Sports physicals (also known as pre-participation physical examination) are required at most public and private schools in the United States for students wishing to participate in sports on an annual or seasonal basis. The purpose of sports physicals is to determine if a student is healthy enough to participate in sports and to minimize the risk of sports-related injuries. This exam is designed to identify any high-risk disorder or condition such as heart disease, diabetes, sickle cell trait, and asthma that might affect an athlete’s ability to play.

While there are no absolute standards about what should be included in sports physicals, most people agree that there should be a heavy emphasis on cardiovascular and musculoskeletal systems. Heart disease is the leading cause of athlete deaths.

Most young athletes and their parents will be asked to fill out a medical history form before the sports physical exam takes place. The medical history is an important tool in identifying health problems that might affect an athlete’s ability to participate and/or perform in sports.

After the medical history form has been filled out, every student should have a physical exam that includes an evaluation of: heart (to look for irregular heartbeat or heart murmur); lungs, blood pressure, weight and height, vision, musculoskeletal to evaluate posture, joints, strength, and flexibility, and a blood test. Specific sports such as wrestling may require additional exams such as skin exams to make sure the athlete does not have a contagious skin disease.

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.

Concerns about needlessly embarrassing boys

Many boys find sports physicals embarrassing because many doctors still require boys to have genital / hernia exams to be cleared to play sports. Many sports physical forms have a check-list for genitalia – hernia (male), genitalia, genito-urinary, genitourinary system, or testicular exam. The hernia / genital exam is considered standard for sports physical by some guidelines.

Dr. Joel Sherman, who has written on the subject is skeptical of the need for these exams. He notes: “It is doubtful that asymptomatic hernias affect one’s ability to safely play sports. A good history should detect who needs to be examined for this. Indeed it is clearly recognized that the need for a genital/hernia exam is controversial. There are no clinical outcome studies available which document the need for these exams.”

Genital / hernia exams can be very embarrassing for boys. Even some boys have refused to participate in sports because of those exams. 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. “Reducing the embarrassment can be addressed in many ways. For most boys, a male physician is less embarrassing than a woman. But women who are a majority of pediatricians nowadays are often the ones who perform these exams. Increasing preference is given to female gynecologists for adolescent girls’ exams; the same preference should be granted to boys.” Another problem is that male doctors often have female nurses as chaperones for male genital exams and that makes the embarrassment much worse.

Many boys still find genital exams embarrassing even with male doctors without any women present. 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.

Parents need to ask how a forced genital exposure shows a readiness to play school sports and how this type of treatment affects boys emotionally and psychologically.

Informed patient consent is often missing from genital / hernia exams. Parents and boys are often not told the truth that there is no need for genital exams to ensure that they can play sports safely or asked if they want them done. Says Sherman: “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.”

Some articles on the Internet such as Sports Physicals – KidsHealth do not mention hernias or genitals at all. We agree with Dr. Sherman that genital exams are not necessary for sports physicals since there is no evidence that they ensure the safety of playing sports. Adolescent boys should be taught to self-examine for testicular lumps and hernias and if they have a problem, they can always go to see a doctor. Kids will know if they have a hernia if it is significant. If it is too small for them to notice, nothing need be done unless they have some pain. Small hernias can usually be left alone.

Concerns about needlessly embarrassing girls

Most doctors do not do genital exams on girls for sports physicals. There is no reason for a genital exam to be done on girls for sports physicals anyway. In one community, a well-respected male doctor took advantage of some girls by conducting private breast exams during the sports physical without parents’ knowledge or presence. Many girls were very upset afterwards, as the exam was unexpected and they did not know why it was done. This doctor should be reported to the state medical board and the school for sexual misconduct. There is no reason for breast exams to be done on girls for sports physicals since they have nothing to do with ensuring the safety of girls playing sports.

How can we end unnecessary intimate exams for sports physicals?

Educate parents, coaches, and teachers about unnecessary intimate exams for sports physicals.

Parents should lodge complaints with schools when unnecessary intimate exams happen during sports physicals.

It is always prudent for a parent to be present for his/her child’s sports physical exam so he/she can help to advocate for their child that no intimate exams happen.

We need to ask doctors and nurses to end unnecessary intimate exams for sports physicals.

Teach children that they should refuse genital / breast exams for sports physicals and to not take their underwear off if asked to.

Parents should fill out as much of the form in advance, including marking “no consent” on portions of the exam that they are not comfortable with. Doctors have the liberty to customize these exams per their judgment, thus not everything listed has to be done.

Parents should consider bringing a letter stating that the doctor cannot do a breast or genital exam on their child.

Misty Roberts is the president / founder of Medical Patient Modesty, a 501c3 non-profit organization in the United States that works to advocate for stronger patient modesty. She may be contacted at http://www.patientmodesty.org/contact.aspx

Full article can be found at http://www.patientmodesty.org/sportsphysicals.aspx.

Sources:

Sports Physicals Are They Needlessly Embarrassing? By Dr. Joel Sherman (http://patientprivacyreview.blogspot.com/2011/01/sports-physicals-are-they-needlessly.html)

Are Breast / Genital Exams Necessary for Sports Physicals? – Medical Patient Modesty (http://www.patientmodesty.org/sportsphysicals.aspx)