SAN FRANCISCO (AP) — A California county cannot routinely examine the genitals and rectums of children removed from homes on suspicion of abuse without a court order or consent from their parents, a U.S. appeals court ruled Wednesday.

The “invasive” medical examinations performed in San Diego County even in cases in which sexual abuse was not suspected violated the U.S. Constitution, a three-judge panel of the 9th U.S. Circuit Court of Appeals ruled unanimously.

A call to an attorney with the San Diego County counsel’s office, David Brodie, was not immediately returned.

The ruling came in a lawsuit filed by two parents, Mark and Melissa Mann, who were not notified when their four children were examined by a doctor at a temporary shelter, the Polinsky Children’s Center, after the county removed them from their home in 2010.

The exams included an evaluation of general appearance and behavior, but they also required blood samples, a skin prick test for tuberculosis and a gynecological and rectal exam.

“The Mann children were subjected to invasive, potentially traumatizing procedures absent constitutionally required safeguards,” Judge Kim Wardlaw, writing for the 9th Circuit panel, said. The judge said the county’s failure to provide parental notice and obtain consent for the exams has “harmed families in Southern California for too long.”

Donnie Cox, an attorney for the Mann family, said tens of thousands of children in San Diego County have been subjected to such tests over more than a decade.

“They’re placed in a frightening place that they have no idea where they are or why they’re there and then they’re taken into a room where strangers strip them naked and touch the private parts of their body that every parent tells the child, ‘Don’t let anybody touch you there,’ “ he said.

County officials argued that the exams were intended to assess the children’s health and were not part of an investigation. The 9th Circuit, however, noted that a doctor who performed the exams testified that she and her staff looked for signs of abuse and documented any evidence they found.

The exams may only be OK without parental consent in cases of a medical emergency or where there was reasonable concern that evidence may be lost, the appeals court said.

Wardlaw said in the Mann case, there was no suspicion that the children had been sexually abused or needed immediate medical attention. A juvenile court later determined there was insufficient evidence to take custody of the children away from the Mark and Melissa Mann, according to the 9th Circuit.

The appeals court said the exams violated parents’ due process rights and the Mann children’s right to be free from unreasonable searches. Cox said the case will now go back to the trial court for trial on damages.