According to the American Congress of Obstetricians and Gynecologists, girls should have their first gynecologic visit between ages 13 and 15. Depending on your family doctor, some prefer that girls go earlier or later depending on their health issues, concerns, and personal circumstances, such as if a teen is going off to college. You know your child best.
It is normal for a young girl to feel nervous and it can ease some of her stress if she understands what to expect. Basically, the first visit may simply be a conversation between your daughter and her gynecologist, in which she discovers what to anticipate at future visits and gathers information about how to stay healthy. Your daughter should be prepared to answer some personal questions about her menstrual period or sexual activities including vaginal, oral, or anal sex.
“Heavy periods, heavy menstrual bleeding, missing periods, and irregular menstrual cycles are all reasons to see the gynecologist,” says Dr. Leslie Hayes, chief of adolescent medicine in the department of pediatrics at New York Methodist Hospital. Young girls may feel relief just to know that changes in their body are normal.
“During the first two years or so, it is not unusual for the menstrual cycle to be irregular and it is not really anything to worry about,” said Hayes. Young girls are encouraged to keep a menstrual calendar so they can see their pattern. “Write down the first day you start bleeding and the date you stopped, and do that monthly,” says Hayes. They will find that everybody’s period is not the same and does not come on the same day every month.
Your daughter may have her own agenda for the first visit and the gynecologist will be accommodating.
“Your daughter may want to start on some sort of birth control, may have a vaginal discharge, or may be having abdominal pain,” says Hayes. She may want to find out about screenings or just be reassured that she is developing normally. “Depending on the sexual history of the patient, we may need to do what we call anticipatory guidance with someone who is not sexually active to talk about their level of knowledge about protection, preventing sexually transmitted diseases, and preventing pregnancy, and if someone is active, we want to find out if they are interested in using protection or adding another birth control method,” she says.
Girls are often worried about confidentiality and should be reassured that information shared is kept private. If they feel more comfortable, they may have a nurse or family member accompany them for any part of the general physical exam or external genital exam that are often performed. A pelvic exam is not typically part of the first visit unless the girl complains of abnormal bleeding or pain. If she is sexually active, tests for sexually transmitted diseases may be advised, but most can be done by a urine sample. Sometimes vaccinations are addressed.
During the physical exam, the gynecologist checks the girl’s height, weight, and blood pressure. In the external exam, she looks at the vulva and may give the girl a mirror so she can look as well, and learn about her body. The American Congress of Obstetricians and Gynecologists states that the pelvic exam involves looking at the vulva, looking at the vagina and cervix with a speculum, and checking internal organs with a gloved hand.
If your daughter understands the purpose of the Pap test, she will be more likely to comply.
“The Pap smear is a screening test for cervical cancer, as well as any sort of cervical cell abnormality, and it is also a way to test for certain infections, primarily HPV,” says Hayes. During a Pap test a sample of cells is taken from the cervix with a small brush and the doctor may put one or two lubricated fingers into the vagina, up to the cervix, and the other hand will press on the abdomen from outside.
“The Pap smear is recommended to be done three years after you have started being sexually active or if you have what we call high-risk sexual behavior, which would include early sexual activity, history of sexually transmitted diseases, or pregnancy,” explains Hayes.
The American Congress of Obstetricians and Gynecologists urges girls to talk about cramps, problems with menstrual periods, acne, weight, sex, sexuality, birth control, sexually transmitted diseases, alcohol, drugs, smoking, and emotional ups and downs. The gynecologist promotes maintaining a healthy weight through a well-balanced diet and frequent exercise. The doctors ask that girls avoid smoking, drinking, and using illegal drugs. If a patient is having emotional ups and downs or feels depressed, she is asked to turn to a mental healthcare provider. If girls are having sex, birth control is suggested, as well as protection from sexually transmitted diseases by using a latex condom. The gynecologist asks that girls know their partners, limit sexual encounters, and most importantly, keep up with routine exams, screenings, and immunizations. The gynecologist is meant to be a young girl’s partner and advocate for good health.
Jamie Lober, author of Pink Power (www.getpinkpower.com), is dedicated to providing information on women’s and pediatric health topics. She can be reached at jamie@getpinkpower.com.
© 2012 Jamie Lober.
