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

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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.

as part of the yearly well child checkup begining when the patient is 12 or 13 I try and set aside some time with just the patient without the parent in the room so If there is anything the patient wants to discuss without there parent there they can feel free to open up with me. Sometimes that is easier said than done. I find it more difficult for girls to open up and ask questions they feel embarrassed talking to me since I am a male nurse practioner but I try and calm there nerves and let them know whatever they tell me does not go beyond the exam room. If anybody has any other tips or suggestions for me to try and help me with talking with adolescent girls and how you approach talking about such sensitive topics with them I would appreciate it. Thank you

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I am having trouble with my young patients both boys and girls open up to me about such sensitive subjects especially about there genital health if any fellow np have any tips or suggestions to get my patients to open up and feel comfortable talking to me about such subjects I would greatly appreciate it.

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Specializes in CEN, Firefighter/Paramedic.
4 hours ago, twahls65 said:

I am having trouble with my young patients both boys and girls open up to me about such sensitive subjects especially about there genital health if any fellow np have any tips or suggestions to get my patients to open up and feel comfortable talking to me about such subjects I would greatly appreciate it.

Brother, I'm want to believe you mean well and are trying to learn, but literally ALL of your posts are regarding juvenile genitals.

It creeps me out.

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Why such hatred towards me all I was doing was asking for was simple advice but if I can't find that here I guess I will have to look elsewhere to further my training and look for friendship and fellowship where I won't be constantly judged. I thought this was a friendly forum where I could ask questions I guess not.

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On ‎12‎/‎13‎/‎2019 at 10:33 AM, Hoosier_RN said:

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...

Breast self exams are not evidence based. I don't teach them or encourage them. https://www.aafp.org/patient-care/clinical-recommendations/all/breast-cancer-self-bse.html

Screening exams for testicular cancer are also not evidence based. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/testicular-cancer-screening The undescended testicle mentioned in a different story should have been caught at a much, much younger age.

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Specializes in Short Term/Skilled.

Can't answer the question because I'm not a provider but I think you are being exactly thorough enough.

Not only that but I think it emphasizes the importance of "checking things out" down there at an early age. I wasn't comfortable doing so until much later in life and I would imagine many are the same.

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Specializes in PACU.
On 12/9/2019 at 8:46 PM, 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.

@AmyB_NP Your the reason that my son goes to a male doctor for his school and sport physicals. No pre-teen / teen boy should have to be humiliated with a female NP. It happen once when his mom took him to her NP and the next year he said he did not want to play baseball. Found out that he wanted to play but did not want to have another sport's physical where "the lady" aka NP embarrassed him my checking is parts. Think about the damage that you are doing to boys mental.

Mike

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8 minutes ago, RNMikeMiller said:

@AmyB_NP Your the reason that my son goes to a male doctor for his school and sport physicals. No pre-teen / teen boy should have to be humiliated with a female NP. It happen once when his mom took him to her NP and the next year he said he did not want to play baseball. Found out that he wanted to play but did not want to have another sport's physical where "the lady" aka NP embarrassed him my checking is parts. Think about the damage that you are doing to boys mental.

Mike

To be fair, there is an accommodation that can and should be afforded for any such issue. I’m a male NP and have had male teens in for sports physicals that are equally reticent to the exam. I do gyn exams as well but leave the option open to females who would prefer someone of their own gender. Being open to the patients comfort level is important in any clinical exam.

Nothing is finite in how someone should exam a patient. You just shouldn’t sign off on anything you didn’t perform. If it’s a contact sport that requires specific exams, you can either not clear them or specify in the clearance what exams were refused and attempts made to educate/accommodate the patient to limit yourself from liability.

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Specializes in PACU.

"I do gyn exams as well but leave the option open to females who would prefer someone of their own gender. Being open to the patients comfort level is important in any clinical exam."

I agree that every person should have an OPTION to have same gender exams. Unfortunately this is not always the case when the school has an agreement with a clinic that only has 2 providers who are both females. These sports physicals are free to the students because the school system covers them.

When you do GYN exams how many of the females ask for a female provider?

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2 hours ago, RNMikeMiller said:

"I do gyn exams as well but leave the option open to females who would prefer someone of their own gender. Being open to the patients comfort level is important in any clinical exam."

I agree that every person should have an OPTION to have same gender exams. Unfortunately this is not always the case when the school has an agreement with a clinic that only has 2 providers who are both females. These sports physicals are free to the students because the school system covers them.

When you do GYN exams how many of the females ask for a female provider?

I’ve probably only had a handful in two years of practice. I typically get those wishes when establishing care as new patients. Or if I’m seeing an established patient for something else and they are due for screenings, I offer to schedule them with myself or one of our female providers as needed. The vast majority have had no issue and all of my exams have an MA present anyway. Rapport with a patient and bedside manner go a long way as well.

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Specializes in PACU.
33 minutes ago, djmatte said:

I’ve probably only had a handful in two years of practice. I typically get those wishes when establishing care as new patients. Or if I’m seeing an established patient for something else and they are due for screenings, I offer to schedule them with myself or one of our female providers as needed. The vast majority have had no issue and all of my exams have an MA present anyway. Rapport with a patient and bedside manner go a long way as well.

I bet the Medical assistant was a female. My friend who is a male had to have a physical for is job. He did not have an option of which provider. Of course the provider was a female NP and the medical assistant was another female. Don't you think that is a double standard that a male patient has 2 females NP & MA in the room, but a female patient will never have 2 males (MD/NP & MA/Nurse)?

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Specializes in NICU.
4 hours ago, RNMikeMiller said:

 @AmyB_NP Your the reason that my son goes to a male doctor for his school and sport physicals. No pre-teen / teen boy should have to be humiliated with a female NP. It happen once when his mom took him to her NP and the next year he said he did not want to play baseball. Found out that he wanted to play but did not want to have another sport's physical where "the lady" aka NP embarrassed him my checking is parts. Think about the damage that you are doing to boys mental.

 Mike

I find it odd that you used the words "male doctor." There is such a thing as male NPs...if your school's form requires there to be a genitalia exam and only allows you to see a female provider, then you should take it up with the school for putting in such restrictions...

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