Advice: preteen vs doctor re: "privates"

[Mrs Mungo]

And again, no one is saying it should never be done.

 

The question is why is it being done?

 

And the answer, IMO, needs to be more than, "to see if they are developing pubic hair".

 

I don't disagree. I think the doctor should explain it. I think the mom has final say. Like I said, I've been threatened by a GP in a similar manner over a different issue. I'm not suggesting *at all* that I think the doctor behaved perfectly.

[Nakia]

My girls' pediatrician asks permission, takes a quick peek, and that's it, every year. This year my 6 year old refused, and it was no big deal. Doc asked me if everything down below was normal, I said yes, we moved on. And the doctor praised Cora for speaking up.

 

I can't believe anyone would say it's not okay for children to refuse a "private area" exam at any age, unless of course, there is a serious problem that needs to be addressed (injury, infection, etc).

 

 

ETA: The funny part is that I had no idea why Cora refused until later when I realized she had no panties on. LOL! She HATES wearing panties, so we've established "panty rules." One of them is that everyone must wear panties when we leave the house. She didn't that day and thought she'd be in trouble. I just laughed.

Edited May 23, 2012 by Nakia

[WagsWife]

My girls have been in the military medical system all their lives. We have not had one doctor want to perform an exam on them like that! I would not have forced my daughter to do it, unless the doctor could give me a very good-precise reason why it was needed. I think you did the right thing!

[WagsWife]

:iagree:

I suppose every clinic does it differently, but at our clinic, our daughters were never asked to do this at routine check-ups. That would only happen if there was a problem related to that area. There were times when the doctor would feel around in the ovary area, but underpants were left on and the doctor never felt a need to look beyond.

[ChocolateReignRemix]

All of these things are rare. In a perfect world we could have our bodies scanned inside and out to find any rare possibility of everything. Even with screening stuff is missed. At this point I think the girl's feelings are more important than the exam.

 

I had an abusive doctor. I now hate doctors and don't trust them. If my mother had just stuck up for me sooner I might not be in this situation.

 

I haven't been to a doctor in years.

 

Most medical conditions are rare, but the point of a check up/physical is to catch what is out of the ordinary. By your logic, nothing in a physical should be done because it probably won't find anything wrong.

[WagsWife]

I voted "other" because I feel you should have prepared her for the exam. You might have avoided the situation by either talking her through it beforehand, or going to a different doctor.

 

If your daughter would have refused to allow any doctor to examine her, even with all the preparation in the world, then that's a problem. I would wonder if there were any "issues" going on beyond just normal girl modesty.

 

I would not have prepared my daughter for that kind of exam. It would never have occurred to me that a doctor would want to perform an exam like that at a simple well child exam. A doctor has not asked to look at my girl's pr*vate area since they were babies.

[DianeW88]

I voted "other" because I feel you should have prepared her for the exam. You might have avoided the situation by either talking her through it beforehand, or going to a different doctor.

 

If your daughter would have refused to allow any doctor to examine her, even with all the preparation in the world, then that's a problem. I would wonder if there were any "issues" going on beyond just normal girl modesty.

 

:iagree: I would have told her, "suck it up, buttercup" and let the doctor do her job. I also would have told her that she might as well get used to it now, because she'll be doing those kinds of exams for the rest of her life.

[mommymilkies]

Most medical conditions are rare, but the point of a check up/physical is to catch what is out of the ordinary. By your logic, nothing in a physical should be done because it probably won't find anything wrong.

 

So should everyone go through routine MRIs of the brain because so many people have strokes (a higher rate, by far, than the risk of an unknown mass in the testicles of a young male)? No, because the risk is outweighed (not to mention the cost!). The risk of missing something in an exam of a child's genitalia without symptoms or cause is outweighed by the psychological risk of doing so to an unwilling patient.

[mommymilkies]

:iagree: I would have told her, "suck it up, buttercup" and let the doctor do her job. I also would have told her that she might as well get used to it now, because she'll be doing those kinds of exams for the rest of her life.

 

But as an adult, you have the legal right to refuse anyone-even a HCP-the right to look at or examine your privates.

[ChocolateReignRemix]

So should everyone go through routine MRIs of the brain because so many people have strokes (a higher rate, by far, than the risk of an unknown mass in the testicles of a young male)? No, because the risk is outweighed (not to mention the cost!). The risk of missing something in an exam of a child's genitalia without symptoms or cause is outweighed by the psychological risk of doing so to an unwilling patient.

 

Logic fail. No where did I post where anyone should be forced by the doctor, or even a parent. I do believe that getting over a fear of these exams is important, and that if handled correctly there are no psychological risks.

[Farrar]

I voted other. I think at any age it's okay, as long as there's no other issues that specifically point to a need for the check, in which case, I think a child doesn't get to make that decision because it's potentially too important and they're not old enough to weigh the risks and understand it. But I think cases like that are probably pretty uncommon.

 

The "why" of this has been discussed here before. All I can add to that is that if the ped hadn't done that quick look at ds's private parts, his hernia would not have been discovered and that could have been bad.

[Jeanne in MN]

I would need to understand why the doctor is wanting to check before I could make that decision. My daughter has never been checked like that during a physical so it sounds odd to me, but that one post someone found where the doctor explained why, is helpful. I would go over that info. with my daughter before hand and discuss it. If I thought it necessary, I would carefully explain why, explain how the doctor has seen naked private parts many, many times it's nothing out of the ordinary for them and that I think it needs to be done and then what can we do to make it a more comfortable situation. Or if I didn't think it necessary, I'd say, "That's ok, I don't believe you need it at this time and I'll stand by you, but perhaps when you are older it would be beneficial."

 

A boy's checkup I do know and understand. I believe it's necessary. My 13 yo son recently had a checkup and had an undescended testicle. It could be a cancer related issue down the road or sterility-neither of which I wanted for my son. He had surgery and I'm grateful we found out.

[KidsHappen]

I have five dds. We have never done well child checks but we do do sports physicals. None of them ever had their privates checked as part of a standard exam. The dr. simply asked if they started their periods yet, if they were regular and if they had any concerns. A quick peek in the undies only tells the dr. if the child has pubic hair or not. They never even had to undress, simply undo their jeans for abdomen palpitations and the dr.. reaching inside shirt to check heart and lungs.

 

My oldest didn't have her first pap until a month before she got pregnant with my grandson. The next one was pregnant for her first and the one after that when she started BCP. One of them had a UTI when she was about 5 and we had the hardest time getting her to give a clean urine sample. Even then the dr. was very understanding.

 

My dds absolutely have the right to bodily autonomy and no one gets a special pass that would override this especially for such a trivial and unneccesary reason. If they had a medical problem that required that area be examined, I would talk to them, explain why it was neccesary and if they were still ademant then maybe talk to the dr. about a mild anti-anxiety med for any neccesary procedures.

[Alice]

I'm a pediatrician and I've responded to this kind of question many times on these boards.

 

In your poll, I answered "any age". A child always has the right to refuse, although I suppose I am technically forcing myself on the 18 month old who screams at the entire physical exam. Common sense says the parent has the ability to consent for the toddler. I guess I'd say there is no absolute age. It depends on the situation and the child and the parent. A very precocious two year old might refuse and Mom is ok with letting her make the choice, I'd honor that. An immature five year old might refuse but be having some kind of issue and the parent might insist and help hold the child for the exam. I'd certainly say I will not force it on any child over the age of say 8 or so, even if parents want me to.

 

I think kids/teens have the right to refuse. However, I do think there are important reasons we do the genital exam in girls and boys. I consider it part of my job to try and explain that to a child without being rude or aggressive. If I explain it and they still refuse, I write "refused" in the chart and we move on. I've often had kids who have refused for several years agree to it when they get older and understand more the reasons. I think it is important for kids to realize that we aren't doing it for some weird reason and that a quick genital exam by a physician with a parent present or consenting is very different from someone inappropriately touching or looking at them.

 

I also think this is an area where it really helps to have a doctor that you know and trust. I rarely find a kid refuse when I've seen them for many years. It's just kind of one those awkward things they roll their eyes at but understand. But if it's someone meeting me for the first or second time, it's much harder.

 

ETA: I don't know what your daughter's health issues are but in some cases a thorough exam, including a genital exam, may be even more important. For example, abdominal pain. She still would have the right to refuse, but in that case I might try harder to convince her as a physician. Hopefully, that can be done in a respectful way, but I'm aware that all too often we physicians can be rude and too aggressive.

 

ETA: I wanted to add that in my experience it's very very rare for kids to refuse the exam when they've had it explained to them matter of factly and when parents are fairly matter of fact about it. I have had that be the case but my experience is much more that they are embarrassed but ok with it.

Edited May 23, 2012 by Alice

[TranquilMind]

And why do we need to evaluate that?

 

I never had that "evaluated".

 

That's like saying they need to look for gray hairs on my head to evaluate I'm getting older. I KNOW I'm getting older. Nobody needs to evaluate it.

 

Lol. With you on both...no need to "evaluate" pubic hair and no need to evaluate my millions of gray hairs either to determine I'm aging.

[WagsWife]

:iagree: I would have told her, "suck it up, buttercup" and let the doctor do her job. I also would have told her that she might as well get used to it now, because she'll be doing those kinds of exams for the rest of her life.

 

Mmm. Not at 11. Maybe 16, but not at 11. There is just not a good enough reason to put them through that. My 13 year old still gets dressed in a room with a closed door...and no one is allow in, period. It causes all kinds of issues...especially when she shares a room with her 11 year old sister. Her sisters and I fight her on it all the time. There is no way that she would ok with a pr*vate exam, and I would not force her unless there was a real issue down there!

[Alice]

Lol. With you on both...no need to "evaluate" pubic hair and no need to evaluate my millions of gray hairs either to determine I'm aging.

 

We look in younger kids to see if it's precocious puberty. We look in older kids to see if the stage of puberty matches everything else. Let's say a 10 year old is less than 5% for height. Maybe not a big deal, but if her puberty staging shows a Tanner V, that would be concerning as a sign that perhaps she is not going to grow anymore and might lead to a whole work-up or diagnosis. Let's say a girl starts developing hair and breasts at 11 , she should start her period within a couple of years. I see that same girl the next four years and she still hasn't started her period, it's a red flag to me that something else may be going on.

 

Let's say a girl is developing on the early side but is too embarrassed to tell her Mom (very very common). When I see that she is starting to develop, I usually make a general comment about whether she has any questions about her body changing and make sure the Mom has talked to the girl about puberty. I've frequently had girls where the Mom has not yet had that conversation and is grateful to know that it should be sooner rather than later.

 

Let's say it's a 16 year old who is shaving her pubic area and causing folliculitis, more common than you might think.

 

We also look for hernias and in boys we look for undescended testes, hernias, and pubertal development.

 

It's fine to refuse it and it's fine to tell your kids it's ok to refuse it but that doesn't mean it's worthless.

Edited May 23, 2012 by Alice

[Alice]

"

For boys we are looking primarily for whether or not the testicles are descended and hernias. It's not uncommon (I'm guessing off the top of my head we have about one a year) where we find an undescended testicle in a boy where we previously recorded it as descended. This can be for a couple of reasons: the doctor messed up previously and the testicle was never there, the doctor felt a fat pad before instead of a real testicle, or a testicle which had been retractile but able to be brought into the scrotum is now fully in the canal. Testicles develop in the abdomen and descend into the scrotum. There are true undescended testicles, which means they never left the abdomen or canal. There are testicles that are retractile (spending most of the time in the canal but can be brought down into the scrotum) and then there are testicles in the normal position. The age of the boy also dictates what is normal. It's normal for a 5 year old to have retractile testicles it is not normal for a 14 year old. However, because sometimes the exam changes or another doctor has done it previously, I don't like to assume that "it's ok because it was ok last year".As a boy gets older, I can often just see by visual inspection if the testicles are in the scrotum.

 

We also check boys for hernias, which are very important to know about, especially in the case of sports. Finally, we check for masses, although that's much less common. In our practice we have had two kids diagnosed with serious illnesses during the exam of the inguinal area.

 

For girls, we check for labial adhesions in younger girls.

 

In both boys and girls we check for pubertal development. I once had a baby brought in at 4 months who had very elevated testosterone that we discovered because of abnormal genitalia size. More commonly we have older kids who are showing signs of early puberty (or delayed puberty).

 

Other points:

Sometimes older kids and teens have concerns about the genital area that they are not going to ask about and parents are not seeing. I've seen STDs and folliculitis and abcesses and acne. None were asked about when I asked if they had any concerns. I saw the issue and asked, the teens were then relieved to be able to address it.

 

I think examination of the genital area is important, just as I think examination of the rest of the body is important for a physical. I try and be sensitive to the kids (and parents). I try to explain what we are looking for and why it's important (in general age appropriate terms "I need to make sure your whole body is healthy".) Still, I know some kids who are very embarrassed or outright refuse. I would never force anyone and if they are really sensitive we just let them waive the exam. It is their right."

 

I agree that waiving it isn't a huge deal, and is the right of the parent/patient.

 

Hmmm....maybe I should have read the whole thread before posting! :) I skimmed and missed my old post being quoted.

 

ETA: The funny part is that I had no idea why Cora refused until later when I realized she had no panties on. LOL! She HATES wearing panties, so we've established "panty rules." One of them is that everyone must wear panties when we leave the house. She didn't that day and thought she'd be in trouble. I just laughed.

 

This is really really common. It's usually boys though and I can always tell because we'll ask them to get undressed down to their underwear and they'll get a panicked look on their face. :lol: Usually the Moms are more embarrassed then the kids though.

 

All of these things are rare. In a perfect world we could have our bodies scanned inside and out to find any rare possibility of everything. Even with screening stuff is missed. At this point I think the girl's feelings are more important than the exam.

 

I had an abusive doctor. I now hate doctors and don't trust them. If my mother had just stuck up for me sooner I might not be in this situation.

 

I haven't been to a doctor in years.

 

So few doctors bother to take the time to explain any of this though. Thank you for doing that.

 

 

 

You're welcome. I'm sorry you had a bad experience with a doctor (or multiple doctors). I absolutely agree with you that a patient's (kid or not) feelings are more important than the exam. I can think of only a few truly emergent instances where we might have to force someone. And even in those cases, we can do things like exam under anesthesia (which I've seen happen in a girl with severe herpes who refused a normal exam because of the pain). Most of the time it is just good screening, and although ideal it can be waived. And most of the time if medically necessary I've found with enough explanation and discussion we can do the exam with the patient's consent.

[Dealea86]

It's fine to refuse it and it's fine to tell your kids it's ok to refuse it but that doesn't mean it's worthless.

 

I was one of the ones earlier who said I never had those kinds of exams when I was the OP's daughter's age. I find it odd to consider them 'necessary', because they were not 'necessary' for me. I understand the reasons for the exam, I just don't see why a child (a girl in particular - I didn't have a brother and don't have a son) needs that kind of exam every year.

 

However.

 

Assuming the doctor is respectful about it, and assuming my child isn't completely upset by it, I would not refuse it just because it wasn't done when I was a child. I think there's a difference between saying it's not a necessary procedure to force onto a child, and routinely refusing it. YKWIM?

 

What surprised me so much about this thread were all the moms who said the OP should have made her daughter consent to the exam - or at the very least should have strongly encouraged the daughter to get the exam.

 

I think the pediatrician used very poor judgment. If she was just looking for signs of puberty, she could have smiled at the daughter and said something like, "I understand, but this exam is very important for your health. Maybe we can try again next time. In the meantime, can I ask you a few questions?"

 

If the exam was necessary for other reasons (like the daughter's ongoing health problems), then perhaps the doctor was justified in pushing harder for the exam - though she should have spent more time explaining the reasons and less time trying to force her. JMHO

[Alice]

I was one of the ones earlier who said I never had those kinds of exams when I was the OP's daughter's age. I find it odd to consider them 'necessary', because they were not 'necessary' for me. I understand the reasons for the exam, I just don't see why a child (a girl in particular - I didn't have a brother and don't have a son) needs that kind of exam every year.

 

Assuming the doctor is respectful about it, and assuming my child isn't completely upset by it, I would not refuse it just because it wasn't done when I was a child. I think there's a difference between saying it's not a necessary procedure to force onto a child, and routinely refusing it. YKWIM?

 

I think the pediatrician used very poor judgment. If she was just looking for signs of puberty, she could have smiled at the daughter and said something like, "I understand, but this exam is very important for your health. Maybe we can try again next time. In the meantime, can I ask you a few questions?"

 

If the exam was necessary for other reasons (like the daughter's ongoing health problems), then perhaps the doctor was justified in pushing harder for the exam - though she should have spent more time explaining the reasons and less time trying to force her. JMHO

 

By that logic, you could say that car seats aren't necessary or bike helmets. Many of us didn't have that as a child. (Actually I do hear those arguments all the time.)

 

I think though that we pretty much agree. Important, yes. Forcing, no.

 

And agreed, it sounds as a lot of the angst could have been avoided if the doctor had either explained things better or respectfully disagreed with the patient but respected her wishes. I know I've had patient encounters that went poorly and in the end I look at it as my failure. Communication is a large part of the job.

[coffeefreak]

Our peds not only don't look, they tell the child that no one, not even a Dr has the right to look unless you give them permission, and the only reason to give permission is if you are have problems down there. Meanwhile, they are chatting with parent and child, VERY nonchalantly about puberty, and what you're experiencing. My youngest has had a rash for a month now, and every time they need to look under her shirt, they ask permission and let her lift it up.

 

I would find another Dr.

[mommymilkies]

Logic fail. No where did I post where anyone should be forced by the doctor, or even a parent. I do believe that getting over a fear of these exams is important, and that if handled correctly there are no psychological risks.

 

Logic fail? How tactful. You also said her logic failed because it was checking for rare and obscure problems and the risks (psychologically) were outweighed by the benefits. I never said you said a patient should be forced-I only agreed with her that in the issue at hand (child not ok with privates exam by doctor), the risks of forcing an exam were much less than the benefits of finding a rare issue with puberty or adhesions.

 

Thank you, Alice, for explaining. I am a former Andrologist/CNA/EMT and I would never personally be able to go through with an exam of an adult or child against their consent. It's one thing if it was for a medically necessary treatment (hernia, etc.), but just to check for pubic hair? Not ok, in my book. There should be more respect for a person's bodily autonomy. Some HCPs violate that trust. And *that* seems to be the issue at hand. We can not teach our children to protect themselves from unwanted touching/looking and then force them to undergo an exam of their privates against their will. I have one child with profound Hashimoto's who gets a quick and noninvasive peek (after her doctor asks for her consent!) to check for precocious puberty and to see the progress of her medication. That is ok. But my 11 yo is at an age where she is NOT ok with it and has no medical need for it. I would not be ok for a doctor to look without her permission. Because as much as we like to think that just because someone is a doctor makes them benign, the records show that that is not always the case. I would not force them to approve because all HCPs are trustworthy. They aren't-nobody should be trusted solely because of their credentials.

[Dealea86]

By that logic, you could say that car seats aren't necessary or bike helmets. Many of us didn't have that as a child. (Actually I do hear those arguments all the time.)

 

I had both bike helmets and car seats as a child, btw. ;) But I get your point. In one of my drafts of that post (yes, I made drafts of forum posts....:tongue_smilie:) I said that I give my daughter vaccines that I didn't receive as a child. So I think we're really pretty close on this one. :)

[coffeefreak]

We look in younger kids to see if it's precocious puberty. We look in older kids to see if the stage of puberty matches everything else. Let's say a 10 year old is less than 5% for height. Maybe not a big deal, but if her puberty staging shows a Tanner V, that would be concerning as a sign that perhaps she is not going to grow anymore and might lead to a whole work-up or diagnosis. Let's say a girl starts developing hair and breasts at 11 , she should start her period within a couple of years. I see that same girl the next four years and she still hasn't started her period, it's a red flag to me that something else may be going on.

 

Let's say a girl is developing on the early side but is too embarrassed to tell her Mom (very very common). When I see that she is starting to develop, I usually make a general comment about whether she has any questions about her body changing and make sure the Mom has talked to the girl about puberty. I've frequently had girls where the Mom has not yet had that conversation and is grateful to know that it should be sooner rather than later.

 

Let's say it's a 16 year old who is shaving her pubic area and causing folliculitis, more common than you might think.

 

We also look for hernias and in boys we look for undescended testes, hernias, and pubertal development.

 

It's fine to refuse it and it's fine to tell your kids it's ok to refuse it but that doesn't mean it's worthless.

 

I truly respect your answer and appreciate you saying all this, but can't you ask questions and get your answers without looking if the child refuses? I will admit, if a 16 year old has folliculitis, I would tell her she will HAVE to let the dr look in order to get help. That's not what I'm talking about. I'm talking about in the case of developing early, or late, can't you check under the armpits, or ask about the changes before going straight to looking?

 

I ask because I think it's good for everyone to get a good education on what is "Normal" for a Dr's visit and what is not. I still would let my 11 dd say no, but you've at least educated me on the reasons the Dr might want to look. In your examples, I could answer all the questions the Dr was asking, but I understand not all parents would be able to.

 

Blessings!

Dorinda

[61Keys]

Maybe I missed it but I haven't seen this mentioned.

 

Mom was already uncomfortable with this dr before going in. I know my kids would have picked up on my feelings in a heartbeat no matter how hard I tried to hide it. The lack of trust going in combined with the personal nature of the exam was just too much for this child. I wonder how she would have responded if Mom had better feelings towards this dr? Either way, I think it is now time for this child to have a new dr.

[mommytobees]

My daughter is 15 years old and this has never been done to her.

 

Thank GOD for Family Practice doctors with common sense. Curious...was this a pediatrician? They really go overboard, from what I've been told.

 

Yup!

 

I'm requesting a new PCM to be assigned tomorrow.

 

I will NOT be subjecting my dd to that again.

 

I've yet to decide if I'm going to file a complaint.....

 

Kris

[mommytobees]

I am wondering if she wanted to check whether or not she had p*bic hair to determine the stage of puberty? Quick glance type thing?

 

Regardless, I think the doctor handled that poorly, and I think your support of your daughter was the right thing to do.

 

I would talk with your daughter about it and ask if there was anything in particular that bothered her about it? If she didn't like the dr, if she would feel better without you in the room, etc. (I also experienced the sense of being embarassed to have the exam with my mother in the room but not feeling like I could tell her that.) I would talk about why drs may want to examine her, and that there WILL come a time when it is necessary.

 

But, for a well child check up, with no issues in the area, and in the absence of precocious puberty, I think standing up for a child who is saying NO loudly and clearly, particularly with a doctor with whom she has a poor rapport, when she is obviously terrified is the right thing to do. She needs to know that you are on her side. It may make it easier if there comes a time when you do have to insist. It would, however, make me want to address that, since it is a radical change. However, sudden modesty in an eleven year old is pretty normal, esp if puberty is starting.

 

Forced exams can be traumatic. They aren't necessarily going to be, and they shouldn't, but if a child is terrified and adamantly opposed, it can feel very much like a violation and cause long-term anxiety.

 

We had a few conversations this afternoon. As a "true" homeschooler, DD spent the afternoon buried in every "s*x ed" book we owned, forgoing her regular school work.

 

If the doc wanted to know about hair she could have asked... I did!

 

I will NOT allow a forced exam on my dd. I had one when I was a kid and it was BAD BAD BAD.

 

We did discuss there WILL be a time in the future that she'll have to have a visual exam down there and eventually a physical exam. BUT, she needs to have time to mentally prepare for that eventuality. We had a discussion about her brother's birth (she was a c-section). She was grossed out, but wanted details. So, we discussed them.

 

Kris

[QuirkyKapers]

I would have respected my daughters no too unless being checked had something to do with why we were there for the visit. The question that came to my mind was, what if the same child refuses year after year? Would you think that is o.k. or would you think it was a red flag?

[BigMamaBird]

I said any age. However, my 3 year old son hates having his ears checked, sorry Bud, you're getting your ears checked. But for something like you described, the private area, if there were no complaints from the child about the area, if they don't want the Doctor to look at or touch it, they don't have to.

[Alice]

I had both bike helmets and car seats as a child, btw. ;)

 

Oh goodness, I think I just showed my age. ;)

 

I truly respect your answer and appreciate you saying all this, but can't you ask questions and get your answers without looking if the child refuses? I will admit, if a 16 year old has folliculitis, I would tell her she will HAVE to let the dr look in order to get help. That's not what I'm talking about. I'm talking about in the case of developing early, or late, can't you check under the armpits, or ask about the changes before going straight to looking?

 

I ask because I think it's good for everyone to get a good education on what is "Normal" for a Dr's visit and what is not. I still would let my 11 dd say no, but you've at least educated me on the reasons the Dr might want to look. In your examples, I could answer all the questions the Dr was asking, but I understand not all parents would be able to.

 

Blessings!

Dorinda

 

Yes, absolutely. My experience, however, is that most kids are just as embarrassed about talking about development. So, yes, if they refuse I could explain what I am looking for and ask them questions without an exam but I'd prefer to do the exam myself. It's quicker and more matter of fact. Which brings me to my favorite response ever, in a 5 year old boy who asked me if he could just "check it himself and get back to me if there were any problems". We can always ask questions, it's just that an 11 year old might not know what is normal or might be just as embarrassed about detailed questions about their development as they would a quick peek. It's really going to depend on the kid.

 

My experience is that often the kids who have problems (like folliculitis) don't always report it and are sometimes too embarrassed to ask questions. I've seen kids with abscesses or STD's who didn't ask but who were glad I think to have the problem discovered and treated.

 

My examples weren't meant to be why we should force someone who refuses but why we even look in the first place.

 

I would have respected my daughters no too unless being checked had something to do with why we were there for the visit. The question that came to my mind was, what if the same child refuses year after year? Would you think that is o.k. or would you think it was a red flag?

 

I wouldn't on it's own. The few kids I have seen who refuse usually do refuse again and again. They are more modest or more sensitive or whatever. It usually doesn't surprise me that they are going to refuse again.

Edited May 23, 2012 by Alice

[mommytobees]

I voted "other" because I feel you should have prepared her for the exam. You might have avoided the situation by either talking her through it beforehand, or going to a different doctor.

 

If your daughter would have refused to allow any doctor to examine her, even with all the preparation in the world, then that's a problem. I would wonder if there were any "issues" going on beyond just normal girl modesty.

 

I did prepare her for the exam, just as I do all exams. My other child is an Aspie and if you don't go over every. single. detail. he won't cooperate. So, I'm used to detailing out what to expect.

 

I didn't expect her to go under her undies. I didn't even know that was an issue. We've had doctors ask about her privates, but never want to look since she was little.

 

Kris

[mommytobees]

Really? :confused: Would you still wonder if it was your own child, a child you know well, or does this make you wonder about the OP's child, or are you saying that the doctor may be wondering if there are issues?

 

Of course it's possible there's some "issue" but I think developing modesty and physical boundaries is a normal developmental stage. This particular girl may just trust that if she's unwilling to have her privacy invaded in a way that makes her that uncomfortable then she has a right to say no, even to a doctor, and her mom will back her up and allow her to make that choice.

 

Cat

 

I asked if anyone has touched or even looked at her naked (other than me, cause I know I've seen her naked in the past month) and she said :001_huh: "no".

 

I agree that this is just her developing modesty and physical boundaries. I chatted with a friend of mine who has 5 girls and she said each of hers when they hit 10-12 they each resisted strangers seeing them naked and sometimes even people they knew. They would still streak in front of their mother/sisters/little brother.... but they just didn't want other people to see them.

 

Kris

[mommytobees]

I would not have prepared my daughter for that kind of exam. It would never have occurred to me that a doctor would want to perform an exam like that at a simple well child exam. A doctor has not asked to look at my girl's pr*vate area since they were babies.

 

Oh good!! I'm glad to know that I'm not alone here. 1) I didn't expect my dd to object to her pants being removed and 2) I did NOT expect the doctor to look at her privates.

 

Kris

[mommytobees]

I'm a pediatrician and I've responded to this kind of question many times on these boards.

 

I was hoping you would respond, thank you!!

 

In your poll, I answered "any age". A child always has the right to refuse, although I suppose I am technically forcing myself on the 18 month old who screams at the entire physical exam. Common sense says the parent has the ability to consent for the toddler. I guess I'd say there is no absolute age. It depends on the situation and the child and the parent. A very precocious two year old might refuse and Mom is ok with letting her make the choice, I'd honor that. An immature five year old might refuse but be having some kind of issue and the parent might insist and help hold the child for the exam. I'd certainly say I will not force it on any child over the age of say 8 or so, even if parents want me to.

 

I think kids/teens have the right to refuse. However, I do think there are important reasons we do the genital exam in girls and boys. I consider it part of my job to try and explain that to a child without being rude or aggressive. If I explain it and they still refuse, I write "refused" in the chart and we move on. I've often had kids who have refused for several years agree to it when they get older and understand more the reasons. I think it is important for kids to realize that we aren't doing it for some weird reason and that a quick genital exam by a physician with a parent present or consenting is very different from someone inappropriately touching or looking at them.

 

This doctor didn't explain anything. My dd is smart and very articulate and needed information. Heavens, _I_ couldn't figure out what needed to be checked on an 11-year old girl to be able to fudge it in the 10 seconds I had to explain.

 

We did discuss the difference between a stranger and a doctor, but honestly, this doctor WAS a stranger. She didn't talk TO my dd, she talked _about_ my daughter. Whenever there was a question it was asked of me.... even when we were talking about her poops!!! I mean really! I don't know how often she poops!! If she isn't having problems then she doesn't tell ME about it!!! :001_huh:

 

 

I also think this is an area where it really helps to have a doctor that you know and trust. I rarely find a kid refuse when I've seen them for many years. It's just kind of one those awkward things they roll their eyes at but understand. But if it's someone meeting me for the first or second time, it's much harder.

 

THis is hard for us. We move every few years and I prefer to stay in the military healthcare system. That comes at a cost.... this cost is that she's had 2 doctors here and we've lived her for less than 1 year. Her first doctor was wonderful, but quit the military healthcare system. SIGH. I may have to take my dd/children out into the civilian system.

 

ETA: I don't know what your daughter's health issues are but in some cases a thorough exam, including a genital exam, may be even more important. For example, abdominal pain. She still would have the right to refuse, but in that case I might try harder to convince her as a physician. Hopefully, that can be done in a respectful way, but I'm aware that all too often we physicians can be rude and too aggressive.

 

She really doesn't _have_ health issues. She had something which turned out to be mono in December. We took a round-about way to figure it out and it was some strange strand.... her first Ped's doc, the ID, and Hem/Onc all decided that in 6-months we needed to do a full blood workup and see how she looked "healthy". Just to make sure there wasn't something else going on with her.

 

This is why I pushed her to have the physical exam in the first place... she needed to be seen and have her body examined. However, the push for the genital exam was over the top. She has the right to say no and as her mother _I_ have to back her up and refuse content to check.

 

ETA: I wanted to add that in my experience it's very very rare for kids to refuse the exam when they've had it explained to them matter of factly and when parents are fairly matter of fact about it. I have had that be the case but my experience is much more that they are embarrassed but ok with it.

 

I hope that is the case here. Maybe next time she'll be unhappy about it but comply. We discussed what happens at my exams (she asked) and what would happen at _her_ exam. I think with the next doctor we will be discussing it WITH the doctor first and will still give her the ability to refuse... but to refuse with comprehension of what to expect.

 

Thank you for your post. I really do appreciate it!

 

Kris

[mommytobees]

I wanted to clarify that while I think the OP should have prepared her DD, if she has been getting well child checks since birth and every year has had her private parts checked without any issues, and because of that, the mom didn't remind her that, just like every other year, the doctor would need to look at her private parts, it is totally understandable. Because my children are used to this happening during yearly check ups, I see no need to remind them each year before the apt. that the doctor will look at their private parts. So was this the first time that your DD reacted like this? Was she fine getting a full exam at age 8 and 9?

 

Again, we did prep for the exam.... I just had no idea the doctor was going to look under her undies.

 

We've had numerous doctors over the past 11 years. Negative side of military life. I can't help it nor can I do anything about it. We don't have the doctor/patient relationship built up over the years.

 

As for her last exam, she stripped down to her undies in 30 seconds. Didn't care a lick. It was just under a year ago.

 

BUT, no one has looked under her undies since she was a baby. Really, since she wore a diaper.

 

Kris

[mommytobees]

I was a little unclear. Did the doc actually want to do a pelvic exam? That's out of line on an 11 year old. Or did she just want to look at her structurally.

 

No, not a pelvic. That _I_ would have refused right off. No, this was just a spread the legs and look kind of exam.

 

Kris

[mommytobees]

I am actually curious whether this was a pediatrician or a GP. Because I've *had* issues like this (not with this same topic) with my kids and (civilian) GPs in the military system (implying a threat to call CPS or something if I did not agree to do X or Y), but never a pediatrician.

 

This was a Pediatrician. She is a civilian but has worked at a MTF for most of her career (it was in her bio).

 

Kris

[whitestavern]

I haven't read all the replies, but my kids' ped has checked their "private" areas at every yearly checkup since they were small, so it's normal for us. It's pretty quick, noninvasive, and he always tells them that it's part of the physical exam, that Mom's in the room and that he's a doctor, and those things make it okay. This last visit (my dd's 12 year checkup) he had a couple of recent med grads in the room and he asked them to leave prior to him doing that part of the exam.

[mommytobees]

I wouldn't have expected that either. Why would I? I'm not a doctor. I don't know what the protocol is. And I was 11 a million years ago (so I'm now 1 million and 11 :tongue_smilie:).

 

LOL!!!! Well, just so we know........ did you wear a helmet while riding a bike and have a car seat when you were a kid?!?!?!?!

 

Kris, who didn't have either

[Melissa in Australia]

other

I have said this before on other related threads.

I am fortunate enough to live in a country that doesn't subject their children to such degrading examinations, where people go to the doctor when they are sick,not for well-checks and the general health of the population is one of the best in the world.

 

Personally I get the impression from this board that the majority of American doctors are perverts.

[The Girls' Mom]

I have three daughters, and have been to many, many doctors. Never, not once, has a doctor even requested a look at their private parts once they were past the age of 3!

 

I cannot imagine subjecting my 11 year old girls to that. They would be beyond mortified. They don't even let ME in the room when they are changing.

[Greta]

It is a valid part of a routine physical, and numerous posters have questioned that throughout the thread.

 

I question it because it has NEVER been a part of a routine physical for either myself when I was growing up, or for my daughter. Our family doctor is great, and he has talked to my daughter about her periods, and did a good job of making her feel as comfortable as possible about a topic that was clearly uncomfortable for her. He's also the kind of doc who lets you keep your regular clothes on instead of changing into a gown, always explains what he's doing before he touches you, and goes out of his way to enable you to maintain your modesty and dignity throughout the process. He has been our family doctor for eight years now, I trust him and respect him. He has never asked to examine her genitals, but if he did, I know he would have a good reason to do so, that he would EXPLAIN that reason, and that he would try to make her feel as comfortable as possible.

 

The scenario the OP describes sounds very different. First time visit. Little or no explanation. And it doesn't sound like there was a whole lot of concern for the child's feelings. I'd refuse that too. And look for a new doctor. Bedside manner matters. A lot.

[Trish]

Don't remember doing any stripping down with doctors as a kid. But when she's a little older it would be time for a gyn thing, at which point it would be appropriate (unless she's having a problem sooner). I think I'd look for another doctor.

[Word Nerd]

It is a valid part of a routine physical, and numerous posters have questioned that throughout the thread.

 

It's not part of all routine physicals for kids, as many posters have explained, so it's hardly unreasonable to question whether the practice is necessary.

[mamajag]

Our ped does a quick check at the boys' checkups, but he *always* asks them and me for permission.

 

Cat

 

I agree. My kids' ped asks to take a look every couple of years, BUT he has always asked both me and my kids and makes sure to tell them if they change their mind in the middle it is perfectly okay. They have no problem with him looking but are a little embarrassed.

 

If he had made an issue out of a refusal, he would no longer be their ped. He knows about my abuse situation and how protective I am because of that and asked me privately if I was okay with it before even bringing it up in front of them.

[mamakim]

This was a Pediatrician. She is a civilian but has worked at a MTF for most of her career (it was in her bio).

 

Kris

 

 

We've been in the military health care system all of our dc's lives, too.

 

a) My girls have never, past toddlerhood, been asked to have this area examined. Just recently the boys have been asked to allow a "private" check.

 

b) The time we received similar CPS threats (over a different issue) it was also a career civilian pediatrician in the military facility.

 

c) As a generalization, doesn't it seem like military providers are so much more used to never being crossed or even questioned than those on the outside? And much less open to a collaborative approach to healthcare. When I find an exception it's such a thrill :D.

[Harriet Vane]

Unless there is some specific problem or health concern, there is NO reason for this boundary to be pushed. My sympathies are entirely with your dd. I would probably have gone all mama-bear on the idiot dr over this one.

 

Get a new dr.

[Bluegoat]

other

I have said this before on other related threads.

I am fortunate enough to live in a country that doesn't subject their children to such degrading examinations, where people go to the doctor when they are sick,not for well-checks and the general health of the population is one of the best in the world.

 

Personally I get the impression from this board that the majority of American doctors are perverts.

 

Perverts might nott be the best word, but it is pretty well documented that American medical practice has aggressiveness as one of its major characteristics.

 

We don't have well checks for older kids here either, and I have never heard of doctors doing a "quick check in the underwear" for kids when they do come in as a routine matter. In general women get checked when they start having paps after becoming sexually active.

[ChocolateReignRemix]

other

I have said this before on other related threads.

I am fortunate enough to live in a country that doesn't subject their children to such degrading examinations, where people go to the doctor when they are sick,not for well-checks and the general health of the population is one of the best in the world.

 

Degrading? I think that is a bit extreme.

 

Personally I get the impression from this board that the majority of American doctors are perverts.

 

I know this is extreme, and quite offensive.

[TranquilMind]

Bluegoat: Perverts might nott be the best word, but it is pretty well documented that American medical practice has aggressiveness as one of its major characteristics.

 

You forgot that they suffer from the "god-syndrome", are condescending, and ridicule patients who have done their own research. Not all, but lots. I've met them.

 

 

We don't have well checks for older kids here either, and I have never heard of doctors doing a "quick check in the underwear" for kids when they do come in as a routine matter. In general women get checked when they start having paps after becoming sexually active.

 

I think it's insane.