Implementation of standards

Of the adolescents surveyed, 626 (58.4%) had a well-care visit in the past 18 months. There were no differences by gender (p = 0.9573).

Effect of patient gender

Examination of intimate regions was performed in 107 (17.1%) adolescents. Of these, 107 were assessed for pubertal stage according to the Tanner scale, and 41 underwent examination of external reproductive organs that included testicular palpation or manual exposure of the vaginal vestibule. Pubertal stage scale assessment was performed more frequently in boys than in girls (OR = 5.5; 95% CI 3.4, 8.4), during 32.1% vs. 8.2% of visits, respectively (\(^\)[1, n = 626] = 59.00, p < 0.0001). Examination of external genitalia was also performed more frequently in boys than in girls (OR = 14.1; 95% CI 5.4, 36.4), during 15.4% vs. 1.3% of visits, respectively (\(^\)[1, n = 626] = 47.66, p < 0.0001). Patient gender was not found to influence the frequency of abdominal (62.6%) or spine (87.2%) examinations. Girls were auscultated with a stethoscope slightly more often than boys, during 91.6% vs. 86.8% of visits, respectively (\(^\)[1, n = 626] = 3.72, p = 0.0537).

Influence of physician gender

A visit to a female doctor was associated with a higher likelihood of examining intimate areas than a visit to a male doctor (OR = 2.2; 95% CI 1.3, 4.0). Pubertal stage assessment was performed during 19.5% of visits to female doctors and during 9.8% of visits to male doctors (\(^\)[1, n = 626] = 7.59, p = 0.0059), and genital examinations were performed during 7.6% of female physician visits and during 3.3% of male physician visits (\(^\)[1, n = 626] = 3.56, p = 0.0591) (see Table 1, part A).

Table 1 Implementation of selected elements of the well-care visit, as well as the assessment of its parameters and consequences, by adolescents subjected and not subjected to examinations requiring exposure of the genitals

Physician gender was not found to influence the frequency of abdominal or spine examinations. Female physicians auscultated the chest slightly more frequently than male physicians—91.3% vs. 85%, respectively, (\(^\)[1, n = 626] = 5.10, p = 0.0239).

Respect for intimacy

Of the 107 adolescents who underwent genital region examinations, 47 (43.9%) were asked for consent beforehand. The others were examined “by surprise” or under a sense of “coercion”. Consent was significantly more often asked from girls than boys—66.5% vs. 36%, respectively (\(^\)[1, n = 107] = 6.39, p = 0.0114). Male doctors were more likely to ask for consent than female doctors—66.7% vs. 40.2%, respectively (\(^\)[1, n = 107] = 3.66, p = 0.0556).

Doctors shielded 37.5% of the girls and 20% of the boys with screens during intimate examinations (\(^\)[1, n = 107] = 3.64, p = 0.0564). Male doctors used the screen significantly more often than female doctors—46.7% vs. 21.7%, respectively (\(^\)[1, n = 107] = 4.25, p = 0.0393) (see Table 1, part B).

Emotions and their consequencesThe effects of examining the genital region

Adolescents who underwent intimate region examinations were more likely to rate their most recent visit “very poorly” or “poorly” in the “respect for intimacy” category (1 or 2 points on a 5-point scale) than non-examined adolescents (OR = 9.21; 95% CI 5.24, 16.21). Adolescents who received an intimate examination at their last well-care visit were more likely to say they felt “very discouraged” or “discouraged” from attending another visit (OR = 4.83; 95% CI 3.01, 7.76).

The effect of gender configuration

The proportion of negative or very negative ratings in the “respect for intimacy” category was higher among adolescents examined by a doctor of the opposite gender than among adolescents examined by a doctor of the same gender (OR = 3.71; 95% CI 1.43, 9.64). Adolescents who had their genitals examined by a doctor of the opposite gender were more likely to report being “discouraged” or “very discouraged” from attending the next visit than adolescents who had their genitals examined by a doctor of the same gender (OR = 2.92; 95% CI 1.29, 6.62) (see Table 1, parts C and D).

Social convictions

A sizeable proportion of respondents mistakenly believed that the Polish law prohibits preventive examinations of adolescents’ external genitalia, in particular, by doctors of a gender incompatible with the adolescent’s sex.

All groups of respondents—girls, boys, and parents—were convinced that the law provides greater “protection” against genital examination by a doctor of a different sex for girls than for boys.

All groups of respondents were convinced that male doctors have less right to examine girls’ genitals than female doctors to examine boys’ genitals. The mentioned differences are statistically significant (p < 0.05).

Almost 30% of parents believed that prophylactic examination of the external genitalia in adolescents is prohibited by law (see Fig. 1).

Fig. 1

Beliefs on the permissibility (under the law) of prophylactic genital examination in adolescents depending on the gender of the patient and the gender of the physician. The figures in the tables outline the percentage of respondents who believe that, in a given gender configuration, preventive genital examination is permissible under the law

Physician gender preference

The importance attached by adolescents to the gender of the physician depends on gender and the nature of the examination. Of the four procedures analysed (weight measurement, chest auscultation, spine examination, genital examination), the least gender-sensitive appears to be the spine examination—65.7% of girls and 72.2% of boys declared no preference for the gender of the doctor (\(^\)[1, n = 883] = 3.88, p = 0.0488). The most gender-sensitive was the genital examination—only 9.1% of girls and 27.2% of boys declared no preference for the doctor’s gender (\(^\)[1, n = 883) = 50.65, p < 0.0001).

Gender of the adolescent

87.1% of girls and 49.5% of boys preferred to have their genitals examined by a doctor of the same sex (\(^\)[1, n = 883] = 147.37, p < 0.0001). In the hypothetical situation of an abnormality involving the genitals, this percentage of boys increased to 72.8% (\(^\)[1, n = 309] = 35.31, p < 0.0001), but no statistically significant change was observed for girls in an analogous situation (see Fig. 2).

Fig. 2

Distribution of adolescent preferences on the gender of the doctor conducting examinations (healthy and in the case of infection). The respondents indicated the preferred gender and the strength of this preference on a scale from − 5 to 5 (with zero indicating no preference, scores less than zero indicating a male preference, and scores greater than zero indicating a female preference)

For more information about adolescents’ preferences, see Supporting information.

Age of the adolescent

Among younger adolescents (14–15 years old), a higher percentage of respondents indicated that they preferred intimate examinations be performed by a doctor of the same sex than among older respondents (16–17 years old). This effect was particularly pronounced for boys—56.5% (younger) vs. 43.9% (older; \(^\)[1, n = 309] = 4.9, p = 0.0269), and in girls, it was not statistically significant (p = 0.1058) (see Fig. 3).

Fig. 3

Influence of age and sex of adolescents on their preferences for the gender of the doctor conducting examinations of the genitals (healthy and in the case of infection). The graph shows the mean value (triangles and circles) of the preference assessment on a scale from − 5 to 5 (with zero indicating no preference, scores less than zero indicating a male preference, and scores greater than zero indicating a female preference). Horizontal line = standard deviation