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Respecting Adolescent Modesty

Intimate physical examination of children, and particularly of adolescents, presents a unique challenge for the healthcare provider. Adolescents and older children are usually very modest and concerned about maintaining strict privacy regarding their personal space. This space encompasses both individual (physical) and environmental domains. Shyness is a common feature seen in adolescence, particularly in girls, who tend to physically mature earlier than boys. Teens may be particularly reticent to disrobe for any reason-and especially for a "medical" examination. Practitioners should be attuned to this need for privacy by structuring the intimate portions of physical examination to be as unobtrusive as possible. Older children and adolescents should be afforded the facility to
disrobe in private, with or without the parent, as is their preference. Gowns should be provided as well, with attention to proper additional draping for any particularly intrusive type of examination (e.g. genitalia). The clinician should complete less intrusive parts of the examination first, so that the patient may remain disrobed or exposed for the shortest time possible. Respecting concerns for modesty and understanding potential embarrassment in adolescents will help the clinician build needed rapport useful for future visits.

In addition, adolescence is typically a time of uncertainty concerning ones sexual identity, and many adolescents experience confusion about the proper expression of sexual identity among peers as well as adults. Fear of homosexuality is not uncommon, nor is anxiety about violation of ones own personal space. Therefore, healthcare providers working with adolescents should educate themselves concerning the specific psychosocial issues which typically present in this group.

Assessing children: Infancy through adolescence (chap. 17). In L.S. Bickley & P.G. Szilagyi (Eds.), Bates' Guide to Physical Examination and History Taking, 8th ed. (pp. 652-654). Philadelphia, PA: Lippincott Williams, & Wilkins

American Academy of Child & Adolescent Psychiatry, Facts for families (info. sheet), No. 57. (n.d.). Normal adolescent development. Retrieved September 9th, 2004, from
http://www.aacap.org/publications/factsfam/develop.htm