Pediatric examination standards I don't understand

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Cul2

242 Posts

JBudd -- One of the main questions is this: What kind of exam is this? You have valid suggestions, but a sport's physical is not a wellness exam or a full physical. It's an exam required to play sports. As you say, if it's a wellness exam or a full physical, then both boys and girls should get the works. If not, just check what's needed, absolutely necessary to play the sport. If a kid gets a testicular injury during a game or practice, and seeks treatment, the phyician checks it out. Why force these checks on boys in order for them to be able to play a sport. I've know of boys who wouldn't play sports because of the insensitive nature of these exams. What if a kid's playing ping pong, does he need a genital exam, too?

klone, MSN, RN

14,790 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
thanks for the reply, I know importance of hernia and testicular cancer screening in males, but it seems like she over protects the modesty of adolescent females and omitting important criteria, such as checking developmental issues. It is not like females are just that much more immune to growth problems.

It's not recommended to do a pelvic exam until 18-20 or when she becomes sexually active. A pelvic exam is not recommended for a routine sports physical.

klone, MSN, RN

14,790 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
The purpose of the exam is not a yearly physical for overall health but to see if the student is SAFE to play sports..

Sadly, the annual pre-admission physical is often the ONLY "preventive" care that many children get. With that in mind, many doctors are trying to do a "catchall" exam in order to identify other problems. However, I agree that a pre-admission screening is not the appropriate place/time for a pelvic exam.

middleager

115 Posts

It seems to me many are over looking the bigger question, what about the double standard of ignoring the male patients modesty while seemingly going the extra mile to protect the modesty of the female patients. While a pelvic exam may not be needed, what about the fact that the OP says the NP is examining the orifice of only the male patients, not the female. Doesn't any of this seem wrong, if the pelvic exam for female patients is not required, my are we not equally questioning the need for rectal exams of only boys of that age? Isn't the NP's obvious different approach to patients based on gender a concern, to not even provide a gown...doesnt this seem wrong?

zone9

6 Posts

Shuck how do the boy's react? I think the NP is strange to have them remove their underwear. Normally one would just pull them down to knees. Also what is your job title? How do the other female doctor's preform exams on boys? Do non clinical staff chaperone exams? Thanks for your post

Shuck

10 Posts

1. As far as how sports physicals should only evaluate cardiovascular and motor systems, the NP did say something in the lines of, "These sports physicals are the only physicals many of these boys get." I guess that's part of the reason why she is particularly thorough.

Although I do agree that for sports physicals, genital area doesn't matter (except hernia), I have seen several school sports medical forms where they are biased towards males. For instance, I've seen several where one of the exam criteria said, "Genitalia and orifice"

Other was when one teen came in for a sports physical, he brought a form issued by the school, and apparently there was an option to have the school nurse do the exam during school hours. His parents opted out for a private MD to do the exam. On part of the opt-out form, it said,

"Please have your student athlete come to the Physical night with t-shirt and shorts with elastic waist band (males). The male exam will include a check of the genitals. The female exam will not include genital or breast exam."

JS343

4 Posts

1. As far as how sports physicals should only evaluate cardiovascular and motor systems, the NP did say something in the lines of, "These sports physicals are the only physicals many of these boys get." I guess that's part of the reason why she is particularly thorough.

Although I do agree that for sports physicals, genital area doesn't matter (except hernia), I have seen several school sports medical forms where they are biased towards males. For instance, I've seen several where one of the exam criteria said, "Genitalia and orifice"

"

Yes, it may be the only physical boys get, but it is also the only physical that many of the girls get. There is still an irrational double standard at play. Why does everyone assume that a male hernia exam is so vital? There is little evidence for that either. Significant hernias are symptomatic and the boy will know if there's a problem. Or is the theory that you can't trust the kid to tell you if he has an inguinal bulge? American medicine likes routine check ups, such as the recent ACOG recommendation that adolescent girls get yearly pelvic exams. There's no evidence that annual pelvic exams in asymptomatic girls accomplish anything except embarrassing girls. Hopefully most parents ignore that recommendation.

whereslilly

80 Posts

Specializes in Long term care, Rehab/Addiction/Recovery.

My first question for the OP would be, are u present in the room during the actual exam? The reason I ask is perhaps the NP examines the young females, undrapes as necessary, then she covers again. Perhaps its a modesty issue? Usually when an adolescent comes in for an annual sports exam..it is his/her annual physical exam. Insurance wise, the physicians office cannot bill get reimbursed 2x for another physical. I'm sure the NP at least visualises the females genitalia for Tanner scale purposes. Ideally the NP should do a breast exam, and either her or an RN teach the girl how to do a self breast exam. One can do a scoliosis check by lifting a shirt up. Ideally a gown should be offered, but alot of offices would rather spare the expense. Just my :twocents:.

mark444

1 Post

I am a nurse for a np also she preforms physical on all types of ages and all males are completely nude . As a woman it brothered me at first I have to be in their. But now it ok I know I have a job to observe . But it has to be done

Cul2

242 Posts

'I am a nurse for a np also she preforms physical on all types of ages and all males are completely nude . As a woman it brothered me at first I have to be in their. But now it ok I know I have a job to observe . But it has to be don,e.'

This response is disturbing on at least two levels. First, the way the procedure itself is done, only with males. Second, the fact that the you didn't let your intuition or conscience guide you. You felt something was wrong but you rationalized it. You convinced yourself that you've got a job to do, the job comes first, it has to be done, somebody's got to do it, if I don't do it someone else will...etc. What about the sensibilities of these young men? How about respecting their dignity? How do you think they feel not only being completely naked but having two women staring at them? How does that fit into your ethic. Anyway, that's how I read your comment. If I'm wrong, let me know. Explain to me why you think boys should treated this way and not girls.

middleager

115 Posts

Cul2 has an excellent post, first off there is no reason for the males to be nude during the exam. If a female patient was to be nude, would she not be provided a gown, my Dr. does an excellent exam and I go through the majority in my boxers, lowering them when needed. I went for an insurance exam and was provided disposable exam shorts. And as while Cul2 points out, while you say you have become comfortable with it, what about the patients. One has to know a second female only makes the discomfort greater for at least some of the patients. An observer is for the benefit of the NP not the patient so the least they could do was take what ever steps they could to minimize the impact on the patient. I am not blaming you for doing what you are told to as part of your job, we all do things we don't want to so we can put food on the table. While I do not blame you, I do blame the NP, and it still doesn't make it right. I hope you will at least discuss this and advocate for your patients, male or female.

ITSSOSIMPLE

56 Posts

Statistically, females have a higher incidence of inguinal hernias than males.

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