Snapchat, Instagram, Facebook and iMessage have revolutionized the world of sharing penis photos – and not just between friends. As doctors try to connect with young, digitally native patients, those same patients are sending pictures of their genitalia to their doctors’ mobile phones.

It is uncharted, legally treacherous territory for clinicians, and the leading American medical organizations have not yet issued guidance on what to do with pictures of patients’ genitalia shared over mobile phones.

A sexual and reproductive health doctor in New York City said the first time a patient texted him a photo of his penis, “it was shock, and a weird way, awe”.

The doctor, who asked to remain anonymous because receiving patients’ photographs potentially violates his employers’ policies, said he was surprised that his patient was comfortable enough to send the photo, and happy he trusted him enough to share the picture. But he soon realized that the patient’s willingness to share the photograph wasn’t so much due to trust, as it was the prevailing sexting culture.

“It probably wasn’t specifically me, it was just the nature of young people being comfortable just showing a picture,” he said, laughing.

But medical ethicists expressed concern about the practice, because of the risk it could pose for doctors who treat people under the age of 18, arguing that because it is a form of telemedicine, it should only be practiced on a secure network, where it is protected under the federal health privacy information act, Hipaa. Concerns were also raised about the severe legal consequences that could arise for doctors, if the images could be construed as child abuse images.

Health ethicist Lois Shepherd, at the University of Virginia, said exchanging photos like this is incredibly risky.

“When photos are in the medical record, generally, you have safeguards,” Shepherd said. “Obviously, we are concerned about situations where boundaries are breached and where people are sending their photos in a way to create an improper relationship between a healthcare provider and patient, minor or not minor.”

But she also understood why patients could be compelled to do such a thing. When her own daughter was traveling in Asia and concerned about a rash, she sent the photo to her mother, who works with medical professionals she hoped would determine whether the rash was dangerous.

Shepherd conceded that in rare instances, she could see why people would do this. “If someone is in a resource-poor environment, doesn’t have a computer, can’t do proper telemedicine and it’s an emergency situation – you’d have so many caveats, right? So many conditions would have to be in place to make this appropriate,” Shepherd said.

She insisted that this matter should be taken up by medical organizations.

“Everyone can’t just be floating this on their own – like, ‘I tell them not to but if they insist,’” she said. “If this is going to happen with more frequency, some professional groups need to sit down and think about what they’re going to do about it”

But, when asked for its guidance on patients and doctors who interact over mobile phones, a spokesperson for the American Medical Association, the largest physician’s association in the country, said it didn’t even know that primary care doctors communicate with patients on mobile phones, where pictures could be exchanged.

The American Academy of Dermatology (AAD) recently updated its position on telemedicine on 7 March. It now calls for secure networks, high-quality imaging equipment and for the doctor to have worked with the patient before – but it does not mention unsecure mobile phone communications.

Carrie Kovarik, chair of the AAD’s Telemedicine Task Force, acknowledged that the practice is common in dermatology, whether doctors like it or not. Patients send emails and pictures from mobile phones of possible skin conditions, sometimes to doctors they have never met, but whose contact information they found online.



Kovarik said the nature of the technology means that the practice cannot be stopped and noted that it is similar to how patients would call doctors to describe their ailments over the phone and see whether they needed to schedule an appointment.

But Gil Siegal, a medical ethics expert at the University of Virginia, said that there were too many unknowns and that young people should be more engaged with meeting their doctor.

He warned these type of photos should not be shared on non-secure networks, because it becomes a form of telemedicine, and should therefore only be circulated in a system protected by Hipaa’s strict privacy regulations, as medical companies are notorious for having bad technological security and weak privacy protections, leaving these images vulnerable to hackers.

The American Academy of Pediatrics declined to respond to a request for comment, despite the practice concerning patients under the age of 18.

Danielle Keats, a law professor at the University of Maryland, said a doctor could be in serious trouble if the image could be construed as child abuse images. “It’s one of those areas of the law where there is no flexibility,” she said.

Even though the US is a deeply litigious country with an aggressive criminal justice system, David Finkelhor, the director of the University of New Hampshire’s Crimes against Children Research Center, said it would be difficult to imagine a situation where a doctor could face criminal charges for possessing such images, unless the photos were sexual in nature.

The New York City doctor said all but one of his patients has asked for permission to share the picture before doing it. And sometimes he asks them to send it. “Given that it is professional in nature – and it is really clear we are talking about a worry about an STD or some rash or whatever – that it’s not something inappropriate, I guess I have a base respect for the law that I’d be OK,” he said.

Finkelhor said there is precedent for images of this nature in medical practice.

“There are medical textbooks with tons of child genitalia, this is not contraband, you can buy it,” he said. “There was a time in history when even medical texts that had images of that sort were considered to be criminal, but that’s not been the case for a long time.”