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What's normal at physicals?


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Long time lurker here finally asking a question!

So I took DS12 and DD14 to the doctor today for their first yearly check-up in quite a few years and the new nurse practitioner we went to was a bit more thorough than I was expecting her to be, at least for DS.

DD stayed fully clothed the entire time but at the end of DS' exam she put on gloves and asked DD to step outside for a moment. 

She then asked DS to pull his pants and underwear down and then she felt each testicle, had him "turn and cough," and then she pulled his foreskin back. Finally, she had a brief conversation with him about when he can expect puberty to start as well as proper foreskin hygiene, then she told him he could get dressed and called for DD to come back into the room. 

DS obviously was pretty embarrassed by the whole ordeal and thought it was really unfair, and DD is asking questions too (the door was thin enough that she could hear everything from outside).

So I'm just wondering are boys' physicals usually that thorough (especially compared to girls)? Obviously, I don't think she was acting inappropriate or anything, but was all that (especially the foreskin stuff) necessary, especially with his sister in earshot? What happens at your kids' physicals?

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Well, I took my 18 yo ds for a physical before he went to college. I was in the room when the Dr came in, stepped across the hall to quickly use the bathroom (and give ds privacy), and was called back into the room by ds because the Dr was done. I think the "physical" lasted maybe 5 min. No labs drawn, no checking of anything, just a couple of questions answered. The physical your ds was what I was expecting for my DS.

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I remember 40 years ago my brothers telling me that was how their physicals went (sports physicals for school).  So it doesn't sound strange to me - maybe more unusual that your son didn't mind you being in the room for that.  😛

My daughters' physical at a "doctor's office" around the same age was a bit weird for them.  IIRC it was the moment the NP decided to put her hand down their pants to see/feel what it was like down there.  I understand the point, but she should have warned them first that she was going to do that.  They felt kinda violated.

Normally I have my kids' physicals done by their chiropractor.  A lot more relevant stuff checked and no privates touched.  (But maybe they would touch for a boy - I guess they are checking for an injury that would matter for a kid in sports.)

Edited by SKL
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Sounds pretty similar to my experience.  I am glad they do the checks, because they found a problem with one of my son's when he was a bit older than typical that could have led to future fertility issues.  My kids have physicals every year because they need them for summer camps.  They have had a couple different doctors and they have all done checks of their private areas.

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9 minutes ago, SKL said:

I remember 40 years ago my brothers telling me that was how their physicals went (sports physicals for school).  So it doesn't sound strange to me - maybe more unusual that your son didn't mind you being in the room for that.  😛

My daughters' physical at a "doctor's office" around the same age was a bit weird for them.  IIRC it was the moment the NP decided to put her hand down their pants to see/feel what it was like down there.  I understand the point, but she should have warned them first that she was going to do that.  They felt kinda violated.

Normally I have my kids' physicals done by their chiropractor.  A lot more relevant stuff checked and no privates touched.  (But maybe they would touch for a boy - I guess they are checking for an injury that would matter for a kid in sports.)

I wouldn't say he didn't mind, but she asked me to stay since office policy is to have for under-16's so he didn't really have a choice.

1 minute ago, Loowit said:

Sounds pretty similar to my experience.  I am glad they do the checks, because they found a problem with one of my son's when he was a bit older than typical that could have led to future fertility issues.  My kids have physicals every year because they need them for summer camps.  They have had a couple different doctors and they have all done checks of their private areas.

What did the checks consist of?

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I think it was totally inappropriate for her to have been the one to manipulate his foreskin (she could have asked him to do it, to see if it was retractable yet, but even that is unnecessary to me at that age, as it’s really not relevant or a concern until the end of puberty; she could cause a problem if she retracted more than it was naturally ready for). I also think it was inappropriate for your ds not to have been offered for you to leave for that part, given his age (though then there should have been another adult in the room). I think that would be mortifying for many 12yo, and they deserve more bodily respect than that. 

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1 minute ago, vivianalicethompson said:

What did the checks consist of?

The privates checks for my sons include checking for signs of puberty (when they are younger), making sure testicles are descended, the cough test to check for a hernia.  I don't recall any checks of the penis since they were pretty little, but I don't look during that part of the exam obviously.  For my daughter checks seemed to stop after puberty for "down below", but they do a breast exam, especially since they have found lumps in the past.

My children have always been given the option of me waiting in the hall or waiting room if they prefer, which I think is something that is important for their comfort and privacy.  All of them, so far, have wanted me to stay.

I would also say that if you son felt uncomfortable or violated, you should mention that to the doctor.  I feel it is important for doctors to get permission, especially in private areas.  After a certain age, probably around 9 or 10, the doctor always explained that part of the exam and got permission before proceeding.  I think a lot of doctors just have their routine and don't think about how it may make the patient feel, it would be good to remind them.

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1 minute ago, Loowit said:

The privates checks for my sons include checking for signs of puberty (when they are younger), making sure testicles are descended, the cough test to check for a hernia.  I don't recall any checks of the penis since they were pretty little, but I don't look during that part of the exam obviously.  For my daughter checks seemed to stop after puberty for "down below", but they do a breast exam, especially since they have found lumps in the past.

My children have always been given the option of me waiting in the hall or waiting room if they prefer, which I think is something that is important for their comfort and privacy.  All of them, so far, have wanted me to stay.

I would also say that if you son felt uncomfortable or violated, you should mention that to the doctor.  I feel it is important for doctors to get permission, especially in private areas.  After a certain age, probably around 9 or 10, the doctor always explained that part of the exam and got permission before proceeding.  I think a lot of doctors just have their routine and don't think about how it may make the patient feel, it would be good to remind them.

 

Are they circumcised?

And I think violated is way too strong a word. He was definitely embarrassed but she did ask permission and he did say yes.

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4 minutes ago, vivianalicethompson said:

 

Are they circumcised?

And I think violated is way too strong a word. He was definitely embarrassed but she did ask permission and he did say yes.

One is, one isn't.

I think it can be hard to say no to a doctor, even if you want to.  Maybe if you do it again in the future you could talk to him ahead of time and if he doesn't want the exam then he can have you be an advocate.  Although it might help to explain why the do they exam.  It is not pleasant and can be embarrassing, but sometimes it makes them feel better when they understand why it is being done.

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My son (16) had two physicals in a row this summer (I was trying to make sure he had an up to date physical for school sports before we moved to make it easy to transition onto a high school soccer team, it turned out the new school would not take out of state physicals. Sheesh.)

So, at his physical in early July, our pediatrician that we really liked did not check his privates and told me that the American Academy of Peds no longer recommends the cough test unless there is a problem...)

Then at his physical in early August at an acute care walk-in place, the doctor brought in an assistant and told us a weird story about needing someone in the room to back him up and parent permission (to avoid a law suit) before he would perform a physical including a check of his private parts. I mentioned that my son just had a physical and his previous doctor said it was not necessary... he responded with “that’s highly doubtful” and said he would not sign the form allowing our son to play any school sports without the full physical. It gave me a really yuck feeling. Luckily my dh was there, he felt like it was fine and stayed in the room for the exam. He said it was fine, a quick check of parts, a cough, etc.

Anyway, no way to know if that doc was a perv, but I am for sure not going back there, ever. Sorry it was an uncomfortable exam for your son, too!

Edited by WendyLady
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My son, my only boy, is only just now 7 and we haven't done many phsyicals as I tend to be a "establish a relationship, then take them in when they are sick." sort of mom.  

However, in terms of girls, what I can say is that I am not in any way surprised that your DD didn't received any sort of unclothed exam.  There would be pretty much nothing to examine.  In addition, it's my understanding that the first gynecology exam isn't usually recommended before 15 or................when the teen begins to engage in activity.  As you know, a gynecology exam involves much more.

SO, all that to say that while I can't comment on just what is or isn't typical in a boy's exam.....since he will never undergo what reproductive age women undergo to keep their reproductive system healthy, I can't say that I find it all that extraordinary.

 

(but again, my son so far hasn't had many physicals, and he's only 7, so no puberty talk necessary.)

 

I will say, on one hand I find it interesting that the doc didn't give the same puberty talk to your DD, but if your DD has already begun her cycles, the doc may have assumed, incorrectly or otherwise, that you have already taken her to a gyn specifically.  When I had my oldest begin her gynecological exams, I think she was 15 or 16 and I only took her to a female gyn, NOT the regular doc.

 

 

And with that, I am curious....is there a male equivalent of a gynecologist that boys would go to?  Urologist doesn't seem right, but maybe?

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Our pediatrician, who all the kids have seen since they were born (so for over a decade), has always done a genital check during annual physicals.  She always tells them what she is going to do, always mentions that it is only okay for someone to touch them there if they are a doctor and have the child's parent's permission, and then does the exam quickly and matter of factly.  She also always pulls their pants down far enough (as they lie on the exam table) to check pulses in their thigh/groin area.

I don't know how the routine might change as the kids get older, but I do know that as of 10 years old it remained the same.  We, however, decided that 10 years old was a good age to stop having siblings present during exams so we made arrangements for DH to watch the others while I took DS to the doctor.

Wendy

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5 minutes ago, happysmileylady said:

And with that, I am curious....is there a male equivalent of a gynecologist that boys would go to?  Urologist doesn't seem right, but maybe?

I think urologists are just for when there's problems. I think their general doctor just covers it at annual exams.

4 minutes ago, wendyroo said:

Our pediatrician, who all the kids have seen since they were born (so for over a decade), has always done a genital check during annual physicals.  She always tells them what she is going to do, always mentions that it is only okay for someone to touch them there if they are a doctor and have the child's parent's permission, and then does the exam quickly and matter of factly.  She also always pulls their pants down far enough (as they lie on the exam table) to check pulses in their thigh/groin area.

I don't know how the routine might change as the kids get older, but I do know that as of 10 years old it remained the same.  We, however, decided that 10 years old was a good age to stop having siblings present during exams so we made arrangements for DH to watch the others while I took DS to the doctor.

Wendy

What does she do to examine them?

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I take my kids to a doctor who gives 1 full hour for physicals. Part of the reason I stay at this practice, is that it is doctor owned and there is no rush while there.

There is about 15 minutes of discussion of medically relevant information. ie medications, different doctors following their care and updates in those areas, etc.  (Ds has barely any, both of my daughters could fill 30-45 minutes). The kids get into gown/shorts with underwear on (depends on what they are wearing). There is the exam which I am present for to a certain extent and then the doctor asks how to proceed from there (especially in regards to undressing). He allows as much privacy for the child as possible, within the parents comfort level. For ds I used to leave for parts of the exam, for dd13 I don't leave at all. He is completely fine either way, but a nurse goes in, if he is examining the girls without the parent. There is a history of testicular cancer in dh's family so there is extra attention on ds due to that. Before they are completely dressed, the doctor lightly talks about development and asks for any questions from the kids. (He asks when I am not in the room, so the kid can ask questions without me being there).  After they are dressed, we all meet again, and go over it all.  For ds, it is about 30 minutes in total, start to finish. For dd's it usually takes a full hour.  Any shots or blood tests are at the end (unless the parent asks to get them out of the way). 

When ds was about 15, he started going back by himself. At the end, I check in the with doctor to get an 'all clear' and we head on our way.  For gyn exams, I have the ob/gyn do them for the girls. We have one who specializes in 12yo-young adults.  She only examines what she absolutely has to and has the tools/expertise to make them comfortable. Due to this, the pcp skips this part of the exam once they see the see the gyn. 

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13 minutes ago, vivianalicethompson said:

What does she do to examine them?

She has them pull their pants down to mid-thigh, keeping their underwear on.  She pulls down the front of their underwear just enough to lift their penis up (I assume looking and feeling for anything notable as she does so) and then feels each testicle.  The whole things takes 30 seconds.  Then the underwear gets pulled back up and she feels the pulse in their groin area.  Then their pants get pulled back up and she moves down to rotate ankles and examine feet.

One reason I chose this pediatrician is that she was not overly pro-circumcision.  My boys are not circumcised, and the only time the doctor has ever manipulated their foreskin at all was when one had a bad diaper rash as a baby.  When they were little she always told me to just wash their penises like any other body part and otherwise just leave them alone.  Again, I don't know how that might change as the boys enter puberty.  At this point, I absolutely trust our pediatrician completely, so I will respect her opinion as to best practices at various ages.

Wendy

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Many Canadian family doctors use the Grieg Adolescent Record as the periodic health exam/check-up template.  The website is inefficient to browse, but chock full of information and based on evidence as much as possible.  There is good evidence to support many of the counselling/talk-based bits, and not much good evidence for any of the physical exam maneuvres - recommendations for physical exam are mostly based on consensus opinion.   Different doctors are going to have different ideas about what's important based on their own clinical experience.  Genital exam for sexual development staging and screening for hernias isn't inappropriate, but it''s  also not really supported by evidence.  And neither is any physical exam maneuver at this age, really (for screening/check-up purposes in asymptomatic patients without risk factors.)  Read the Technical Report:

"Physical Examination: Consensus opinion supports the inclusion of height, weight, blood pressure and visual acuity screening as part of the physical examination. Headings for other examinations have been included as reasonable for the purpose of case-finding."

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It’s interesting to me that the kids were together for most of the exam. I don’t recall ever having a physical with my sister, let alone my brother. I could see this for younger ages, but the daughter is already a teenager. It makes me feel uncomfortable even thinking about having a physical at age 14 with my brother in the same room. I’m assuming the OP paid for two physicals, not one. So why combine them?

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I too was surprised they had the 12yo boy in with the 14yo girl.  But if they don't do anything invasive to the girls, then I guess it makes sense.

My daughters, who are the same age and grade, do pretty much everything together.  It would be more weird if they were separated during a physical.  It gives them a lot of comfort to know they have a shared experience and discuss it later.  Maybe this will change as they get older though.

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Our pediatricians (group practice) will peek under the waistband of the underwear to check that things look ok, and to check for stages of puberty, but that's it. Pants/undies don't come off, and I can't think of any reason a doctor should be retracting a foreskin on a child.

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My son is 30 but I know they checked his private areas and I am so glad they did.  He had undescended testicles and had surgery once as a small baby or toddler(I do not remember exactly when that surgery was) and then a second one when he was 6 or 7 because they re-ascended.  I believe they kept checking him when he was still going to physicals.  He was circumcised so no issues there.

The girls were checked, I believe, just a quick peek to make sure there were no external genital issues or skin issues in that area.  Both of my girls had (and one still has) bad eczema.

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A check of genitals has always been a part of my boys' physicals. I can't remember from when they were little - but the doctor did actually find a hernia from this check when one boy was a toddler, so I'm glad they do it. More recently, the check and cough thing was definitely part of it. The foreskin thing... I'm pretty sure they asked them to retract it. And they definitely warn them. I'm going to check this, this is why. May I do this. Can you do this. Etc. Just abruptly diving into a genitals check... I mean, not cool. They'd never do that to adults. They'd warn them. They should warn the kids and explain too.

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17 minutes ago, TravelingChris said:

My son is 30 but I know they checked his private areas and I am so glad they did.  He had undescended testicles and had surgery once as a small baby or toddler(I do not remember exactly when that surgery was) and then a second one when he was 6 or 7 because they re-ascended.  I believe they kept checking him when he was still going to physicals.  He was circumcised so no issues there.

The girls were checked, I believe, just a quick peek to make sure there were no external genital issues or skin issues in that area.  Both of my girls had (and one still has) bad eczema.

They definitely check babies to make sure both testicles descend, but by the age the OP is describing that would no longer be an issue. 

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13 hours ago, wendyroo said:

Our pediatrician, who all the kids have seen since they were born (so for over a decade), has always done a genital check during annual physicals.  She always tells them what she is going to do, always mentions that it is only okay for someone to touch them there if they are a doctor and have the child's parent's permission, and then does the exam quickly and matter of factly.  She also always pulls their pants down far enough (as they lie on the exam table) to check pulses in their thigh/groin area.

I don't know how the routine might change as the kids get older, but I do know that as of 10 years old it remained the same.  We, however, decided that 10 years old was a good age to stop having siblings present during exams so we made arrangements for DH to watch the others while I took DS to the doctor.

Wendy

 

Last year (at age 11) my son asked that we find him a male doctor and dad take him to his physical. He doesn't mind me taking him to other doctors, but he's more comfortable with a man at that appointment.

 

Before that point my kids went to get physicals together. Their birthdays are a week apart and as long as they didn't mind, it made things easier.

Edited by vonfirmath
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4 hours ago, Ktgrok said:

I can't think of any reason a doctor should be retracting a foreskin on a child.


Probably to check for phimiosis? Something like 95% of uncircumcised boys can retract their foreskin by the time they're 10, so if a 12 year old can't then it's likely he has some sort of issue.
 

She also said that the NP discussed foreskin hygiene with him, which makes it seem like her son might have had some build-up under there, so they're probably checking for cleanliness too.

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32 minutes ago, dcmommy1 said:


Probably to check for phimiosis? Something like 95% of uncircumcised boys can retract their foreskin by the time they're 10, so if a 12 year old can't then it's likely he has some sort of issue.
 

She also said that the NP discussed foreskin hygiene with him, which makes it seem like her son might have had some build-up under there, so they're probably checking for cleanliness too.

Generally my thought was the have the child do it themselves, or ask if it can, if there is pain, etc. My understanding is that a non retracting foreskin with no pain is not actually a medical problem, although steroids may be warranted. I have a feeling hygiene is probably just a rote thing they say or she may not even know what she was talking about - there is supposed to be some smegma, just like there is supposed to be discharge with girls. Although maybe she was clarifying not to use soap under the foreskin, or something like that. 

 

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3 hours ago, Farrar said:

A check of genitals has always been a part of my boys' physicals. I can't remember from when they were little - but the doctor did actually find a hernia from this check when one boy was a toddler, so I'm glad they do it. More recently, the check and cough thing was definitely part of it. The foreskin thing... I'm pretty sure they asked them to retract it. And they definitely warn them. I'm going to check this, this is why. May I do this. Can you do this. Etc. Just abruptly diving into a genitals check... I mean, not cool. They'd never do that to adults. They'd warn them. They should warn the kids and explain too.

 

That's pretty close to what she did. She didn't just do it with no warning.

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3 minutes ago, Ktgrok said:

Generally my thought was the have the child do it themselves, or ask if it can, if there is pain, etc. My understanding is that a non retracting foreskin with no pain is not actually a medical problem, although steroids may be warranted. I have a feeling hygiene is probably just a rote thing they say or she may not even know what she was talking about - there is supposed to be some smegma, just like there is supposed to be discharge with girls. Although maybe she was clarifying not to use soap under the foreskin, or something like that. 

 

She just told him he needed to make sure he was keeping it pulled back when he went pee, and that he was pulling it back and rinsing every day, because he if he doesn't it'll start to get cheesy and smell bad.

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8 hours ago, Ktgrok said:

They definitely check babies to make sure both testicles descend, but by the age the OP is describing that would no longer be an issue. 

They don't always catch it when the kids are babies but I'd say they would usually catch it before the age of 4. (I know of a couple of 3 year olds that had 'button' surgery -- called orchiopexy.) I think I'm agreeing with you but clarifying age.

I think our pediatrician checks the size of each testicle when they are still under 10. I don't really know what best practices are.

Edited by RootAnn
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I think her biggest error was not making it clear to dd that she should walk down the hall or to the bathroom or breakroom. I would gently explain to dd that her brother's medical exam is private and she shouldn't ask questions about what happened when she wasn't there. 

That's definitely an age when I would be separating them for physicals. You can still bring them on the same day, but they are certainly old enough to stay in the waiting room while the sibling has their appointment. It's also an age when you can expect the doctor to start asking you to step out, so don't be surprised if that happens. They want to make sure the kids don't have questions they're embarrassed to ask in front of their parents. 

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  • 3 weeks later...
On 11/19/2019 at 8:33 PM, katilac said:

I think her biggest error was not making it clear to dd that she should walk down the hall or to the bathroom or breakroom. I would gently explain to dd that her brother's medical exam is private and she shouldn't ask questions about what happened when she wasn't there. 

That's definitely an age when I would be separating them for physicals. You can still bring them on the same day, but they are certainly old enough to stay in the waiting room while the sibling has their appointment. It's also an age when you can expect the doctor to start asking you to step out, so don't be surprised if that happens. They want to make sure the kids don't have questions they're embarrassed to ask in front of their parents. 

She was mostly just curious about why he needed a private exam and she didn't. The only other question she had was what do "foreskin" and "uncircumcised" mean. Thankfully, she waited until her and I were alone to ask me that one 😂.

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OP it says there are 37 replies as I begin writing this and I haven't read them.  How could your DD have received any kind of a Physical Examination, while fully clothed?

The examination of your DS sounds good. I suspect she was looking for a number of issues: Hernia, Undescended Testicle, and possible issue with the Foreskin,

There should be some lab tests (Blood and Urine) and the doctor or nurse should listen to the chest (Lungs) and check for possible Cardiac issues.

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  • 3 months later...

I know that a number of others have already responded, but to add in another experience based reply for OP, yes this is completely normal. My wife and I have custody of our nephew; I take him to his yearly physical. His pediatrician has done a genital exam on him each year. For the first couple of years it was a pretty quick check, long enough to make sure he didn’t have a hernia and that his testicles were descended. His underwear would be down 10-15 seconds max.

This past summer that part of his physical was a bit longer. She checked his penis and foreskin, checked both of his testes for lumps, as well as the hernia check, and talked with him a little bit about puberty. This is also what I remember experiencing as a kid/teen seeing the pediatrician growing up.

I think the thing your son’s pediatrician could have done better was communicate with you and your son. My nephew’s pediatrician sent us a note through MyChart when we scheduled his appointment letting my wife and I know that this year his exam would be a bit more thorough, and she recommended that we talk to him beforehand so he wouldn’t be caught off guard. But even a heads up before the exam started on the day of would have been better than the 5 seconds of warning you got when she asked your daughter to step out.

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Just a thought--many schools/camps will not accept a chiropractor's physical. Many will only accept a DO or MD. Just wanted to mention that. I'd hate to have someone go to that trouble and expense and then find out it won't be accepted. 

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Sounds like a completely normal exam for your DS. I'm surprised your DD didn't also have a quick check of her genitals to check for signs of puberty, unless the doctor could tell from developed breasts perhaps?

By those ages, my kids do not go to physicals together. After about 10yo, the boys have male doctors and my dh takes them, precisely because their genitals are checked. That way dh and ds can discuss what a male physical entails on the way to the appointment. I handle all the female physicals after 10yo, and the girls see female doctors. I have a similar conversation with the girls.

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On 11/18/2019 at 7:51 PM, WendyLady said:

My son (16) had two physicals in a row this summer (I was trying to make sure he had an up to date physical for school sports before we moved to make it easy to transition onto a high school soccer team, it turned out the new school would not take out of state physicals. Sheesh.)

So, at his physical in early July, our pediatrician that we really liked did not check his privates and told me that the American Academy of Peds no longer recommends the cough test unless there is a problem...)

Then at his physical in early August at an acute care walk-in place, the doctor brought in an assistant and told us a weird story about needing someone in the room to back him up and parent permission (to avoid a law suit) before he would perform a physical including a check of his private parts. I mentioned that my son just had a physical and his previous doctor said it was not necessary... he responded with “that’s highly doubtful” and said he would not sign the form allowing our son to play any school sports without the full physical. It gave me a really yuck feeling. Luckily my dh was there, he felt like it was fine and stayed in the room for the exam. He said it was fine, a quick check of parts, a cough, etc.

Anyway, no way to know if that doc was a perv, but I am for sure not going back there, ever. Sorry it was an uncomfortable exam for your son, too!

I assume the 2nd doctor needed to complete a full exam before he felt comfortable signing the permission slip, which is reasonable in my opinion. The doctor's beside manner may have been lacking, but I can see why he would not short-cut the process if he is signing a form that says he completed a full physical.

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