Physical exams at the pediatrician: What to know

It's always fun when we're togetherWhen should a doctor do a genitourinary (GU) exam?

A GU exam is an important part of the physical exam at the annual checkup. Pediatricians must make sure that children are developing through puberty at the appropriate time. There are conditions that can cause puberty to start too early or too late. Your pediatrician should do a brief GU exam that is mostly just a visual inspection. Boys are the exception. It is important to make sure that the testicles have descended in younger boys and to check for lumps or abnormalities in older boys and to check for hernias in all boys. The current recommendation from ACOG (American College of Obstetrics and Gynecology) is that women should have a routine pelvic exam beginning at age 21.

A GU exam is also indicated if the patient has a complaint relating to that part of the body. Abdominal pain can also sometimes indicate a problem in the GU area, so a GU exam may also be needed in this situation.

When is a GU exam NOT needed?

A GU exam is not needed if the complaint is about any other area of the body and it is not your checkup. Complaints like ear ache, sprained ankle, or pink eye definitely do not require a GU exam.

If you have a concern or it seems inappropriate, just ask. Your doctor should have no problem explaining the exam and why it is needed. If you still have concerns, ask for a second opinion.

What should happen during a GU exam?

First, your doctor should explain why the GU exam is needed that day. If you still don’t understand or feel comfortable, ask for clarification.

Your doctor should then ask permission to perform a GU exam. Participating in the exam is always your choice. Refusing an exam that is needed may make it difficult to adequately diagnose and treat your complaint, but you should always feel comfortable in the situation.

Your doctor should step out of the room while you change. Your privacy should be maintained at all times.

Your doctor should explain the exam to you and tell you what will happen next. He or she should do everything possible to make sure that you understand the exam as it is happening and to ensure you are comfortable.

What should parents expect?

The role of the parent will change depending on the child’s age. Young children will want their parents with them. Your Pediatrician should explain everything to the parents of small children and the parents should be comfortable with the exam. Some children may be more comfortable if their parents are nearby. Some children need to see their parents. Others may need to hold your hand. Do what you need to do to put your child at ease and make them comfortable.

Older children and teenagers may not be comfortable with their parents in the room. Parents may stay with an older child or a teenager, but if they request that their parent leave the room, then your doctor should get a chaperone to be in the room during the exam. This may be a medical student, another doctor, or a nurse. The doctor should not perform a GU exam alone.

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About Heather Felton, M.D.

Dr. Heather Felton is medical director of UofL Pediatrics – Sam Swope Kosair Charities Centre. She is also an assistant professor at the University of Louisville School of Medicine. She received her bachelor’s degree from the University of Kentucky and her medical degree from the University of Louisville School of Medicine. She is a member of the American Medical Association, Kentucky Medical Association, American Academy of Pediatrics and Group of Women in Medicine and Science. Her specialty is pediatrics. Dr. Felton’s areas of interest include safety and injury prevention; improving anticipated guidance provided to families during check-ups; and advocating for children’s safety. http://www.uoflphysicians.com/uofl-pediatrics-sam-swope-kosair-charities-centre

All posts by Heather Felton, M.D.