Your Daughter's First Gynecology Visit

As girls grow into teens, it's important that they get the right health care. Doctors recommend yearly checkups that focus on the female reproductive system, starting between the ages of 13 and 15. Often called well-woman visits, they can catch small issues before they become big ones.

Why Is the First Gynecology Visit Important?

The thought of seeing a gynecologist or having a pelvic exam can make a girl feel nervous, embarrassed, or scared. To help your daughter feel more comfortable about it:

• Explain why the visit is needed.
• Help your daughter know what to expect.
• Talk about any questions or fears she might have.

Your daughter might associate doctor visits with health problems. She may not get why she would need to go to the doctor when she feels fine.

Explain that a well-woman visit provides:

• Information. She'll get accurate information and confidential answers to questions about sex, sexuality, her changing body, and her periods.
• Prevention. She can learn about pregnancy prevention, STDs (sexually transmitted diseases), and healthy lifestyles.
• Treatment. The doctor can diagnose and treat any problems, such as missed periods, and pelvic or stomach pain.

For some teens, the first visit may just be a talk with the doctor. For others, the doctor might do a physical exam, which can include looking at the genitals. (Genitals are the sexual or reproductive organs that are on the outside of the body.)

Also, reassure your daughter that the actual physical exam doesn't take long at all. Most girls won't get an internal pelvic exam. These are recommended starting at age 21 for healthy women. But a girl who has problems like heavy bleeding, painful periods, or unusual vaginal discharge might need a pelvic exam sooner.

How Should We Choose a Women's Health Care Provider?

The doctor or that your daughter sees should be someone who takes the time to make her feel as comfortable as possible. You have probably made your daughter's health choices until now, but it's wise to involve her in this one.

Ask your daughter what type of health provider she would prefer:

• Male or female? Younger or older?
• Would she like to stick with the pediatrician or family doctor she has seen before (if they provide women's health care), or see someone new?
• Would she like to see the same person as you, or does she prefer to confide in someone who has no connection with you?

Then, ask around to find a doctor who best fits your family's needs. Your pediatrician or family doctor might be able to recommend someone. If you like a specific hospital or medical office, see someone linked to it.

Asking these questions can help you choose a health care provider:

• What is your confidentiality policy? (This may affect how open your daughter is during the visit. Most offices won't share the details of the visit with a parent unless the patient says it's OK, or if the doctor feels that the child is doing something harmful. Also, different states have different rules about confidentiality.)
• Are you board certified?
• What is your approach toward discussing sexual activity?
• Do you have experience with first-time patients and teens?
• Will you see my daughter at each visit or will she see different providers?
• Who else will be in the examining room?

Share the answers to these questions with your daughter. And don't hesitate to talk to a few health care providers before making a decision.

When you go, ask your daughter if she would like you to be in the exam room with her. Whatever she decides, give her some time alone with the health care provider. You want your daughter to be honest and not hold back information she might not share with you there. Also, alone time lets her get to know the doctor. That can help her feel at ease talking about any concerns in the future.

What Will the Doctor Ask About?

The doctor will talk to your daughter about her . This means she'll answer questions such as:

• When was your last period?
• Are you, or have you ever been, sexually active (meaning vaginal, oral, or anal sex)? If so, are you using birth control and STD protection?
• Are you having any problems with your period, such as pain or heavy bleeding?
• Do you have any unusual vaginal discharge, or sores, itchiness, or discomfort in the vaginal area?
• Do you think you could be pregnant?

Her answers can help the doctor decide which tests to run and what issues to discuss. Tell her it's important to answer truthfully, even though she might feel uncomfortable. Remind her that the doctor or nurse has discussed these things many times before and will not share the information with anyone else.

What Happens During the Physical Exam?

Before the exam, give your daughter a sense of what will happen. She should know what to expect, and why the doctor is doing it. If you are both comfortable with the idea, consider letting your daughter see these steps firsthand by sitting in on one of your exams.

Basic checks. First, a nurse or assistant will measure things like your daughter's weight, heart rate, and blood pressure. The doctor may examine her neck, heart, lungs, and belly. This will give the doctor a sense of her general health and a baseline to use for comparisons in future exams.

The breast exam. Breast cancer is very rare in teens. But the breast exam is still an important part of the visit. The doctor does this to make sure that your daughter is developing well and to detect lumps, cysts, or breast problems.

The external examination. If she hasn't already, your daughter will undress and put on a gown. Her pelvis and thighs will be draped with a sheet. She may be asked to lie on the table with her knees bent and spread apart. The doctor may have her place her feet in stirrups. In this position, the doctor will check the vulva (the external genitalia). This is to make sure there are no sores, swelling, or any other problems with the external genitalia.

The internal examination (pelvic exam). If a pelvic exam is needed, the doctor will place one hand on the outside of your daughter's belly and one or two fingers inside the vagina. This way the doctor can feel the size and position of the ovaries and uterus. A tool that opens the vaginal walls (a speculum) lets the doctor see the walls and cervix and do screening tests, such as a Pap smear and tests for some STDs.

Let your daughter know that she may feel some pressure, but this shouldn't hurt. To decrease any discomfort, she can take slow, deep breaths and relax her stomach and vaginal muscles.

The Pap smear. During the internal exam, the doctor or nurse may take a Pap smear. Gynecologists recommend a Pap smear starting at age 21, and then every 3 years for women in their 20s. In this test, the doctor gently scrapes cells from the cervix using a small brush or spatula. The sample is checked in a lab for cell changes and cervical cancer.

The provider may ask if your daughter got the human papillomavirus (HPV) vaccine at her pediatrician's office. If she didn't, they might offer it. This vaccine protects against the main types of HPV that cause genital warts and some types of cancer, especially cervical cancer. Even if your daughter gets the HPV vaccine, she should still get regular Pap smears starting at age 21 to screen for other forms of cervical cancer.

What Is STD Testing?

Testing for STDs isn't a regular part of a well-woman visit. But girls who have been sexually active should ask for STD testing. Sometimes, doctors do this with blood or urine (pee) tests. Other times, the doctor takes a sample with a cotton swab (as in a Pap smear) during a pelvic exam.

The lab checks the samples for STDs like gonorrhea and chlamydia. When talking to your daughter about STD tests, explain that vaginal intercourse isn't the only way to get infected. Germs also can pass through oral sex and anal sex.

Ask the office staff about how your daughter can get test results confidentially. For instance, instead of calling the patient or sending a letter with the results, some offices ask the patient to call in.

After your daughter's first visit, encourage her to talk about it (as much as she feels comfortable). If she says that the doctor or nurse practitioner made her feel uneasy, find a new one. Your daughter should continue to go for well-woman visits every year to keep her informed and healthy.