Initiation of Gynecologic Care in Adolescence

Many mothers want to know when routine gynecologic examinations for their daughters should begin. The answer is simple: When the need arises. Reasons for an adolescent to see a gynecologist include (but are not limited to):

• Pelvic pain, including painful menses, not responding to Ibuprofen
• If the patient has become sexually active, considering a sexual encounter, or there is a strong suspicion on the mother’s part of sexual activity. At this juncture serious birth control and sexually transmitted diseases discussions should be had. If there has been a sexual encounter, STD testing should be done.
• Abnormal vaginal bleeding; either extremely heavy, regular menses or irregular menses (not regular for the entire year after menses initially begins – Menarche)
• Referral by a primary care physician for any reason
• The failure to begin menstruation along with absence of growth in height, lack of breast development, and lack of sexual hair growth by age 14
• The failure to menstruate by age 16
• The sudden absence of menstrual bleeding for 3 to 6 months when the patient typically has regular menses
• When pregnancy is suspected
• Counseling and serious consideration of the HPV vaccine, if not initiated by the pediatrician.

If none of these apply, an introductory visit to the gynecologist may be wise between the ages of 17 and 19, possibly coinciding with entry into college. Although Pap smear testing is typically not recommended until age 21, an examination to confirm normal anatomy may be appropriate, along with a discussion about birth control and sexually transmitted diseases. A pelvic exam isn’t always needed at the initial visit, but just the opportunity to ask questions may be extremely valuable to the patient to help develop a comfortable relationship with a doctor that she can call on when in need.