Babies, Children & Teens Sexual Health

When Should Teens Start Seeing a Gynecologist?

For many parents of teen girls, the question of when teens need to start seeing a gynecologist sparks uncertainty.
The American Congress of Obstetrics and Gynecology and the North American Society for Pediatric and Adolescent Gynecology recommend annual Pap tests to screen for cervical cancer starting at age 21, regardless of sexual activity. But issues can come up long before then.
Because the average age of starting menstruation is 12 years and 9 months in the United States, it’s appropriate for girls to begin seeing a gynecologist as early as age 13, said Alla Vash-Margita, M.D., a fellow physician specializing in pediatric and adolescent gynecology at University of Michigan Von Voigtlander Women’s Hospital.
Dr. Vash-Margita explained more about when and why teen girls should visit a gynecologist—as well as what parents should know before they go.
Not like Mom’s appointments. “Don’t expect your daughter’s first visit to mirror your own annual trip to the gynecologist,” said Dr. Vash-Margita.
Most initial exams won’t include a pelvic exam, and young girls should know that ahead of their visit to put their mind at ease, she suggested. “Ninety-five percent of the time we don’t do a pelvic exam that young, so that shouldn’t deter anyone from coming.”
Dr. Vash-Margita advised that the vast majority of patients won’t need to begin Pap screening for cervical cancer until age 21. Instead, the visit will likely include a general physical exam, which includes height, weight and blood pressure measurements. The physician may also perform a brief external genital exam, but the visit will likely be conversational more than anything else.
Important conversations. In most cases, your daughter’s first appointment is an opportunity to talk about her development and establish a relationship with her gynecologist.
During visits, Dr. Vash-Margita counsels patients about risky behavior such as smoking, drug and alcohol abuse, and unprotected sex. She likes to have a parent or guardian in the examination room initially to help girls feel less anxious and answer questions from the teen that the gynecologist might not be able to answer. But at some point, she asks the adult to step outside so her young patients can feel free to speak candidly.
“I stress to them that whatever they say to me will be kept strictly confidential unless they’re doing something that could hurt them or someone else,” Dr. Vash-Margita said.
Another major topic during many initial patient visits is vaccination against human papillomavirus, or HPV. This sexually transmitted infection is associated with most cervical cancers. Doctors advise that one of the most effective tools for prevention is the HPV vaccine, a series of two or three injections ideally given at age 11 or 12.
“I have parents tell me their daughters don’t need it because they are not sexually active, but that’s the whole point: to get protection before she starts sexual activity,” Dr. Vash-Margita said. “After sexual activity, the vaccine will still work, but it’s a lot less effective. We want to get her started before she’s been exposed to HPV for the maximum efficacy.”
Dr. Vash-Margita directs parents who are nervous about the vaccine to the Centers for Disease Control and Prevention website, where the federal government tracks its efficacy and safety.
“It’s not rumors and speculation. It’s hard data,” Dr. Vash-Margita said. “In all the years I’ve been giving this vaccine, I’ve seen little, if any, side effects. Typically, the most you’ll see is some pain and swelling at the injection site, or in rare cases temporary lightheadedness, but most people don’t experience any problems.”
Knowing what’s “normal.” Every child is different, but in general if girls don’t show secondary sexual characteristics such as breasts and pubic hair by age 13, they may need an evaluation. If there is breast and pubic hair development but no menstruation by age 15, then seeing a gynecologist is a must.
It doesn’t necessarily mean something is wrong if a girl’s period isn’t regular at first. Especially in the first two years of menstruation, it’s common for periods to deviate from the strict cycle of every four weeks or even to skip a month.
But pay attention to menstrual pain if it’s excessive, Dr. Vash-Margita said. Some pain with periods is normal, but girls should be able to manage routine cramps with over-the-counter pain medicines.
“We ask whether pain is so severe that it’s interfering with daily activities,” she said. “Is she missing several days of school every month? If she plays sports, is she able to compete?
“And to get an idea about amount of menstrual blood flow, we ask about the number of pads or tampons used per day, as well whether she’s soaked through clothes during the day or soiled sheets at night. If it’s that painful and that heavy, it may be time for additional testing.”
Pill talk. There are a number of reasons a physician might recommend birth control medication that have nothing to do with avoiding pregnancy, such as heavy periods or extreme cramping.
Dr. Vash-Margita doesn’t like to use the words “birth control” or “contraceptive” with young patients or their parents. She prefers to call treatment for gynecological conditions “hormonal therapies.”
That’s because too often, parents shy away from treatment they associate with birth control even though girls who are not sexually active could benefit from hormonal therapies if they have problematic menstrual cycles. “If contraception is not an issue, we don’t want to give the wrong impression,” Dr. Vash-Margita said.
Choosing a doctor. Just as you would seek out a cardiologist for a heart condition, it is recommended that parents seek out a pediatric and adolescent gynecologist if their daughter has recurring issues or if they have concerns about her development.
To help, the North American Society for Pediatric and Adolescent Gynecology has a listing of pediatric and adolescent gynecologists by state, in addition to other resources for parents and girls.
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