Unnecessary Genital Examination - Child Student Athletes

Michael Westhead | The Daily Knight

(Stocksy Untited)

As students return to school slowly, and sports seasons grind to a start parents will inevitably have to arrange for a sports physical exam for their student athletes. However, before following through on school protocol take this information into consideration, especially from a Catholic perspective.

Physical exams usually entail intrusive, intimate examinations and some have asked, “why”? It would appear that the genital and/or breast aspects serve no obvious connection to sports performance. Some posit that for males, it is important to check for a hernia, but the research does not bear this out and it may have additional psychological implications. “Ann Friedenheim, an Allentown psychologist with a specialty in sexual abuse, says young children are rarely bothered by having their genitals looked at by a doctor. But for a preteen or teen, it's a different story. A genital exam can tap into big issues in the child's emotional development.”

And then there’s this parent who writes, “My son almost didn't want to go out for football because he knew he would have to have an exam”. Likewise, Carolyn Moynihan deputy editor for Mercator Net and contributor to Crisis Magazine notes that the potential for psychological trauma is acknowledged by New York schools:

“It is very disturbing that some school districts such as this school district in New York require breast exams for girls and genital exams for boys as part of physical exams. This school gave out a handout encouraging parents to prepare their child for breast / genital exams. This is horrible. Children should never be forced to have breast or genital exams for physicals. There is no evidence that these are necessary to ensure safety of playing sports.” [1]

Additionally, she has found evidence that the physicians themselves are aware of the psychological problems. Dr. Sherman shares that he has seen female physicians blogging about how embarrassed boys gets during those exams and that this problem is rarely addressed.” [1] Joel Sherman, MD is a clinical physician and cardiologist practicing in Connecticut who goes on to note:

"Some male doctors have humiliated boys. One male doctor blogged using terms such as “hilarious”, “entertaining”, and “quite funny” to describe the embarrassment and humiliation felt by his young male patients during the hernia exam. This, after commenting extensively about the fact that he knew the exam was unnecessary and that he as a doctor had the option to omit it but chose not to. He talked about how he had to make a boy pull down his pants and underwear.” [1]

This practice is needlessly embarrassing at best, and downright disturbing at worst. Doctors should never persuade children against their will to reveal what is privately theirs. Dr. Sherman then goes on to destroy the asymptomatic hernia theory which supposedly justifies such examinations in boys. “It is doubtful that asymptomatic hernias affect one’s ability to safely play sports.” [4] In fact, it is clear that even the higher echelons of athletics do not see any reason to conduct these exams:

Hernia exams should only be done when the history indicates a possible problem. The NCAA 2008-09 Sports Manual doesn’t even mention the word hernia. There is no other need for genital exams to play sports. Given the total lack of evidence that routine intimate exams add to the safety of participants, the regular use of these exams should be abandoned.” [4]

Others have picked-up on the unnecessary nature of these exams. Morteza Khodaee, MD, MPH; Jeffrey A. Housner, MD; and Elizabeth M. Tweed, MLIS, AHIP write in the Journal of Family Practice - Clinical Inquiries that, “No patient-centered studies have evaluated the effectiveness of male genital examinations during a PPE.” [7] That’s right – none. Zero.

However, for girls, according to Dr. Sherman, the story is a bit different. “Girls usually have no further standard exams. They do not have to take off their bra or panties for most exams. Boys typically have genital and hernia exams done. This is considered a standard of care by some guidelines. The reason for this is unclear and the need for a genital and hernia exam is undocumented. Though some information as to the child’s development can be obtained by a genital exam, the exam is usually not pertinent to the ability to play sports safely.” [5]

But there is more. Although genital or otherwise intimate examinations may not take place at the time of a sports physical, they still find a way to be incorporated into the normal adolescent milieu for American teenage girls:

"An estimated 1.4 million adolescent girls and young women in the U.S. might have received an unnecessary pelvic exam between 2011 and 2017, according to a new study. And an estimated 1.6 million might have received an unnecessary Pap test. The authors of the study, which was published this week in the journal JAMA Internal Medicine, say the overuse of these procedures — which can cause false-positives and anxiety — led to an estimated $123 million annually in needless expenses in 2014 alone.” [6]

For those who are unaware, pelvic exams are incredibly invasive, are actually no longer recommended, and according to the CDC too over-practiced. “The American College of Obstetrics and Gynecology no longer recommends pelvic exams — which involve a physician inserting two fingers into the vagina, to check for abnormalities or infection — for most people under the age of 21, and hasn’t since 2009.” [14] Why then are millions of young women, adolescents, minors receiving these exams. Why are countless doctors inserting themselves literally into their lives! What’s more disturbing is the illusion that this practice is safe, recommended, and beneficial when in fact it does little if anything for the patient and clinician. Consider the complete un-usefulness of routine breast exams according to Dr. Muir Gray, the Director of Great Britain’s Department of Health National Screening Committee:

“Examination of the breast by a GP gives false reassurance, or raises unnecessary anxiety. There is no evidence that it reduces mortality. We do not think that the hand of another person (as opposed to the hand of the woman herself) is sensitive enough to detect the emergence of a new, discreet lump.” [9]

Evidence continues to mount against the use of pelvic exams, as well:

Ten years ago, Guiahi co-authored a study that had a similar message: pelvic exams may become obsolete with the advent of emerging technologies such as urine tests for STIs and self-administered vaginal swabs to test for HPV, which can cause cervical cancer. And yet, routine pelvic exams in asymptomatic women under the age of 21 are still happening.” [10]

Maryam Guiahi, is an OB-GYN and researcher at the Colorado University School of Medicine. In her own words:

"The reality is that doing a routine exam on an asymptomatic woman not only puts her in an uncomfortable position, literally, but it also often leads to unnecessary tests... So a provider might feel around and then think, 'Oh, maybe her uterus is a little bit bigger,' and then get an ultrasound.”

She adds, “That ultrasound can lead to a biopsy or other tests that, according to one systematic review, may not reduce the number of women who get sick or die from the conditions these tests are supposed to screen for. The exception is cervical cancer, and in that case only a visual inspection and Pap test are required.” [10]

The final word, according to a study published in the Journal of Women’s Health, is that, “No evidence identifies benefits of a pelvic examination in the early diagnosis of other conditions in the asymptomatic woman. Speculum and bimanual examinations are uncomfortable, disliked by many women, and use scarce time during a well woman visit.” [11]

Why then does this remain in practice? An article asking this very same question and written for Colorado Public Radio stated that, Dr. George Sawaya, a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, and the study’s lead author, told NBC that the team didn’t know why these procedures remained so widespread, although it may have something to do with habit.” [14] I suspect that in many cases this applies not only to the examination of girls, but also boys and it is hard to conceive a worse rationale for stripping the innocence away from our children at the hands of otherwise unknown adults.

Are we to accept that something of this nature, which under any other circumstances would place the adult behind bars, is suddenly acceptable when done by ‘doctors’ acting under force of habit? Are we to accept this practice even if doctors themselves have no clue why they are doing it? Does any of this information preclude a more sinister motive in the case of certain individuals? And, have we become so degenerate as to uncritically hand our children over to unnecessary genital examination?

In a particularly jarring discovery, it would appear that the culture of death has not failed to corrupt the medical field in a particularly profound way according to a study published in the journal Bioethics. Paul Hsieh comments: