Fear Not Young Ladies! The In’s and Out’s of the First Gynecological Exam

By Kassandra Patton

Screening

The American College of Obstetricians and Gynecologists recommend a young woman’s first visit to the gynecologist sometime between the ages of 13 and 15 years, unless indicated sooner. This information may make any teenager reading this want to hide the magazine…But wait! Things have changed significantly in the last 10 to 15 years in regards to a young woman’s screening and wellness care in our offices. Gone are the days when a teenager is required to have a full female exam just for setting foot in a gynecologist’s office. The newest recommendation is that there is no need for a pelvic exam on women under the age of 21 that is not having symptoms consistent with genital tract disease or dysfunction, even if she is sexually active. A Pap smear is also not required on any woman under the age of 21 regardless of sexual activity.

If there is concern of sexually transmitted disease, we will most likely be able to screen a sexually active woman by using a urine specimen obtained in complete privacy by the patient during her visit.

So, what exactly happens at a female screening or wellness visit for a teenager? 

A thorough medical history is obtained as well as detailed information about your periods and any other concerns.  I prefer to have a parent or guardian present during this portion of the visit as many teenagers do not have knowledge of their family histories. When it comes to asking more personal questions, such as about sexual activity and any private questions that the patient might have, I will offer to have the parent or guardian step out of the room to allow for questions that might feel too embarrassing to ask with an audience.  Counseling may also be done at this time regarding safe sex, substance abuse, and healthy lifestyle.

After we are done taking a complete history, a brief physical exam is often performed.  For patients younger than 18, a physical exam similar to that at a pediatrician or family practitioner’s office will be performed.  If she is older than 18, a breast exam may be taught and performed as well.

Sexual Activity

Ideally, a teenager will be seen prior to having sex. It is a good rule of thumb to come into the gynecologist if the patient has a steady boyfriend or if she is considering “taking things to the next level”. It is also good to start on birth control prior to becoming sexually active as some methods take one month before they are fully effective. Many teenagers are afraid to report that they are having sex because they do not want to have an exam. This is concerning as it is important for her to not be afraid to come to our office for evaluation. A pelvic exam is rarely needed. A careful history and a lot of counseling will be the focus of this visit. A urine sample may be taken for STI testing.

Gynecological Concerns 

Period Problems

If the patients periods are heavy or painful enough that they are interfering with their school work, sports or job, further evaluation is needed. If they are experiencing very irregular periods or periods that don’t appear for 3 months or more, or if their periods have not yet stared by age 15 despite other signs of puberty (such as breast development) they should be seen in our office.

Yeast infection/vaginal irritation

If the patient has concerns about vaginal discharge, odor, itching, or burning, they may have an infection that needs attention. This is especially common in the summer months as prolonged exposure to wet bathing suits or clothes damp from sweat can make ideal conditions for growth of a yeast infection.

Other concerns

Any other concerns that a patient may have about your gynecological health can be addressed with a visit to a gynecological practitioner. The patient may no longer get a sucker or sticker when they leave the doctor’s office, but what they will get as a reward is peace of mind that their health can be carefully maintained without fear of GYN visits.