What is an Adolescent Gynecologist?

We are OB/GYN doctors who have completed additional training (generally a 2 year post graduate fellowship) specifically to manage the surgical and medical issues involving the reproductive system in girls and young women. Back when I started my fellowship in 2005, there were only 2 formal programs in the nation. Now there are more than 10 programs and several in development. For more information about Adolescent Gynecology, or to find a qualified provider in your area, go to NASPAG (North American Society of Pediatric and Adolescent Gynecology).

When should I take my daughter to see the gynecologist for the first time?

The American College of OB/GYN actually recommends that girls have their first “reproductive health visit” sometime between the ages of 13-15, in order to start establishing care and determine if everything is going normally in terms of pubertal development, growth, etc. However, if there is a problem or concern sooner than that, it is certainly appropriate to seek help at that time.

Will my daughter need a pelvic exam during her first visit to the gynecologist?

Mostly likely, no. The first visit to see the gynecologist is usually mostly talking, to help girls and their parents understand if what they are experiencing is normal and if there is anything concerning. It’s really uncommon for me to need to perform an internal exam on my young teen patients.

What about testing for infections?

Often, any needed testing for infection can be done with a urine test or a small swab in the vagina.

What about a Pap smear?

Many people are not aware that we no longer recommend Pap smears (a screening test for cervical cancer) for anyone under the age of 21, so teenagers DO NOT need Pap smears!

What happens during the first visit to the gynecologist?

Mostly we spend time talking, usually together with parents, to address any concerns and answer questions. Then we do a physical exam that mostly involves just looking and, when ready, teaching girls about their own anatomy, reassuring them about what is normal.

Will you talk to my daughter alone?

It depends on her comfort level, but I always try to take some time to talk with the patient when her parents are not present, so she can feel comfortable discussing things that might be sensitive and to explain doctor-patient confidentiality. I always congratulate both girls and parents on taking the time for their first visit, as it is a big step towards a young woman taking care of herself and a great opportunity for parents to discuss important, (if often uncomfortable), values with their children.

Do you recommend the HPV (human papilloma virus) vaccine?

Absolutely! It’s a very effective cancer prevention strategy, and in nations such as Australia where the majority of the eligible population has been vaccinated, the decrease in the rates of HPV-related disease has been dramatic-as much as a 93% drop in 6 years.

How common is HPV anyway?

Extremely common: almost everyone who is sexually active will be infected with some strain of the virus at some point in their lives.

What health problems are caused by HPV?

Genital warts (about 1 in 100 sexually active people will have them at any given time), abnormal Pap smears and cervical cancer are the most common problems (11,000 women are diagnosed with cervical cancer in the US every year).

Isn’t the HPV vaccine just for people who are sexually active?

No-the vaccine is much more effective if given in early adolescence, before the chances of exposure to HPV is higher. Also, the immune response in a young person is much, much larger and potentially longer lasting than the production of antibodies seen after vaccination in an adult.

At what age should girls and boys be getting the HPV vaccine?

Between the ages of 11 and 12, but as old as 26 to catch up the series of 3 vaccines is recommended.

What kinds of problems do Adolescent Gynecologists (PAG) manage for younger girls?

We often see young girls who have vulvar rashes, itching and irritation or skin changes. They have usually already seen the pediatrician, who may recommend a referral to see a PediGyn provider. We also see girls with signs of early puberty, such as breast development or vaginal bleeding before age 8. While they are uncommon, we also see and manage patients with congenital defects of the reproductive system-these often first become an issue when menarche (the first period) occurs.

What kinds of problems to PAG doctors see and manage for adolescents?

Almost every gynecologic problem that we see in adults can present in adolescents as well. We see girls with difficult periods that may be very heavy, irregular or painful, affecting their life at home and their performance in school. Girls who are missing periods, sometimes because of eating disorders or intense physical training. Adolescent patients with pelvic or abdominal pain may need surgical management for ovarian cysts or other issues.

Would a PAG provider take the place of my child’s pediatrician?

No! We work together with your pediatrician to complement their goal of a healthy child and family.