Physical Examinations

Physical examinations are sometimes a necessary and/or important part of healthcare, especially for forms of sexual and reproductive healthcare. However, many trans people have experienced physical examinations that are not necessary and are actively harmful. 

This page explores when physical examinations may or may not be required, for what forms of healthcare, and how to work with health professionals to ensure that any examinations undertaken are done in a trauma informed and affirming way. 

When are genital or chest examinations necessary?

For Gender Affirming Hormonal Therapies 

There is no need for genital or chest examinations in order to initiate or continue gender affirming hormonal therapy – either masculinising or feminising therapy. 

The requirement of genital or chest examinations before or after initiating GAHT is not only not required, but can be actively harmful, and can constitute sexual assault. 

You can say ‘no’ to physical examinations at any point, and if a doctor will not allow you to access GAHT without a physical examination, that is not gender affirming healthcare. If you have experienced an unwanted genital examination, there is more information below on how to make a complaint and how to find support. 

For gender affirming surgery 

Genital or chest examinations may sometimes be necessary prior to gender affirming surgery. Any examinations should be: 

  1. Performed only by the surgeon who is providing the gender affirming surgery, and not by or with any support staff, students or other health practitioners; and 

  2. Done only with your explicit consent,

    • This can include the surgeon providing you with information about exactly how the examination will be conducted, who will be present, and the direct connection of the examination to improved health or aesthetic outcomes; 

  3. Undertaken using a trauma informed approach. 

As part of support post- chest or genital surgery, it can be helpful for a general practitioner or other healthcare provider to coordinate any follow up care or surgical aftercare. This may sometimes include chest or genital examinations in order to support healing and recovery, and this should align with points two and three, above. 

For other reproductive or genital related health needs 

Some reproductive, genital, or chest-related health needs may require genital or chest examinations. The need for a physical examination should be assessed on a case-by-case basis, based on individual risks and preventative health care needs. 

This may include, but is not limited to: 

  • Breast/chest cancer screening; 

  • Follow up care for cervical cancer screening (CSTs) 

  • Diagnosis and/or treatment of some symptomatic STIs;

Where possible, methods other than genital or chest examinations should be used by your health professional, self-administration of swabs if practicable, and with examinations as a last resort for providing care. Any genital or chest examinations should be conducted using a trauma informed approach. 

Any genital or chest examinations should be conducted using a person-centred, trauma informed approach. 

For other non-reproductive or genital related health needs 

There is no need to do genital or chest examinations, or for a doctor to know your genital-surgical status for any other health care needs. Asking or requesting to know your surgical status is a form of inappropriate curiosity. 

In some cases, an examination may be required to better understand the chest-surgical health of a trans patient eg. for providing care around the upper body, rib cage, for non-gender affirming surgeries, or for holistic care such as physiotherapy. 

Do the guidelines require genital or chest examinations?

No guidelines on gender affirming care, nor trans-affirming practice require genital or chest examinations. 

AusPATH (The Australian Professional Association of Transgender Health) states: 

“The AusPATH Board of Directors wishes to make clear that [genital examination] is not in keeping with the majority view of health providers in this space. 

We state emphatically that individuals have the right to decline any form of genital examination. The AusPATH Board of Directors believes that the practice of genital examinations prior to the initiation of gender affirming hormonal treatment adds little, if any, benefit to the assessment process, and creates significant trauma, embarrassment and harm to people who are subjected to this outdated practice. 

AusPATH does not endorse this practice. We acknowledge that fear of being subjected to a genital examination is likely to contribute to distrust of the medical profession and harm the therapeutic relationship.” 

AusPATH statement on Genital Examinations, 29 October 2019

This interpretation aligns with the Medical Board of Australia and World Professional Association of Transgender Health guidelines.  

We have written a page on genital examinations for clinicians too. You are welcome to share that page with your health professionals, as it provides more information and detail on these guidelines. That page is accessible here. 

What to do if you have experienced inappropriate conduct from a doctor

If you have experience inappropriate conduct from a health professional, including genital or chest examinations without your consent, you can make a complaint. 

The NSW Health Care Complaints Commission (HCCC) accepts complaints about any negative treatment you have received from a doctor, nurse, dentist, pharmacist, psychologist, chiropractor, or in a health setting such as public or private hospitals, clinics, medical centres, day surgery centres and the Ambulance Service, among others. 

If your health professional has given you poor advice or treated you poorly when providing you with healthcare services, you can make a complaint. The HCCC resolves or assists in the resolution of complaints, but generally does not have powers to order compensation or refunds of fees. It can however investigate serious complaints that raise questions of public health and safety and prosecute serious complaints, in order to protect the public. 

You can find out more about making a complaint to the HCCC here. 

ACON’s Support Services can provide support after a distressing experience in a healthcare setting, and you can find out more about those services here.