Are Breast / Genital Exams Necessary For Sports Physicals?
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. Many athletes with health problems are still able to play sports. For example, if an athlete has frequent asthma attacks, the doctor might be able prescribe a different type of inhaler or adjust the dosage so that the athlete can breathe easier when she/he runs.
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Soccer DFW
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. One athlete’s
doctor discovered that he had a defective aortic heart valve during a physical
exam. He was told that he would die within a year if he did not have surgery
to repair the valve. He is doing well now and runs in marathons. This case
proves how important a cardiac exam is for sports physicals. “The
manner in which the exams are done is also not standardized. Most schools
will give students an option to see their private physician to have a form
filled out; the private physician may elect to combine this with an annual
exam. Schools will usually offer a group examination which varies greatly
in terms of how it is set up. It could be one physician or nurse practitioner
seeing the students one at a time; it could include multiple specialists
seeing the students at different stations in a large area such as a gymnasium.
It often includes no provisions for privacy.” (Sports
Physicals Are They Needlessly Embarrassing? By Dr. Joel Sherman)
Most 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. Most commonly issues addressed
on the medical history form are:
- Cardiac history
- History of past conditions such as fractures, concussions, seizures, and heat illnesses
- History of asthma, high blood pressure, diabetes, and sickle cell trait
- Family history of serious illnesses
- Allergies
- History of episodes of dizziness or collapse during activity
- Dental and vision history
- Immunization history
- Menstrual history for females
- Use of drugs including steroids, alcohol, and dietary supplements
- Heart (This is done to look for irregular heartbeat or heart murmur)
- Lungs
- Blood pressure
- Weight and Height
- Vision
- Blood test
- Musculoskeletal to evaluate posture, joints, strength, and flexibility
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.
Some schools have started requiring athletes to undergo blood tests for
sickle cell anemia due to the increasing number of athlete deaths from sickle
cell trait. "The NCAA in the summer of 2009 adopted guidelines recommending
that all student athletes be tested for the trait. The policy shift was
prompted by a lawsuit against the NCAA by the family of a Rice University
football player who died during practice in 2006 from a sickle cell attack.
The National Athletic Trainers’ Association has advocated for the
mandatory testing of student athletes since 2007." (Player
death prompts sickle cell testing for Western Carolina student athletes
- Smoky Mountain News)
Concerns About Needlessly Embarrassing Sports Physicals For 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 box that says Genitalia – Hernia
(male), Genitalia, Genito-urinary, Genitourinary system, or Testicular Exam.
The hernia / genital exam is considered standard for sports physical 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. 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.” (Sports
Physicals Are They Needlessly Embarrassing? By Dr. Joel Sherman)
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.” (Sports
Physicals Are They Needlessly Embarrassing? By Dr. Joel Sherman) 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. When the boy told the doctor that he was not going to pull down his pants for the hernia check, the doctor responded by saying, “if you do not do this, you can’t participate in sports”. The boy reluctantly pulled down his pants half an inch showing the band of his underwear. Then the doctor told him he had to pull down his pants and underwear all way. 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. “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.” (Sports
Physicals Are They Needlessly Embarrassing? By Dr. Joel Sherman) Some
articles 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. Check out information
about hernias.
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 breast / genital exams are necessary to ensure
safety of playing sports.
Concerns about Needlessly Embarrassing Sports Physicals for 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?
1) Educate
parents, coaches, and teachers about unnecessary intimate exams for sports
physicals.
2) Parents should lodge complaints with schools when unnecessary intimate exams happen during sports physicals.
3) 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.
4) We need to ask doctors and nurses to end unnecessary intimate exams for sports physicals.
5) Teach children that they should refuse genital / breast exams for sports physicals.
6) 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.
7) Parents should consider bringing a letter stating that the doctor cannot
do a breast or genital exam on their child.
8) Start a petition to end unnecessary intimate exams for sports physicals at your child's school. Use this sample petition (you can modify it if you have Word).
Check out several examples of sports physical examination forms:
Check out our video
about unnecessary breast / genital exams for Sports Physicals.
Other Related Articles:
Unnecessary
Breast / Genital Exams in Sports Physicals - Video
Tips For Parents of Teenage Children
Tips For Male Teenagers To Prevent Sexual Misconduct By DoctorsTips For Female Teenagers To Prevent Sexual Misconduct By Doctors
Different Types of Hernias That Affect Males
Sources:
Sports Physicals Are They Needlessly Embarrassing? By Dr. Joel Sherman
Player death prompts sickle cell testing for Western Carolina student athletes - Smoky Mountain News