Many parents wonder when they should take their daughter to a gynecologist. Is it with their first period? Is it when they become sexually active? When do they need a pap smear? Some women dread their own appointments and worry their daughters will have a traumatic experience. Well, the good news is that gynecologic care for adolescents has come a long way, and teens can be provided with important information in a sensitive and caring way, and many girls do not even need a pelvic exam!
First, let me cover a bit of what’s normal. Most girls begin breast development around 10-11 years of age, and the average age girls start their periods in the U.S. is about 12.5 years. Most girls will bleed 5-7 days and cycles occur every 25-40 days. If a girl hasn’t started her period by age 14, she should be evaluated, and although some girls just need more time, others may have a real problem. Many girls have irregular menses for the first 2-4 years after they start their periods, but if a girl has been bleeding more than 10 days per month, they should be evaluated to prevent problems with anemia. I’ve seen girls who have bled for 6 months before seeing a gynecologist and some have been so anemic by then that they required blood transfusion. Most girls will notice an increase in menstrual cramps about two years after they start their periods, as this is when they start to actually ovulate. Severe cramps so that a girl is missing school are not normal and she should also be seen. Finally, if a girl has had regular menses and then the menses become irregular, skipping months or becoming more frequent, she should also be evaluated. Sometimes there is a hormonal disorder that needs to be evaluated.
Another common concern is vaginal discharge in teenagers. As a girl enters puberty the normal hormones cause her to have a discharge from both cervical mucus and the vaginal walls. It can be clear, light yellow, or white. This is a great time to discuss hygiene, washing daily with water (avoid harsh soaps), wearing a panty liner if needed, and helping out with the laundry! Also as the sweat glands in the area are exposed to the hormones, girls will have a stronger body odor. Again, hygiene is key, but avoid deodorants in the private area. A lot of girls shave their pubic hair at surprisingly young ages. Some develop infections of the hair follicles. Teaching razor safety, use of clean razors, and not sharing razors is important. If a girl has a heavy discharge with a foul odor, if she has itching or burning with the discharge, or if she is sexually active and at risk for an STD, she should come in for an evaluation.
When do Girls Need PAP Smears and Breast Exams?
Women do not need pap smears until they are 21 years of age, even if they are sexually active. Why? The human papilloma virus (HPV) that causes cervical cancer requires five years or more to actually cause significant cell change on the cervix. In fact, most girls will clear the infection completely (just like you can clear a cold) without any treatment. Of course those who are vaccinated with the HPV vaccine are at much lower risk of getting HPV, genital warts and cervical cancer. It is important to vaccinate before sexual activity if at all possible as the vaccine works much better if a girl has not been exposed to the virus. Also, girls do not need a pap smear before they start birth control (American College of OBGYN).
Women should begin having a breast examination at age 20. Of course if a girl notices a lump she should get it evaluated; the good news is that they are 99.5 percent benign at this age.
If they’re Sexually Active, What About Contraception?
For girls who are sexually active, it is very important to visit a gynecologist as long acting methods of contraception such as the Nexplanon implant and the Mirena implant have been shown to be safe in teens and much more effective than birth control pills at keeping girls from getting pregnant. Of course they do not prevent sexually transmitted diseases, and the CDC (Centers for Disease Control) recommends routine screening for these infections for all teens who are sexually active.
The most important reasons for a teen to visit a gynecologist are preventative, and this includes teens who are not sexually active. As a pediatric adolescent gynecologist, I spend much of the time with my patients providing education on a variety of topics including hygiene, abstinence, avoidance of date rape through reducing risky behaviors, contraception counseling, condom use, emergency contraception use and prevention of sexually transmitted ideas. I also discuss some of the emotional difficulties of being a teen. While many mothers bring their emotionally labile daughters in to “fix her hormones,” it is most often not the hormones that are the problem, but rather how the adolescent brain is adjusting to the new hormones and that just takes time. Like all adolescent gynecologists, my visits include some private time with my teen patients, so that they can feel comfortable asking me questions that may otherwise embarrass them. The goal of these visits is to bridge the difficult waters of puberty into adulthood as smoothly as possible by providing sound advice for teens to make smart decisions.