Genital examinations are necessary when a baby or child presents with a variation in sex characteristics. This period can be very stressful for the family, especially if the baby has not yet been assigned a sex. An explanation of the different factors such as physical examination, hormone levels, genetic information and internal structures help inform the clinical multidisciplinary team to make the best decisions for a baby health plan.

Why are genital examinations performed?

Newborn physical examinations for variations in sex characteristics (DSD):

It is important for the clinical team to perform genital examinations to identify anatomy, this will help to understand how the baby gets rid of urine and faeces, this will also assess whether the baby was exposed to testosterone in the womb and where the gonads/testes/ovaries are (this can be referred to as whether they are “palpable” in the pelvic region or not). A full explanation and option to opt out should be provided by clinicians to the parents/ carers of the child.

For some children there will be an option for having surgery to change the genital anatomy – It is useful for the surgical team to have a professional medical photo of the area where surgery will be performed.  Parents are required to consent to this medical photography, this is voluntary, and parents can chose not to have photos of their child taken.

Paediatric & adolescent physical examinations for people with variations in sex characteristics:

There are a few reasons for a child to require a physical examination these are:

• During the time of puberty and patient/child consents and would like information about their body

• If there is pain or discomfort in the genital region

• If a young person has practical questions about dilation

• To assess puberty for some children

• For the consideration of endocrine hormone therapies

• If there is a plan to do surgery

• Post-surgery follow up

It is important for parents and children/adolescents to know they can choose not to have genital examinations, and to ask whether the doctor is able to gain the relevant information using other methods.

Although at times genital examinations are useful for medical management, the clinician’s approach to completing this type of examination should be done with the cooperation and consent of the child or adolescent, if the person does not consent, it is best to not perform a genital examination. 

There are many ways health professionals can gain information about a person’s health (such as blood tests), it is best to avoid repeated genital examinations of a person.

Regular genital examinations in childhood and adolescence are likely to have a negative impact to a person's mental health and their sense of self (Sandberg, 2017). Genital examinations that are completed in front of trainee groups can be experienced as very stigmatising events and should be avoided (Meyer-Bahlburg, 2017).

A 2017 Victorian study found that many young people did not understand the reason for genital examinations suggesting that clinicians could improve in communicating the reason for an examination (Tonkin-Hill, 2018). Communication with the individual and parents should sensitively explain the nature and reason for the physical examination, and to increase individual comfort and minimise stigma associated with bodily difference (Sandberg, 2017).