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.

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:

• Georgia
  
• North Carolina
  
• South Carolina

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

Sources:

Sports Physicals Are They Needlessly Embarrassing? By Dr. Joel Sherman

Sports Physicals - KidsHealth

Player death prompts sickle cell testing for Western Carolina student athletes - Smoky Mountain News