Questionable medical examination practices involving children have been reported at schools around Japan, prompting education authorities to apologize to parents and issue new guidelines.

In June, 100 pupils from the first through sixth grades at two elementary schools in Minakami town, Gunma Prefecture, underwent health checkups. Several of the children later complained about what they went through.

The pupils, both girls and boys, said the doctor who performed the checkups “pulled my underwear down and looked at my lower body.”

The complaints prompted the town’s education board to hold an explanatory meeting with the parents.

The school physician in his 70s also attended the meeting. He explained that what the children said was true, and that the purpose of his method was to check for “secondary sexual characteristics.”

“It is the position of a professional to check for (children’s) sexual characteristics,” he said. “I checked the external genitalia and the growth of pubic hair.”

However, this examination was not listed on the check list of the school, and no explanation for that specific act had been given to the children or their guardians in advance.

The board ended up apologizing to the parents, saying, “There had been a lack of consideration for the children.”

The board also replaced the school physician.

The Japan Medical Association issued its opinion on the case, saying the doctor’s actions “were medically valid, but an explanation should have been given to the parents in advance.”

In Kita-Kyushu, too, several children complained that they “were touched in the lower abdomen” during a medical checkup at a city-run elementary school in June.

The school held a meeting to explain the situation to their parents.

The doctor in his 60s who was in charge of the examination said the purpose of his actions was “to listen to bowel sounds.”

But again, this was not included in the medical check items assumed by the city’s education board. And no prior explanation was given to the parents.

In May, a social media post questioned the appropriateness of a health checkup at a municipal elementary school in Yokohama. The post said children were examined with no clothing on their upper bodies.

Yokohama’s education board conducted a survey of all municipal elementary schools and found at least 16 schools required children to remove their upper body clothing for the health checks.

The board said it had notified each school to conduct the checks on fully dressed children, but that rule was not thoroughly enforced.

In January this year, the education ministry issued a notice requesting boards of education nationwide to “establish a medical examination environment with consideration for the privacy and emotional state of the students.”

In response, Kyoto city’s education board changed its policy of having the children undress for the examinations.

For this year’s medical checkups, the city issued a notice to each school, saying students must wear gym uniforms and underwear, in principle, during the process.

Nagoya city’s education board said it has reminded each school of its policy to have students wear clothing, in principle, for the health checkups.

The board has a budget for the dispatch of nurses and other assistants to attend medical examinations along with the school physicians, starting in fiscal 2024.

The board said that having assistants of the same gender as the students creates an environment where children can receive medical examinations with peace of mind.

Satoshi Kodama, a professor of ethics at Kyoto University who is familiar with public health issues, said a growing awareness of children’s privacy rights may have shed light on issues concerning school health checkups in recent years.

“If we keep conducting medical checkups as in the past, questions will continue to be raised,” he said.

Kodama said the central government “should conduct research on ‘how much difference there is in the results of medical checkups between clothed and undressed children.’”

The government should decide what would be appropriate for the students to wear for the checkups, and then standardize the clothing based on scientific evidence.

“In order to ensure that children can receive health checkups with peace of mind, boards of education and schools must not only explain the items to be examined to students and their guardians in advance but also obtain their consent,” he said.

(This article was written by Naoko Kobayashi and Risako Miyake.)