Genital exams at school physicals and well-child check-ups?

djmatte, ADN, MSN, RN, NP · Dec 10, 2019

15 minutes ago, AmyB_NP said:
Do you perform any kind of genital exam at yearly school physicals and well-child check-ups? If so, what does the exam consist of?
For boys, I always check their testicles, and once they get to be around 10 or so, I also start checking for hernias and for a tight foreskin (if they haven't been circumcised). For girls, unless they have an issue, I'll usually just take a quick look down their waistband to check tanner stage until they start their period.
However, I was talking to a colleague, and she said I'm being too thorough, and that the only kind of genital exam she regularly performs is a hernia check when a boy is getting a sports physical.

Some people are super thorough on a physical exam while others are comfortable letting things slide. My concern with your colleagues method is if she’s choosing to let some assessments slide, what else is she choosing to ignore?

AmyB_NP · Dec 10, 2019

1 minute ago, djmatte said:
Some people are super thorough on a physical exam while others are comfortable letting things slide. My concern with your colleagues method is if she’s choosing to let some assessments slide, what else is she choosing to ignore?

As far as I know, nothing else, she just doesn't think a routine genital exam is necessary.

babyNP., APRN · Dec 10, 2019

While in grad school, we got a lecture from a pediatric endocrine NP. She put forward that if you're not doing an exam on all the body systems, why can't we just skip cardiac or respiratory? The systems are all important for overall health. I don't know the answer for specifics on what to do in your situation, but she told us of many cases where there was an issue but the child and parent didn't have the medical knowledge to recognize that it was an issue. Certainly the annual well child visit should include an exam I would think. The child may not see a medical provider for another full year.

ArmaniX, MSN, APRN · Dec 11, 2019

Not a FNP, but I would think you should be doing thorough and complete exams.

I went to high school (years ago now ?) with a kid who was active in sports and pretty healthy. He was dead two to three years after high school graduation from testicular cancer..

Rumor was a teste never “dropped” and was never brought up in any of his physicals. I would like to think that perhaps if this was noticed earlier in his life and addressed, he would still be around?

Don't always count on the patient to bring up problems to you, many individuals notice something wrong and live in a fear-like state and ignore it. Especially children.

twahls65 · Dec 11, 2019

For older adolescent girls once they do reach puberty and get there periods do you do a little more compressive exam other than looking at there Tanner stage and just pulling out the waistban of the patients underwear? Do you try and counsel them and ask if they have any questions or concerns about there development or there periods? Do you actually look at there lady parts and pelvic area?

AmyB_NP · Dec 12, 2019

5 hours ago, twahls65 said:
For older adolescent girls once they do reach puberty and get there periods do you do a little more compressive exam other than looking at there Tanner stage and just pulling out the waistban of the patients underwear? Do you try and counsel them and ask if they have any questions or concerns about there development or there periods? Do you actually look at there lady parts and pelvic area?

Once they've gotten their period, I ask them if they have any questions or concerns, and I don't bother looking if they don't.

twahls65 · Dec 12, 2019

Even though not necessarily part of a genital exam in older adolescent girls as they develope as part of the yearly checkup do you perform a breast exam on the female patient or just ask her about her development?

AmyB_NP · Dec 12, 2019

Just now, twahls65 said:
Even though not necessarily part of a genital exam in older adolescent girls as they develope as part of the yearly checkup do you perform a breast exam on the female patient or just ask her about her development?

I usually just ask, but if I do an exam it's just visual.

twahls65 · Dec 12, 2019

Do you have your patients undress for their yearly checkup or do you keep them dressed and just do the checkup over there clothes and just move clothes as needed?

twahls65 · Dec 12, 2019

Sorry I am asking so many questions I am just comparing what we do at our pediatric practice to other pediatric offices with well child checkups. What i try and do is keep the patient as comfortable as possible during the checkup and just remove clothing as needed. I have found girls more shy to talk about there development with me even with a parent in the room during the exam when I do ask about puberty and there periods.

Hoosier_RN, MSN · Dec 13, 2019

On 12/11/2019 at 9:20 AM, ArmaniX said:
Not a FNP, but I would think you should be doing thorough and complete exams.

I went to high school (years ago now ?) with a kid who was active in sports and pretty healthy. He was dead two to three years after high school graduation from testicular cancer..
Rumor was a teste never “dropped” and was never brought up in any of his physicals. I would like to think that perhaps if this was noticed earlier in his life and addressed, he would still be around?

Don't always count on the patient to bring up problems to you, many individuals notice something wrong and live in a fear-like state and ignore it. Especially children.

Same here. During exam with my oldest son, MD thought she found something in testicular exam. Luckily, ended up to be nothing. But, both my sons were taught testicular exams, and to let her know if they noticed anything unusual with any body system or its functioning. Females should be taught BSEs. So many kids don't know how to do this, if they even know about doing this. They may be embarrassed to ask how. Do the exam and explain/teach while doing so. An ounce of prevention...