the boy or girl may not mention problems involving the genitalia. I remember the doctor pulling the undies away and at least looking for s few seconds. As I got older a more visual and through exam of the area was always performed.