Nobody really likes to go to the doctor. I’m a physician, and even though visiting my own doctor is high on my list as an ‘ounce of prevention,’ it is not something that everyone particularly looks forward to.
Imagine, then, how a teenager must feel on her first visit to a gynecologist. As girls enter their teenage years, many mothers begin to question when is the right time to bring their daughter for her first visit to the gynecologist. Sadly, they may even delay making that much-needed appointment for their daughter because she is scared and nervous that it may be unpleasant, or, based on their own experience, are apprehensive over the thought of their daughter at some point going through a pelvic exam.
Regardless of the reason, it’s not an appointment that should wait too long given the obvious statistics today.
The United States has teen pregnancy, birth, abortion, and STD/HIV rates that tragically exceed many other industrialized countries. Locally, Holyoke has the highest rate of teen pregnancy in the state, while Springfield, which once occupied the second spot, recently dropped to sixth. As a result, we continue to encourage parents to bring their daughters to an ob-gyn for their first visit earlier rather than later.
The American College of Obstetricians and Gynecologists recommends that adolescent girls have their first visit with an ob-gyn between the ages of 13 and 15 to help set the stage for optimal reproductive health. Also, today the recommendation is that adolescents and young women don’t need their first Pap test until age 21.
The scope of an adolescent’s first visit with an ob-gyn will depend on her unique needs, taking into consideration her physical and emotional development, medical history, and the level of care she is receiving from other health care providers. More often than not, an adolescent’s first ob-gyn visit includes only a basic physical exam such as checking height, weight and blood pressure, as well as for any other existing health problems. It is a popular misconception that the visit will include an abdominal or pelvic exam. Medical evidence tells us that delaying a pelvic exam, unless conditions such as abnormal bleeding or pain warrant one, has no effect on their health.
The majority of time outside of the exam is spent getting to know one another. I often refer to it as a ‘meet-and-greet,’ a time to create a healthy doctor-patient relationship. As doctors, we want to establish a bond of trust with our new young patient, provide accurate answers to questions she might have about her body or health, and offer important information on prevention, risky behaviors, and tips on staying healthy. Our discussions will touch on subjects such as puberty, normal menstruation, healthy eating habits, sexual activity, pregnancy prevention and sexually transmitted diseases, substance use and abuse, acquaintance rape prevention, and the importance of scheduling routine gynecologic visits.
As part of their visit together, gynecologists often ask their young patients personal questions such as “are you sexually active?” or “are you having any problems with your menstrual periods such as pain?”
We want to get honest answers to these questions without a girl having to worry about the confidentiality of her answers. I always explain doctor-patient confidentiality to each of my young patients so that they understand they are speaking to me in confidence. At the same time, there has to be a level of trust between the parent and doctor. Most parents understand and respect the need for confidence. As a rule, most doctors will not share information from the exam with a parent unless given approval by the patient. I only confide in a parent about their daughter if there is reason to believe her life or health is in serious jeopardy, or if she might be a danger to another person.
It is important to note that states have different rules regarding confidentiality and notifying parents about contraceptive use. In Massachusetts, adolescents can make an appointment with a gynecologist without a parent’s knowledge and can be tested for STDs without a parent’s consent.
While I prefer to have a parent involved, there are situations where it won’t happen.
Visiting the doctor can be stressful for anyone, so it’s not unexpected for a teenage girl to be anxious or embarrassed about her first gynecologic visit. Parents can help relieve some of that nervousness by giving their daughter a sense of what to expect. In doing so, it’s important for a mother not to project a bad experience she may have had at the gynecologist’s office onto her daughter.
If a mother makes it sound horrible to their daughter, then it will certainly raise the girl’s anxiety level. And, if she is still extremely nervous after positive reassurance, parents should encourage their daughter to tell us so we can help to further ease her fears.
Also, before making an appointment with their own gynecologist for their daughter, mothers should check first, because some teen girls may be hesitant to share information with someone connected to their mother.
A first-time visit with a gynecologist is a wonderful opportunity for young girls to take charge of their health and to learn to make safe decisions regarding their sexual and reproductive health.
However, while gynecologists play an important role in discussing subjects such as sexual activity, pregnancy, and sexually transmitted diseases, parents must participate in the process and have discussions with their daughter, as well.
It cannot be denied that parents have the opportunity to make a tremendous impact on their children and guide them in making better and healthier decisions in their life. Don’t wait until it’s too late.
Dr. Patricia Bailey-Sarnelli is an attending physician in the Department of Obstetrics and Gynecology at Baystate Medical Center. For more information on Women’s Health at Baystate Medical Center, visit baystatehealth.org