Doctor’s visits can be unsettling for children so I usually examine infants and toddlers on the parent’s lap. However, once boys reach the age of three or four, it’s important to do the testicular examination while they are standing.

Prior to adolescence, the main problem we look for is an inguinal hernia. Although parents may notice a bulge in their child’s groin before the checkup, the finding can be missed if a child isn’t standing when he’s examined. The reason for this is because an inguinal hernia is the result of a small opening between the abdominal cavity and the scrotum. If a person is standing, gravity “pushes” intestinal contents downward making the hernia easier to find.

Doctors look for inguinal hernias in adolescents as well, but this age group can also develop something called a varicocele. A varicocele is a painless swelling in the scrotum due to enlarged veins. (It feels like the scrotum is partially filled with worms or cooked spaghetti.) Like hernias, the problem can be missed if the testicles are examined when a person is lying down because the swelling goes away in this position.

If your child’s genital exam isn’t done while he’s standing, tell the doctor you know someone whose hernia or varicocele wasn’t found until he was checked in this position. Also, because adolescents usually ask parents to leave during the genital exam, make sure your son knows about the importance of being examined while standing.

Although inguinal hernias are much more common in boys, they can occur in girls as well. Therefore, it’s a good idea to do a brief genital check in girls when they are standing.