Our private parts are supposed to be private, or so they say. This certainly does not hold true in the pediatrician’s office where babies’ diapers are opened and kids’ pants come down at every check up.
Most parents trust their health care providers, though it’s natural to feel uneasy or unsure about asking certain questions. This article aims to answer common concerns surrounding the male genital exam. A discussion of the female exam will follow in a future article.
But First
The doctor or other health care provider must ALWAYS ask your permission to do the exam, and frankly, they should tell you why they are doing the exam. If your child is school aged, a good pediatrician will address the child with something like, “No one is supposed to look under your underwear except your parents– not even the doctor unless your mom is in the room and says it is ok. I would like to make sure every part of you, including your penis, is growing normally. Is that ok with you?” Similarly, teens should be offered a chaperone, typically a nurse or medical assistant. If the provider is male, and the teen is female, a parent or chaperone should always be present. And unless very specifically indicated, no one should be sticking a finger in your child’s anus. Rectal exams are done on some occasions– even in babies– but you should be aware and assent.
Babies
In newborns, the genital exam helps identify biological gender. For the purposes of this article, we will talk about babies who are clearly male. Babies with ambiguous genitalia are managed on an individual basis, ideally with a multidisciplinary team.
In general, babies are examined thoroughly to identify and address any congenital abnormalities. While the types of congenital variations are infinite, some common findings include hernias or fluid collections (hydrocoeles). We also ensure testicles are properly located in the scrotal sac and the scrotum appears consistent with the age of the baby. A premature baby’s scrotal sac appears differently than that of a full term baby.
In the penis, we check for proper placement of the meatus (where the pee comes out). The foreskin may be pulled back in order to see the meatus and to ensure the foreskin does not obstruct the urinary stream. If a parent chooses to circumcise, this is usually done within the first week of life, and pediatricians monitor healing of the removed foreskin during early visits.
As Boys Grow…
I like to remind parents that children are examined from head to toe throughout their infancy and childhood, because, as they develop, so does their exam. In the case of genitals, testicles that used to live appropriately in the scrotal sac can slowly climb into the groin or even abdomen! If left unchecked, the child’s future fertility can be affected. Similarly, where there was not a visible hernia or fluid sac, one may appear. Management may be simple observation in some cases, but other cases may require surgical intervention.
Mostly, we are examining your child’s genitals to confirm that he is developing appropriately. Most boys enter puberty between the ages of 9 and 14. We want to make sure that his body is developing as it should– not too soon and not too late. Texture and appearance of pubic hair along with the size of the testicles and penis help determine pubertal staging. The pediatrician may tell you your child’s Sexual Maturity Rating (SMR, previously known as Tanner staging). Babies start at SMR 1 and remain so until puberty. SMR 2 marks entry into puberty, usually starting with testicular enlargement (here we go again, feeling your boy’s scrotal sac). Stage 5 marks complete genital development.
Teens and Young Adults
I advise teen boys to know their testicles and check them once a month. They should feel fairly symmetrical. If there is a new lump or an asymmetry, he should see his doctor. Similarly, during annual exams, your teen’s genital inspection will assess pubertal development and the presence or absence of hernias, signs of sexually transmitted infections, or atypical growths. While uncommon, testicular tumors can occur in teens.
Final Thoughts
Most people would rather skip the genital exam– including me. Nevertheless, they help assess children’s development and occasionally catch conditions requiring intervention. Please make sure your child knows that a parent must be in the room and your teen knows they can ask for a parent or chaperone to be in the room with them. Lastly, if your provider is not describing the reasoning behind their actions, ask them to clarify. You and your child deserve a proper and logical explanation before inspection of such personal space.
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References:
Gerber, J A et al. “Do pediatricians routinely perform genitourinary examinations during well-child visits? A review from a large tertiary pediatric hospital.” Journal of pediatric urology vol. 15,4 (2019): 374.e1-374.e5. doi:10.1016/j.jpurol.2019.05.007
Committee on Child Abuse and Neglect. “Protecting children from sexual abuse by health care providers.” Pediatrics vol. 128,2 (2011): 407-26. doi:10.1542/peds.2011-1244
