Routine GU Exams at Physicals/Well Child Visits

CamilliaJGP · Jan 3, 2016

I originally made a post on this topic by accident in the PICU/Pediatric forum because I assumed that was the forum for all pediatrics related posts (I only just realized that this forum exists). Trying to correct my mistake, one of the moderators moved the post to the school nurses forum (probably because school was in the original title), but it should have been moved to this forum so I'm rewriting it here (I'm sorry if this isn't allowed, I'm new at this and IDK how to delete the original post)

I find it odd how (at least where I practice) routine GU exams are performed for male patients, but not females patients.

During well-child check-ups/physicals at the practice I work at (pediatric/adolescent medicine), standard procedure for the male GU exam as follows:

Determine Tanner stage
Look for any signs of abuse
Check that both testicles have descended (for younger patients)
Check for TC (for older patients)
Check for hernia (if it's a sports physical)
Retract foreskin as far as possible to check for phimosis and improper hygiene (if for some reason the patients did not get circumcised)

This is what I was taught to do for male patients, and what all the other RNPs/MDs do at this practice as well. For female patients however, breast/GU exams are not performed routinely at any age, unless the patient specifically mentions a problem.

At first, I thought that this was just something that happens at this particular practice but then I saw the permission slip students from the local school district (where the majority of our patients are enrolled) have to turn in if their parents choose for them to get their mandatory physicals at their school, instead of at a private practice (In New York, students are required to get physicals done for school when they are in Kindergarten (5-6), 2nd grade (7-8), 4th grade (9-10), 7th grade (12-13), and 10th grade (15-16), as well as any year they play a sport).

Note the passage on page 10 that says:

"During the required examination, the FNP checks the skin, eyes, nose, throat, heart, lungs, checks for structural deformities, abdomen, and external genitalia (all males). This examination does not include a lady partsl exam nor a breast exam. Height,weight, BMI, blood pressure, pulse, vision, and hearing are done by the school nurse prior to the physical exam. A urine check is also done on all athletes."

I'm not saying that we should be doing full GYN checks, but shouldn't it be necessary to check for abuse and determine the tanner stage of all patients, male or female?

Is this only the case where I live or is this how it is everywhere? For you all, what is standard in terms of GU examination during well child visits and physicals?