When and Why Should Adolescent Girls First Visit a Gynecologist?
I can’t remember when I first saw a gynecologist. Now that I have a 15 year-old daughter, I wondered about when she should start.
Turns out we’re already late to the game, as the American College of Obstetricians and Gynecologists (ACOG) recommends that adolescents establish care with an OB/GYN between the ages of 13 and 15. Why this age range, and is this recommendation actually followed?
It’s a misconception that gynecologist visits should only occur once girls are sexually active. Seeing a gynecologist helps young women understand and care for their bodies, develop the comfort and confidence discussing sexual and reproductive health issues with a provider – which they will do throughout their lives, says Dr. Aletha Akers, MD, MPH, FACOG, medical director of Adolescent Gynecology Consultative Services in the Division of Adolescent Medicine at The Children’s Hospital of Philadelphia. Establishing a rapport with the gynecologist is nothing but a good investment in female health.
I inquired on Facebook when friends and/or their daughters started going and received a range of responses. Many said they first saw a gynecologist as a teenager due to heavy and/or irregular periods and cramps. A large number didn’t go until just before college. One friend said her pediatrician told her at 18 that she needed a “big girl doctor.” A few didn’t find themselves at the gynecologist until they were pregnant, like a friend who was 24. Another friend went when she had a yeast infection and was allergic to Monistat.
I wasn’t aware of the age recommendation – which likely didn’t exist when I was a teenager. This isn’t surprising, given it’s not well known among families or even healthcare providers and therefore generally not followed, says Dr. Akers.
These guidelines are in place to recognize that efforts have been made to have pediatric providers address the necessary topics, Dr. Akers says, but few providers do so.
It all starts with the type of primary care provider your daughter is seeing, says Dr. Maria Trent, MD, MPH, Chair, Section on Adolescent Health, American Academy of Pediatrics (AAP). The AAP promotes the integration of gynecologic care – reproductive and sexual function and anatomy — into the medical home (team-based primary care). For example, Dr. Trent is an adolescent medicine specialist, a pediatrician with additional subspecialty training and board certification focused on the care of adolescents and young adults. Adolescent medicine care centers on the adolescent and is family engaged so they can care for the whole person as she develops. Pediatricians with this training and family practitioners who receive gynecologic training during residency can also provide gynecologic care in this primary care setting, Dr. Trent says, and referral to a gynecologist in this instance would only occur for unusual cases that require additional consultation or surgical intervention.
The bottom line: Seeking out a gynecologist depends on patient needs, provider skill, and clinical context. “It’s important to note that not all gynecologists are comfortable managing pediatric or adolescent gynecologic issues,” Dr. Akers points out, like abnormal periods, vaginal discharge, sexual behavior, and development. “Thus, families should make sure that when making an appointment with a gynecologist, they are seeing someone who is comfortable and skilled with managing pediatric or adolescent patients.”
A general rule of thumb is a pediatrician tends to provide more complete health care maintenance, while a gynecologist focuses on reproductive health. To spell this out further, a pediatrician is typically seen for vaccinations, illnesses (cold, flu, rash), yearly checkups, and treatment of serious diseases, according to the University of Alabama at Birmingham. Likewise, a gynecologist is seen for reproductive health, menstrual disorders, sexuality and relationships, pregnancy, and STDs. A trained pediatrician, adolescent medicine specialist or family practitioner can also provide care for many adolescent gynecological concerns, as the American Academy of Pediatrics recommends.
Out of curiosity, I asked my daughter if she knew what a gynecologist was for, and her response was, “vagina issues?” Well, yes, but this barely covers it.
This is likely why the optimal age at which an adolescent and their parents should begin to have anticipatory guidance provided about reproductive health is nine, says Dr. Akers. Age appropriate discussions about topics like birth control, dating, and STDs should then occur each year, because the average age of puberty is a little after age 12.
Other reasons it’s important to see a gynecologist before age 21 include evaluating romantic relationships (is it threatening or harmful?), talking about LGBT topics, and learning about what’s normal. Confidentiality laws will ensure that adolescents – whether or not they’re sexually active – have access to information, counseling, and services to make healthy decisions, says Dr. Akers.
Pap tests are typically not necessary until 21, so any fears about a full internal exam can be put to rest. To learn more about the first visit, read this FAQ by ACOG.
These early visits can prevent heartache later on. A friend first started going at 16 or 17 because of irregular periods. She wishes she had felt empowered to ask questions (given information to read beforehand, websites to check out) and that the doctor had been more through, because she went over 10 years without knowing the true cause of her amenorrhea (absence of menstruation), which led to prolonged fertility issues.
Sometimes girls need this outside support if they’re not getting it at home. Another friend’s mom waited as long as possible to send her; she didn’t go until she was 18 or 19. Her mom couldn’t even say vagina or penis out loud and wouldn’t let her read anything about her body or sex. She wishes she had gone after she got her first period at 12, as awkward as it would have been. “I would have welcomed talking to and confiding in a doctor, since my mom was useless in that arena,” she says.
Not only is visiting early more proactive, but it can positively affect behavior down the road. Take another friend, who first went at 17 and plans to send her daughter then as well. She’s glad her mom took her at that age, because she remembers the doctor showing her this BIG scary book – with actual photos — of all the STDs she could get if she had unprotected sex. “It made a huge impact on me!” she says. She adored this doctor and remained with her until the doctor passed away a few years ago.
As for me, I’m convinced. I’m calling my gynecologist tomorrow!
Edited 5/12/2017: to include American Academy of Pediatrics recommendations.