Dr. Lilja Stefansson, OBGYN at Atrius Health, answers sensitive questions with straightforward answers.
Dear Dr. Stefansson, my daughter is 13 years old and recently started her period. When does she need to have her first gynecology visit? – GrowingUp2Fast
Dear GrowingUp2Fast, this is an excellent question, and I wish I heard it more often! The adolescent years can be a challenging time where our kids are “not really children, but they are also not really adults,” all the while undergoing significant changes — physically, emotionally, socially, and mentally. I often ask questions of Mother Nature, such as, “Could you not have figured out a way to do this without periods?! With the bleeding, cramps, and bloating for 4-7 days every month, did you need to make adolescence any harder?” We do not give adolescent females enough credit for all the changes and challenges they endure in a short period of time (pun intended)!
According to the American College of Obstetricians and Gynecologists (ACOG), the first gynecology visit should be scheduled between the ages of 13 -15, so your daughter is right there. Just to be clear, we do not take the place of our amazing pediatric and family medicine colleagues; we are there to supplement health care during the transition to adulthood.
Who is more nervous about this visit, your adolescent or you? Well, both of you may be equally so, but you do NOT have to be. Here is some info on what happens in a visit with your friendly neighborhood gynecologist. Styles will vary, so I will discuss my recommendations and how I practice.
You will likely participate in the first part of the visit as long as this is what you and your teen want. Then, yep, GrowingUp2Fast, you will probably get kicked out of the exam room. This is all done for one reason: to get your child accustomed to using their voice to speak about their bodies in a safe, medical environment. Talking alone with your child is an opportunity for the gynecologist to discuss topics such as periods, consent, safe sex, and substance use. Rest assured, this is done in an age-appropriate manner. I like to assess each patient and figure out what topics need to be reviewed in more depth. It’s important for both you and your teen to know that HIPAA protects the portion of the conversation that occurs alone with your child, and we need to get their permission to review their health information with you. Once again, this is part of the growing-up process and teaches them that they are the sole owners of their bodies.
During the visit, some of the topics I cover are as follows: I like to think of it as “PS.” Periods, Safety, Sex, Screenings.
Periods. How are their periods? Are they light or a torrential river of blood? How many days do they last, and at what frequency? I also discuss normal expectations for fluctuations in periods as time goes on. Fact: Did you know normal periods happen every 21-45 days for the first couple of years before settling to every 21-35 days? We may also discuss the option of using medication to help control the periods as they normalize.
Safety, safety, safety. Ok, this is a big one. Much of my job for every patient is making sure they are safe. This means safety in relationships, friendships, and at home. Along with this goes “Consent. Consent. Consent.” This is critical because, unfortunately, I have taken care of one too many patients who had not provided consent for someone to touch them. I want your adolescent to use the voicebox they were born with and get used to using it. Let me make myself clear: unwanted touching is not someone’s fault and does not mean they did not do a “good enough” job saying no. I always ask permission before doing an exam and use this as an opportunity to get your child used to being the owner of their body, even if that means telling me I am not allowed to examine them.
Sex. Ok, mom, don’t freak out with this one. I promise the assessments are age-appropriate. I need to assess what your adolescent knows about this topic and what their friends have taught them (oh, the things that are out there!). I speak with my 13-year-olds who just started their period and do not know much about sexual activity very differently from my 18-year-olds who have initiated sexual activity. I cannot tell you how many teens I have cared for who did not understand that having sex could result in pregnancy! I encourage you and your child to have open communication about sex, as awkward as it can sometimes be. By keeping the lines of communication open, your child knows they have a safe place with you to discuss whatever might be going on in their life.
Screenings and health updates. I will recommend any necessary testing for infections and/or pregnancy. Testing can be done through urine, so once again, a pelvic exam may not be necessary. Even though I am a doctor and speak with my patients independently and privately, the fear of information getting to a parent may lead a patient not to tell me the truth. More than once, I have seen a pregnant teen who had told me they had never had sex, and only with the positive pregnancy test did I get the whole story. And I hate that this occurs, but coerced sex is more common than you realize, and I need to ensure your child is safe (there goes that S-word again, “Safe!”). I also like to address any questions regarding the HPV vaccine if your child has not already received it.
Pap Smears. According to new guidelines from ACOG, a routine pap smear for cervical cancer screening is recommended starting at age 21, which is a change from when you were younger. I have many parents who are expecting me to do a pap and are surprised to know their child does not need one yet!
Ok, so we are done talking, now…
The Physical Exam: Never fear the exam! I generally start by getting weight, height, and blood pressure. Then I perform a general exam (think head and neck, back, abdomen and legs), and *only if clinically indicated* a pelvic exam. I don’t want your adolescent to refuse to visit with me due to fear of a pelvic exam. Also, what did I say earlier about consent to examine? If your adolescent does not want to be examined, I will not examine them.
So, GrowingUp2Fast, I hope this helps prepare you and your adolescent for their first gynecologic visit. Go on and pick up that phone and empower your not-a-child-now-transitioning-to-an-adult to use the voicebox with which they were bestowed on their entrance to this world. It is high time we empower the next generation and allow them to speak safely with their clinicians about their gynecologic health. This is, in fact, a very normal part of the human body and life, and not doing so can have devastating consequences. And mom, in a few years, when your once-a-child-who-is-now-an-adult is flying out of the proverbial nest, you will know you did a darn good job by teaching them to care and advocate for themselves.
For more information about a first gynecologic visit, check out these FAQs from ACOG.
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