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Over the past few months, I have watched individuals, organizations and news outlets lie about Initiative Measure IL26-638, which seeks to exclude males from competing in girls' sports.
I have seen firsthand the attempts to scare voters, intimidate supporters and misrepresent the truth.
My own statements have been misrepresented and used out of context to create a false narrative. Therefore, I feel compelled to submit my full statement to the public.
I am a board-certified pediatrician practicing in Washington state. I will explain the universal medical necessity to conduct brief visual genital exams during routine care on newborns and during the routine adolescent health supervision annual visit.
During full body exams of newborns, doctors record the sex of the baby by observing the genitals. This is because the baby's genital appearance correlates with its sex about 99.97% of the time. If we see ambiguous genitals in babies, we must quickly figure out if the child is male or female using medical imaging and genetic testing. A male baby born with a very small penis implies a problem in the brain. A female baby with an enlarged clitoris implies a condition called Congenital Adrenal Hyperplasia.
If we don't catch conditions like these, a baby who otherwise would live fully and well would get extremely sick and possibly die.
The appearance of the genitals is documented for every newborn who sees a medical provider. For the 0.03% of the cases where there is initial ambiguity regarding the baby's sex based on visual exam alone, the conclusive diagnosis regarding sex after a medical investigation is also documented.
This birth record alone is sufficient to verify a young person's sex whenever they wish to participate in sports.
During adolescence, the brief visual examination of external genitals is again important for the health supervision of puberty. This provides an additional opportunity to verify sex outside of the infant period. We track Tanner Staging in all tweens and teens to make sure that the hormone system is working properly. If a child enters puberty early, it could be a sign of a brain tumor or other serious disease. If a young person enters puberty late, it implies gonadal failure. Not only is this very socially distressing, it results in stunted growth, loss of sexual function and fertility, loss of bone mass and intellectual delay.
During the ages when a young person is expected to encounter puberty, the brief visual genital exam is done during one or two of the routine annual health supervision visits, colloquially known as "physicals."
These visits also serve as sports physicals for kids who wish to do sports, but non-athletes get the same care. For the healthcare provider to conduct this exam, the parent and the patient must both consent. The exam takes half a second. It does not involve touching the child. The patient gets to choose if he or she wants a parent in the room. Regardless, a chaperone such as a nurse or medical assistant is always available to guarantee safety and comfort for the patient, and the health provider is never alone with the patient.
The record of this exam is readily available to all families via medical records.
Failure to offer a visual genital exam to young people constitutes medical negligence, and would be contrary to the Bright Futures recommendations on primary care from the American Academy of Pediatrics.
If the young person or family do not wish or cannot provide the documentation of a physical exam at birth, and does not consent to the brief visual exam during a routine health-supervision visit, then they also have the option of obtaining a karyotype, a simple chromosome blood test as their method of sex-verification.
Only one method of sex verification is required. There are no barriers to obtaining an acceptable method of sex-verification because families and medical professionals agree that all children should have primary care providers.
Visual examination of external reproductive anatomy is not unusual or invasive in pediatric care.
All families ought to have access to high-quality primary care that simply practices standards of care.
I hope this answers most questions regarding how sex-verification would likely be conducted when IL26-638 passes.
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Dr. Erica Li is an assistant professor of pediatrics at Washington State University. The views expressed are her own and do not represent those of her employer.
