Q: When should I bring my teenage daughter in for her first gynecological exam?
A: A teenage girl should visit a gynecologist between ages 13 and 15, according to the current recommendation by the American College of Obstetricians and Gynecologists.
This initial visit doesn’t necessarily have to include a pelvic exam and Pap smear. (A Pap smear and a visit to the gynecologist are not synonymous — something only some of my patients seem to understand!)
In the recent past — in fact, only about two years ago — young women were told to start getting Pap smears, in order to detect cervical cancer, at 18 or when they became sexually active.
So the old recommendation of when to begin Pap smear testing has changed. This testing should start either at age 21 or three years after the start of sexual activity. (“Premature” Pap smears can pick up minimal changes that won’t result in cancer, but will cause concern and lead to extensive, unnecessary testing.)
So, for a young teenager who is not sexually active, her first visit to a gynecologist need not include a Pap smear. But other important health issues should be addressed at this critical juncture between adolescence and adulthood.
The doctor can assess whether she has normal development of secondary sex characteristics (the changes that come with puberty). At this young age, menstrual cycles are often irregular for several years. The doctor can offer reassurance that this is common.
The doctor can also monitor those girls who gain weight, develop severe acne and also have irregular cycles, which are possible signs of polycystic ovary syndrome. Treatment during these formative years can potentially prevent weight gain, skin scarring and the complications of diabetes, hypertension and infertility.
If your daughter is experiencing heavy periods, the doctor can order a blood test to check for a possible clotting abnormality seen in a disorder called Von Willebrand’s disease. If she has intolerable cramps, or if she gets cramps but no bleeding, an ultrasound can check for endometriosis.
If you daughter has developed at a normal rate but has not gotten her period, she should also be checked for pelvic abnormalities or, in rare cases, chromosomal irregularities,
The doctor can also provide other crucial health information, showing your daughter how to do a breast exam, and privately discussing issues of sex and contraception.
This aspect is particularly important. By age 18, 60 percent of adolescent girls have had intercourse. A 1995 survey showed that women 25 or younger waited a median of 22 months between their first sexual experience and their first visit to a clinician. The longer the wait to see a gynecologist, the more likely a woman is to end up with a sexually transmitted disease or a pregnancy.
Unfortunately, many adolescents do not perceive any negative consequences of sexual activity, believing they are immune to disease and pregnancy. It is up to parents and doctors to change this sense of “it won’t happen to me.”
Dr. Reichman’s Bottom Line: A young woman should visit a gynecologist in her early to mid-teens, not necessarily for a Pap smear but to check that her development is normal and to get crucial information about her reproductive health.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.