# Genital check at pediatrician



## rachel81 (Nov 16, 2005)

My son has his 15 month WB exam on Monday. The doctor always checks his genitals briefly. He never retracts but just gently feels his testicles. I've never thought anything of it, but now I'm seeing people on this board saying that there is no reason for these checks. Why do doctors do them? Should I be refusing it?


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## forthebest (Jun 19, 2006)

I'm sure the doctor will have a reason for doing this but I for one would not be happy if this was done to my child. It seems innappropriate imo. You can always state you do not want this, there are other ways to check for any testicular problems. I'm hopeful someone more knowledgeable will advise you on this but this is how I personally would feel about this.


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## onelilguysmommy (May 11, 2005)

"to make sure the testicles have descended" is what most of them say, and to check for hyposadias. (sp?)
imo umm..duh, these would have been noticed before, and they just want to check the kids stuff, but thats me...







:


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## MCatLvrMom2A&X (Nov 18, 2004)

The check on the testicles is to make sure 1) They are decended 2) Check for hernia. Part of me wants to just say dont touch anything under the diaper but another part of me worried that he may get a hernia and I might miss it and cause major problems. Some hernias are very obvious while others are more subtle.

You have every right to request they not check under the diaper if you want. As long as the Dr. isnt messing with the foreskin I dont have a problem with them doing the other check. But you have to be vigilent because some Dr. will not bother the foreskin at all until the boy is a certain age then all the suddent they start messing with it







:

So my advice is if you are going to let them do the testicle check then before the diaper comes of tell the Dr. dont touch his penis. That way you wont have to worry about him/her doing it even if they havnt before.


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## New Mexico Beach (Mar 13, 2006)

Our ped doesn't actually touch his genitals at all (although we rarely go). He usually removes his diaper part way (like un-does one tab and checks, then the other tab) and checks his hips, but that's about it.


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## guestmama9908 (Jan 23, 2007)

Our Ped also always does a diaper check. She does this on my DD as well







. She never touches anything on either one of them.....just has a look-see for some reason or another.


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## buckeyedoc (Nov 9, 2006)

My ped is pretty foreskin-friendly, but he does check testicles at the young well-baby visits. At the first visit for each DS, he checked the penis, but no retraction. I was OK with it.


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## hunnybumm (Nov 1, 2003)

Our ped also checks the testies, but I tell them every single time not to even touch his penis. They say "Oh, we don't retract" and I tell them that at his first visit, the doc did so NO one is allowed to touch it. They have been very respectful.

I am curious if they check the diaper area for girls too. I have been told they are checking for signs of abuse as well as medical issues. I have no problem with them looking, and gently touching his testicles.


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## MCatLvrMom2A&X (Nov 18, 2004)

The peds I use always checked dd as well a quick look with a slight spreading of the vaginal lips. I know that sounds worse that what it really was. It is hard to describe with writing. They would put there hands of either side of her thighs and hold her legs apart.


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## eepster (Sep 20, 2006)

I would say my comfort with it depends on 2 things.

1. how much you trust your Dr.

2. whether you have any reason to think problems are a possibility.

There are legitimate reasons to look inside a diaper (more when they are younger,) but if you are uncomfortable or your DC is uncomfortable with it then unless you have a specific concern skip it till you find Dr Perfect.


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## falcon (Jul 8, 2004)

At my sons 3 yr check, he never had to take off his undies. Before that, the dr did the testicle check, but she never tried to retract him. In the future I plan to tell drs to just not touch his penis at all. If they need to move his penis to check his testicles, I can just ask ds to move his own penis. (and if I have another ds who is too young to follow directions, I can just do it myself)


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## gretasmommy (Aug 11, 2002)

For girls, we are checking for adhesions (when the labia fuse together, a very common thing during infancy and again in preschoolers wiping themselves). In young boys, usually the scrotal check is to see that there is no hernia, and also to assess the growth of the testes (there are disorders where they do not grow appropriately, and intervention in a timely manner is key to future fertility). It's easy to do both of these exams with the undies on, simply with the waist band pulled up from the body while the boy is lying across a parent's lap, or by moving the panel of the undies aside while a girl is sitting on a parent's lap with her feet on my knees/parent's knees). Not removing the undies makes most kids much less uncomfortable, IME.

As a parent, when DD was uncomfortable with her ped checking her genitals, I calmed her down, explained why it was important for him to make sure things were okay (she has a labial hemangioma that needs close obsevation) and that she could help by following his instructions and showing him the hemangioma without him touching her at all. And the exam occured with her in my lap. Eventually she was okay with it, and it took just a few seconds. I will remember next year to talk a bit about it ahead of time - she has absolutely no modesty at home, and this was the first evidence of it!


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## Ansett (Feb 19, 2007)

To a health care professional, the genitals are just another body part, no less important than any other. The squimishness and suspicion exhibited by many of these posts is the reason that many clinicians will skip this area in their physical exam. Practitioners that go ahead and include the genitals in their physical exam are being thorough and should be appreciated, imo. It is not uncommon for kids to reach puberty with an undiagnosed problem in this area. When I was in school, we were taught to "get over it" (meaning any squimishness we might have) and practice good medicine. Skipping the genitals when doing an exam is not good medicine. Obviously I'm talking about when the situation warrants...you wouldn't check the genitals if someone was coming in for a sore throat, but when it's a physical, then yeah, it's necessary.


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## Cinder (Feb 4, 2003)

Quote:


Originally Posted by *MCatLvrMom2A&X* 
The check on the testicles is to make sure 1) They are decended 2) Check for hernia. Part of me wants to just say dont touch anything under the diaper but another part of me worried that he may get a hernia and I might miss it and cause major problems. Some hernias are very obvious while others are more subtle.

Don't you feel up higher than the testicles to check for a hernia? My ped feels around in the pelvis area at the same time he is feeling around the stomach (and how he noticed my ds had an inflamed spleen at 15 months old), but since that first check in the hospital when he was less than 12 hours old he has never felt ds's testicles again... I had no idea this was even normal. He also used to check the joints of the legs there cause he had a "clicky" joint...but that resolved by 6 or 9 months (I forget) and he doesn't do that anymore either.


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## gretasmommy (Aug 11, 2002)

Quote:


Originally Posted by *Ansett* 
To a health care professional, the genitals are just another body part, no less important than any other. The squimishness and suspicion exhibited by many of these posts is the reason that many clinicians will skip this area in their physical exam. Practitioners that go ahead and include the genitals in their physical exam are being thorough and should be appreciated, imo. It is not uncommon for kids to reach puberty with an undiagnosed problem in this area. When I was in school, we were taught to "get over it" (meaning any squimishness we might have) and practice good medicine. Skipping the genitals when doing an exam is not good medicine. Obviously I'm talking about when the situation warrants...you wouldn't check the genitals if someone was coming in for a sore throat, but when it's a physical, then yeah, it's necessary.

I had a new female patient see me for the first time - at 7 years old. Her mom was surprised that I asked to check her genitals (I always ask the child and the parent). She consented, saying no one has checked in her underpants before. Luckily I did (can't believe some don't!), as she had an imperforate hymen which could have resulted in a whole host of problems later on!


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## paquerette (Oct 16, 2004)

I think it's important to insist that the doctor ask your child's permission first (may not quite be applicable at 15 mo). I can't imagine ever trying to coerce or even force a child into having a genital exam, assuming there is no known major problem going on in the area. To me, the kid's ownership of their body trumps. How traumatising it must be to have your own parent force you to let some stranger examine your privates against your will.









If you do have the testicle exam, you open the diaper, lift the penis, and hold your hand over it. There's nothing there they need to see.

There's no reason to check for adhesions in prepubescent boys or girls, since even if they're there nothing should be done to them, as long as the child is peeing OK. I think it's just as important to guard our daughters against forcible adhesion breaking as our sons!


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## Cersha (Jun 22, 2006)

Quote:


Originally Posted by *paquerette* 
I think it's important to insist that the doctor ask your child's permission first (may not quite be applicable at 15 mo). I can't imagine ever trying to coerce or even force a child into having a genital exam, assuming there is no known major problem going on in the area. To me, the kid's ownership of their body trumps. How traumatising it must be to have your own parent force you to let some stranger examine your privates against your will.









If you do have the testicle exam, you open the diaper, lift the penis, and hold your hand over it. There's nothing there they need to see.

There's no reason to check for adhesions in prepubescent boys or girls, since even if they're there nothing should be done to them, as long as the child is peeing OK. I think it's just as important to guard our daughters against forcible adhesion breaking as our sons!

This HAPPENED to ME! When I was about 12-13, we started seeing a new ped, and they wanted to check down there. I didn't want them to, but my mom MADE me. I remember CRYING the whole time. It was so tramatizing. Then, I had to sit outside and listen to them do the same to my 7-8 year old sister, who also sobbed thru the whole thing.

Hey, maybe it finds important stuff, but I don't think I will ever forget being forced to do this exam.


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## Ansett (Feb 19, 2007)

The last two posts are about an entirely different issue than the original intent of this thread. This thread was started by a mother wondering if there was a legit reason for a doctor to do a genital exam on a baby/toddler. Obviously when you are talking about an older child for whom this area is not "just another body part", a certain amount of sensitivity is required. Of course the child's cooperation should be sought.
Children should be taught about personal space - that not just anyone should be allowed to touch them "down there". That's how we try to keep our kids from becoming victims. But I also believe that it's a parent's job to teach them that when they go to the doctor's office, it's a safe place and that the clinician just wants to see that they are healthy. Having said that, if a child refused a part of an exam, or expressed distress at having their genitals examined, I would not perform that part of the exam regardless of whether the parent wanted me to or not.


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## MCatLvrMom2A&X (Nov 18, 2004)

Quote:


Originally Posted by *Cinder* 
Don't you feel up higher than the testicles to check for a hernia? My ped feels around in the pelvis area at the same time he is feeling around the stomach (and how he noticed my ds had an inflamed spleen at 15 months old), but since that first check in the hospital when he was less than 12 hours old he has never felt ds's testicles again... I had no idea this was even normal. He also used to check the joints of the legs there cause he had a "clicky" joint...but that resolved by 6 or 9 months (I forget) and he doesn't do that anymore either.

There is a type of hernia that drops the intestines down into the scrotal sack. This is the one they are checking for.

I have no problem with genital checks on my ds as long as I am 100% sure the Dr will keep his hands off my sons foreskin. As a lot of mom's here have learned there is a very real danger of forced retraction by peds who dont know any better.

As far as my dd getting her genitals checked when I took her in for her 4yr physical for school the Dr requested to see her genitals I said ok before I even thought







dd was traumatized by it and she will not be getting another genital check until she wants to get one. I know that some things can be caught by the Dr. but I know what my dd looks like and she has no problems in that area.

If I thought there was a problem I would let the Dr. check of course.


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## Mama Meesh (Feb 1, 2007)

Ansett


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## urchin_grey (Sep 26, 2006)

Quote:


Originally Posted by *Cersha* 
This HAPPENED to ME! When I was about 12-13, we started seeing a new ped, and they wanted to check down there. I didn't want them to, but my mom MADE me. I remember CRYING the whole time. It was so tramatizing. Then, I had to sit outside and listen to them do the same to my 7-8 year old sister, who also sobbed thru the whole thing.

Hey, maybe it finds important stuff, but I don't think I will ever forget being forced to do this exam.

That's strange to me... I can't ever remember having anyone check me down there until I started going to the gyno at 18. I'm sure someone did at some point when I was a baby, but all the peds/family doctors I had when I was older never did. I can tell you now, it would have traumatized me as well. And at 12-13, I would have told them to just kiss my butt.









To the OP - our ped always checks my DS. I trust her because she left her sons intact as well, so she knows not to retract. He's way too young to realize the "difference" yet but once he starts getting shy about that area, I will definately leave it up to him.


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## gretasmommy (Aug 11, 2002)

Quote:


Originally Posted by *paquerette* 
I think it's important to insist that the doctor ask your child's permission first (may not quite be applicable at 15 mo). I can't imagine ever trying to coerce or even force a child into having a genital exam, assuming there is no known major problem going on in the area. To me, the kid's ownership of their body trumps. How traumatising it must be to have your own parent force you to let some stranger examine your privates against your will.









If you do have the testicle exam, you open the diaper, lift the penis, and hold your hand over it. There's nothing there they need to see.

There's no reason to check for adhesions in prepubescent boys or girls, since even if they're there nothing should be done to them, as long as the child is peeing OK. I think it's just as important to guard our daughters against forcible adhesion breaking as our sons!

OMG!!!! You don't want to *break* the adhesions!!!!!

Adhesion formation in young girls is a hygeine issue - and if you teach (by demonstration to the girl and caretaker/parent how to wipe properly, eventually they resolve. If they aren't found early, they actually can lead to difficulties with urination, often noticed with the first UTI. Genital examination is part of the preventive medical examination . . . . .

And we should always give consent for our children's examinations - and the docs should ask for it from us and from our children, always. I start asking at 1 year of age. If the child says no, I don't do that part of the exam. we talk about why it's important, and I ask if it would be okay to do that next time - usually they consent and we move on with ease and the child is comfortable. The most important thing is not to lose their trust (and their parent's trust).


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## KMK_Mama (Jan 29, 2006)

I was actually curious when those exams stopped. They have not checked my DD's down there since they were newborns, but they insist on it for my son at every WBV. At his last exam at 9 months I made sure the new doc knew not to touch his penis and I gave him a brief explanation of why we left the old pediatricians office (retracttion!) and he was very understanding. He never touched his penis but did say he would have to check his testicles at his 1 year appt because one was up too far. His next appt is in a couple weeks.....I'll just remind him not to touch the penis and if all is well I would hope they won't do the genital checks again.


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## paquerette (Oct 16, 2004)

Quote:


Originally Posted by *gretasmommy* 
OMG!!!! You don't want to *break* the adhesions!!!!!

Many of your colleagues are not so well informed, unfortunately.

Ansett, I'm not sure what age you think should start being asked for consent, but I think the OP's son is 15 mo? Probably somewhat verbal, understands the question being asked, and knows his level of comfort. I think a child that age should be asked. I think too often folks make the mistake of thinking that older infants and toddlers aren't aware or don't understand things. I'm always amazed by the stuff my daughter remembers from months ago and reminds me of every now and then.







:


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *gretasmommy* 

Adhesion formation in young girls is a hygeine issue - and if you teach (by demonstration to the girl and caretaker/parent how to wipe properly, eventually they resolve.

can you tell me more about this? DD had adhesions from about 3 months old, and her pedi never mentioned anything i could do differently. i always changed her frequently (but not overnight), and her adhesions cleared up as soon as she was potty trained. is it possible that the adhesions were caused by the nighttime wetness? or maybe irritation from baby wipes?

sorry to be off topic, but thanks for the help!


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## BurgundyElephant (Feb 17, 2006)

Quote:


Originally Posted by *gretasmommy* 
I had a new female patient see me for the first time - at 7 years old. Her mom was surprised that I asked to check her genitals (I always ask the child and the parent). She consented, saying no one has checked in her underpants before. Luckily I did (can't believe some don't!), as she had an imperforate hymen which could have resulted in a whole host of problems later on!

So I'm curious as to what was done with this girl. As I understand it, one just waits until puberty to see if it causes problems later on. http://www.emedicine.com/med/topic3329.htm

Our ped used to check my DDs when they were very little - she said she was checking that their hips were ok. She only did it the first couple of times. Never looked for adhesions or up for the hymen. I feel that would have been inappropriate. DS has never had his diaper off in front of a ped.


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## Daisyuk (May 15, 2005)

Medic or not, that sounds revolting to me.

Anyone tried to look at my daughter like that at the age of 7, I'd be making a formal complaint to the health board for inappropriate behaviour.

Since when is it ok to give a 7 year old what is essentially a gyni exam? What's the fascination over there with messing with children's genitals?


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## gretasmommy (Aug 11, 2002)

Quote:


Originally Posted by *BurgundyElephant* 
So I'm curious as to what was done with this girl. As I understand it, one just waits until puberty to see if it causes problems later on. http://www.emedicine.com/med/topic3329.htm

Our ped used to check my DDs when they were very little - she said she was checking that their hips were ok. She only did it the first couple of times. Never looked for adhesions or up for the hymen. I feel that would have been inappropriate. DS has never had his diaper off in front of a ped.

Oh goodness! You don't need to look "up for the hymen" - it's right there, att he vaginal opening, and you need do no touching to see it! The girl just sits on her parent's lap with her legs in a frog position, undies on. Usually I ask the girl to pull the central panel over herself, so I don't need at all to touch.

For this girl, we didn't need to do anything - just watch very carefully around the months of expected menarche - and her mom and she can be taught what to watch for. It's just preventive medicine.

As for adhesions, you just use a wipe after urination, and be sure to wipe once (at 3 DD can be shown how to do this herself!) between the labia to get the area dry. That's it. Adhesions form on wet skin, and by wiping once btw the labia, you dry the area so that adhesions are less likely to form - and already formed adhesions will eventually weaken and separate on their own by doing this - it may take a year, but that's fine. There's also an estrogen cream that can be used, but this is only in the most dire of circumstances (ie nearly completely closed).

I guess I am surprised by all of the mystique surrounding genitalia. They are part of our bodies, not for showing to others/sharing with others, but as important to check as eyes and ears. Examining them shouldn't be traumatic, and if done right, it won't be.


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## majormajor (Nov 3, 2006)

i always wiped her after pee. perhaps it was the nighttime wetness then...


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## mommyswenn (May 23, 2004)

The first time ds saw his urologist (11 months), the uro addressed himself first to ds, then to dh and I. I loved that -- it showed us that he knows who his patient (and first priority) is. Before he removed ds's diaper to examine his hypospadias, he asked him if he could look. Ds wasn't old enough to consent, but we still appreciated how respectful the uro was.

Each time ds has seen him since then he always asks.

Our family doctor, however, doesn't ask. The last time she saw ds (around 18 months, we thought he had rotavirus) she wanted to see if he had pooped in his diaper so she took it off. It was clean, but before putting it back on she took it upon herself to poke around.







: I was SERIOUSLY ticked, ds isn't intact due to his hypospadias, but she was essentially seeing if he was retractible. At any future visits his diaper will stay on.


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## gretasmommy (Aug 11, 2002)

Quote:


Originally Posted by *majormajor* 
i always wiped her after pee. perhaps it was the nighttime wetness then...


Yep. Keep doing what you're doing, and she'll be fine. I wiped DD with a wipe first thing in the morning as well . . . . but I am surprised how many kids wipe themselves at an early age - my DD just started that a year ago!!!!! It's so hard to let go of those mama jobs!


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## rachel81 (Nov 16, 2005)

Thanks so much everyone for replying and for the excellent information. Hopefully we will have a happy visit with the doc tomorrow.


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