Do you remember your first time, or would you rather forget that it happened? I’m referring to your very first visit to see a gynecologist! In my case, as for many of us, it was right before going off to college. The nurse told me to take everything off and put on the paper gown, then sit on the table and wait. And wait, and wait-my anxiety growing. When the doctor finally arrived and gruffly introduced himself, I had difficulty focusing on his face during the handshake because his shirt was unbuttoned to show off rows and rows of gold chains and massive amounts of chest hair. I recall there wasn’t much discussion before getting down to business: my first pelvic exam and Pap smear and handing me a script for birth control pills-which I hadn’t asked for! Gingerly walking back to the waiting room, I smiled meekly at my Mom and thought: what was that all about?
A lot-thankfully-has changed for young women embarking upon their first reproductive health visit. Most importantly, it is recommended that girls not wait to see a provider to address their gynecologic well-being until they go to college or plan to become sexually active. ACOG-the American College of Obstetricians and Gynecologists-recommends girls see a gynecologist (or other qualified provider) for their first visit between the ages of 13 and 15 years, sooner if there are any concerns or problems. Prevention and education will be more effective if it’s in place before there is any need for getting started on contraception or making smart decisions. An accurate assessment of pubertal development and even menstrual problems also can be difficult for parents and families, especially if mom had heavy, painful, or irregular periods herself and views that as the norm. Identifying pubertal or menstrual problems early on can prevent them from becoming serious issues in the future.
In addition to a shift in the timing of the first visit, there is now hardly any need at all for a pelvic exam using a speculum for an adolescent girl. There is no need for a Pap smear for anyone under the age of 21, and testing for infections-even sexually transmitted infections-can be accomplished with urine testing or self-collection of vaginal swabs. An examination during the first visit will happen after the doctor, the young woman and her parents have had ample time to talk in the office and become more comfortable and relaxed. When appropriate, the doctor will do a focused physical examination that may involve a breast exam and visualization of the vulva, but almost never is a vaginal speculum exam needed. Most of the time it is “just looking”.
The goal of that first visit is to establish a relationship between the doctor, the young woman and her parents; most of the visits actually involves just talking and making her feel comfortable-sometimes that is all that happens, if she feels too uncomfortable to be examined. While there are certainly pediatricians who are comfortable with adolescent preventative care, it can be especially awkward for girls to discuss extremely private matters with an adult that has known them since childhood. Graduating to see a gynecologist is an important step for a young girl, as she transitions to womanhood, and begins to really take responsibility for her own body, health and choices. So congratulations are in order for getting the first gynecologic visit done-for both mother (or father, grandmother, aunt..) and daughter!
Ultimately, she is going to get her information about sexuality, anatomy, reproduction, etc. from somewhere (think friends at school, the internet, the bathroom wall), so let’s make sure she knows who to talk to and who to turn to for questions and help. Providers who specialize in teenage girls know the importance of the mother-daughter (and often father-daughter or other trusted adult) relationship and want to help foster that bond. Parents always want their children to feel comfortable coming to them with any problems or concerns, but in reality the topics of puberty and all that goes along with it, can be so embarrassing to discuss-for both sides-that often the conversations are avoided. The first gynecologic visit is an opportunity to make these issues less “gross and icky”, and allow some time and space to get the communication going. It’s also a chance for parents to ask questions and get guidance and support for the highly challenging prospect of raising a teenager.
My hope is that when it is time for the young woman in your life to see a gynecologist for the first time, the experience is a really good one, for her and her mother (or other trusted, loving adult in her life), and that she comes away from it feeling more comfortable in her body, more knowledgable about what is happening to her, and empowered to make her own good choices. I appreciate you taking the time to read about the first gynecologic visit, and I invite you to share any recollections you may have about your first visit (good or bad!)to the gynecologist, or other experiences involving your adolescent self navigating the winding path to womanhood. Thank you!