Ethical approach to genital examination in children

Question 1

When should genitalia exams be performed?

Answer 1

Only if specifically indicated, for example:

1. Periodic health exam to check for normal development of the external genitalia
2. Look for endocrine anomalies
3. Check for physical signs of suspected abuse
4. If requested by the parents

Question 2

What are some other recommendations re: genitalia exams?

Answer 2

1. Older children who are competent should provide informed consent
2. Remarks of sexual connotation should be avoided
3. Do not touch the patient’s genitals or breasts except when required as part of the P/E
4. Always advise patients before touching genitals or breasts
5. If the child refuses to cooperate the examination should be postponed, neither force nor restraint should ever be used
6. The reason for the exam should be clearly explained
7. For infants and school-aged kids the child’s caregiver should remain close throughout
8. Child should be assisted in undressing and then dressed as soon as possible
9. Girls can sit in the caregiver’s lap and examined in the supine or frog-leg position –> adequate visualization of introitus and anus
10. Knee-chest position allows for better view of the hymen and vaginal vault but may be frightening
11. Use lateral decubitus to examine boys
12. For older children and adolescents a parent or nurse should be present
13. For older children and teens they should be allowed to dress and undress in privacy
14. Pelvic examinations are not a routine part of the exam for teens who are not sexually active