Factors Influencing the Prepubertal Pediatric Genital Examination and Practical Recommendations for a Trauma-Informed Approach

Abstract

Competency in the pediatric genital examination is critical, but physician comfort and ability are often limited. Contributing factors include lack of standardized teaching, inconsistent training, and the examination’s sensitive nature. These gaps may lead to missed signs of abuse or misinterpreted findings. A trauma-informed approach emphasizing patient safety, empowerment, and healing may help address these challenges. We conducted a qualitative study to explore pediatricians’ experiences and identify barriers, facilitators, and recommendations. We interviewed 7 pediatricians in an ambulatory setting at an academic hospital in New York City. Data were analyzed thematically, with transcripts coded by the research team. Themes focused on provider experiences, barriers, and recommendations. Barriers included limited training, time constraints, discomfort, and fear of causing trauma. Pediatricians suggested building rapport, empowering patients, standardizing examinations, and ensuring cultural sensitivity. Trauma-informed strategies may improve provider comfort, examination frequency, and patient care.