When teens should have their first visit
Young women should have their first gynecologic visit for a Pap smear at age 21 regardless of their sexual activity. They should be seen for yearly visits prior to age 21 if they have been sexually active.
Reasons for Visits
A teenager may need to see a gyn for a variety of reasons, even before becoming sexually active. Most commonly, teens may have problems with their periods, such as painful, irregular, or heavy periods. Many teens have irregular periods because their cycles have not yet fallen under the more strict hormonal regulation that is expected for adults. This is often normal and may not require diagnostics or intervention. However, girls should be evaluated if they have symptoms that are severe enough to interfere with their daily lives (missing school, sports, or other activities, for example) or are having prolonged or heavy periods, especially if they have become anemic as a result.
They may also be concerned because they have not yet started their menstrual cycle, especially if all their friends have. Teens should be evaluated if they are 16 and have not yet started their period, or possibly at a younger age if they also lack secondary sex characteristics such as breast development or pubic hair.
Teenage girls are susceptible to vaginal yeast infections. If they suspect a yeast infection, it is usually appropriate to attempt to treat with an over-the-counter preparation first, however, if her symptoms do not resolve, you probably need further evaluation by a gynecologist.
Less frequently, gynecologists also see younger children or even toddlers and babies for certain complaints. A pediatrician is the best person to help decide when they need a referral to a gynecologist. Ask for a referral to a gyn who has experience with pediatric patients.
What to expect
First of all, teens are likely to be nervous and embarrassed about what will take place at the appointment. This feeling is totally normal. Although they may not need a complete pelvic exam, it may be necessary to get undressed or for the physician to examine their genitalia.
Talking to your Teen
Most girls are accompanied by a parent or close relative when they see a gynecologist for the first time. This is helpful both to convey medical history and to help them feel more at ease. The doctor will usually meet with the patient and her mom (or caregiver) together first in their office just to talk. The doctor will ask questions about the patient’s general medical history and the symptoms she is experiencing. Depending on the age of the patient and what seems most appropriate, the doctor will often then ask Mom to leave the room so doctor and patient can speak privately. Teens often have questions they are more comfortable asking without their parents present. If the patient is more comfortable having her mom there, she certainly may be present for the entire interview.
Next, the doctor performs a physical exam. This may be as simple as listening to the heart and lungs and feeling the abdomen with the patient fully clothed. Most teens with irregular or painful periods can be treated without a pelvic exam, particularly if they have never been sexually active. The physician may order bloodwork to check for anemia or even an ultrasound of the pelvic organs. This can be performed over the abdomen, most often with a full bladder for a younger or virginal patient, but many girls who use tampons may tolerate a small vaginal probe, which often gives better quality images.
Some visits will require a pelvic exam, particularly if there is a vaginal complaint or symptom, or for girls who have primary amenorrhea (haven’t had a menstrual period by age 16). A small pediatric speculum designed for young teens can be used. Young children and toddlers can often be examined in various positions that enable visualization of the vagina without a speculum. Teens can often decide whether they want Mom in the room during the exam—some girls are more comfortable with mom close-by and other girls feel more embarrassed if their parent is in the room. Obviously, younger children are examined with a parent present, and a nurse is present for any examination that requires the patient to undress.
The gyn will discuss the findings and recommendations after the examination. For menstrual complaints, many girls respond quite well to birth control pills to regulate their periods, alleviate cramps, or lighten and shorten the duration of flow. Most teens can safely take oral contraceptive pills, so be prepared for a discussion about this. Alternatively, the physician may offer other medications or simply reassure the teen that nothing is wrong and no treatment is necessary.
We advise annual visits for patients who remain on medication.
Most complaints are treatable in one or two visits, but a follow-up visit may be advised.
Going to the gynecologist does not have to be a painful or scary experience! We can help you find a physician who has experience with pediatric or teen patients, and with proper preparation, your first visit to a gynecologist should be a positive experience!