Preparing for Your Teen’s First Gynecology Appointment
A gynecologist explains what to expect and how to help your adolescent get the care they need.
As girls grow into teens, seeing a gynecologist is an important step toward helping them get appropriate health care.
Going to the gynecologist should be “similar to going to the dentist or the eye doctor,” says Dr. Julia Cron, chief of the Department of Obstetrics and Gynecology at NewYork-Presbyterian Lower Manhattan Hospital. “The more we normalize reproductive health for adolescents, the easier it is for them. It gives them someone to talk to who can answer their questions, give them advice, and dispel some myths that they might have heard.”
Contrary to what some parents may think, gynecological care for adolescents and young women is “not just about sex,” says Dr. Cron, also an assistant professor of clinical obstetrics and gynecology at Weill Cornell Medicine. Seeing a specialist is an opportunity to establish a baseline for a teen’s reproductive health, help them understand the myriad changes their body is going through, and set them on a path toward lifelong health.
Preparing for the first appointment
The American College of Obstetricians and Gynecologists (ACOG) recommends scheduling the initial appointment between ages 13 and 15, whether or not a teen is sexually active.
Dr. Cron, who specializes in pediatric and adolescent gynecology, suggests talking about the idea before you make the appointment. “A big thing for teenagers is control, so it’s much better if they are on board with this,” she says.
A good time might be when they have their annual visit to their pediatrician. “Bringing it up in that context gives parents an opening,” Dr. Cron says. “They can say, ‘We’re going to go see the eye doctor and the dentist soon. And maybe we should think about going to a gynecologist too.’”
It can help to let your daughter know that she probably won’t need a pelvic exam, which can be anxiety-provoking, says Dr. Cron. In fact, most of the visit is just talking — at first with both the adolescent and the parent or caregiver. “I usually say to the parent, ‘OK, now it’s time for me to kick you out of the room,’” she says, which allows the teen to talk openly and confidentially and gives the doctor the opportunity to build trust.
What Happens During the Visit
The doctor will perform basic checks of weight, blood pressure, and heart rate and may give the patient a breast exam and an external exam of the genitals to make sure there is nothing to be concerned about.
If a young patient is sexually active or thinking about it, the gynecologist will discuss contraceptive methods and the prevention of sexually transmitted infections (STIs), and, if the teen is sexually active, will also test for STIs. “Right now the recommendations are that sexually active young people under 25 should be screened yearly for gonorrhea and chlamydia,” says Dr. Cron.
Ideally the patient will have received the vaccine for human papillomavirus (HPV), which protects against cervical cancer, at age 11 or 12. If not, the gynecologist can administer it. The vaccine guards against strains of HPV that cause cervical cancer, which is transmitted through sexual activity.
The recommended age for a young woman’s first Pap smear, which checks for signs of cervical cancer, is 21. “HPV changes are very slow-growing,” says Dr. Cron. “The percentage of cervical cancer cases in people under the age of 21 is almost zero.”
What problems should prompt a parent to take their adolescent to a gynecologist if they haven’t been? “In general, anyone who hasn’t had a period by 15 or 16 should be seen,” Dr. Cron says. “And also significant bleeding — frequent bleeding or very heavy bleeding — and pain that is affecting their lives.”
Period Problems — and More
Whether your adolescent sees a general gynecologist or a pediatric and adolescent gynecologist, the provider can address a variety of issues. “If a young woman or even a young girl has eczema and ‘sensitive skin,’ that has implications for the vulva, including itching and rashes,” says Dr. Cron. Even before puberty, girls can develop annoyances like vaginitis that need treating. “They may have had an issue with hygiene that results in discharge, discomfort, and itching,” she says.
A gynecologist can also evaluate anatomical problems of the reproductive system, such as an imperforate hymen, when the hymen covers the entire opening of the vagina (rather than part of it), requiring surgery. “Those patients can present with pain and a lack of menstrual periods,” says Dr. Cron.
Difficult periods are a common complaint. But gynecologists have a repertoire of remedies for heavy or painful periods or irregular bleeding, such as hormone-based birth control methods or long-acting reversible contraceptives (LARC) — intrauterine devices and implants, says Dr. Cron.
“In the past the thought was that they had to just live with it,” says Dr. Cron. “But, in fact, there are things that we can do that can really transform people’s lives. If your period is impacting your life, meaning you’re missing school, sports, and time with your friends, there are solutions.”
Dr. Cron says a patient’s specific period pattern can also uncover more significant problems. “Periods are a vital sign,” she says. “They can be an indicator of other things going on.”
Missed periods can alert the doctor to a young patient’s eating disorder, for instance. “The girls who are underweight and have disordered eating might present with irregular or no periods,” says Dr. Cron. “And that’s the time to intervene and talk about a healthy diet and the minimum weight that’s normal.”
Teens who have missed, irregular, or very light periods may be experiencing a hormonal problem like polycystic ovary syndrome (PCOS), which causes the ovaries to produce an abnormal amount of testosterone and is associated with a higher weight and, later, fertility problems.
“If we intervene early in terms of diet and exercise, we can improve the hormonal imbalance for lots of these young people and prevent them from developing some of the complications of PCOS,” says Dr. Cron.
As young patients get older and have more complex needs, they will have established a relationship in which they are comfortable talking about them, says Dr. Cron.
“You want your teen to have a trusted adult that they can talk to about their concerns,” Dr. Cron says. “You know they’re talking about them with their friends and going online. But you also want them to have somebody who will give them evidence-based answers.”
Learn more about women’s health at NewYork-Presbyterian Lower Manhattan Hospital.
Dr. Julia Cron, M.D., is chief and vice chair of the Department of Obstetrics and Gynecology at NewYork-Presbyterian Lower Manhattan Hospital and director of Obstetrics and Gynecology Patient Safety. She is also assistant professor of clinical obstetrics and gynecology at Weill Cornell Medicine. Dr. Cron specializes in pediatric and adolescent gynecology.