When should my teen start seeing a gynecologist?

If you have a daughter, sooner or later the question will come up: when should she start seeing a gynecologist?

More than just someone who performs pelvic exams and Pap tests, a gynecologist can be a teen’s trusted partner in navigating all aspects of reproductive and sexual wellness, helping to set her up for a lifetime of good health. So how do you know when your daughter is ready? Dr. Sarah Beebe, from Novant Health Glen Meade OB/GYN - Wilmington, offers this guidance.

What’s the ideal age for a first GYN visit?

The ideal age for a first GYN appointment can vary, Beebe explained, based on several factors. But generally speaking, the American College of Obstetricians and Gynecologists (ACOG) suggests an age range.

“They recommend that a girl have access to a reproductive health conversation between the ages of 13 and 15,” Beebe said.

It’s worth noting that this is well before the recommended age for a first cervical cancer screening, known as a Pap test, which starts at age 21. With the average age of puberty occurring in U.S. girls between the ages of 8 and 13, the right time for a girl to start seeing a GYN will typically occur during this window.

When a young woman starts to get her period, and develop what Beebe refers to as secondary sexual characteristics, like breasts and pubic hair, it’s time to introduce her to a GYN. And if a young woman hasn’t started menstruating by the age of 15, that’s a reason to see a GYN, too.

“If she has normal breast development and pubic hair development by age 15, but has not started her menses, then that's when we would want to investigate if there's something anatomic or genetic going on,” Beebe explained.

Can my pediatrician help my teen navigate puberty instead?

Yes, Beebe said, pediatricians help guide kids through puberty and navigate changes in their bodies, so it may be fine to count on your pediatrician for GYN-related care and questions during your daughter’s teen years.

“A great deal of pediatricians would be comfortable with talking about starting the menstrual cycle and monitoring how heavy and painful menses are,” Beebe said.

Even when teens start seeing a GYN they should still see their pediatrician for annual checkups and other health needs. Pediatricians can help your daughter to monitor her menstrual periods. If any concerns come up related to your teen’s breast or gynecologic health, your pediatrician may choose to refer your daughter to a gynecologist.

Same goes for any questions and concerns your daughter may voice regarding contraception. It’s fine for her to ask her pediatrician. However, most pediatric offices will not offer the full menu of contraceptive options. A pediatrician may prescribe birth control pills but will likely not be equipped to implant an intrauterine device, for example. So for a full, comprehensive discussion of birth control options (ideally before a teen becomes sexually active) this may be best for a GYN.

Either a pediatrician or gynecologist can also administer the HPV vaccine, Gardasil, which is one of the most important things Beebe said she discusses with her teenage patients.

“I talk to all my younger patients about the Gardasil series,” Beebe said. “It’s multiple vaccines that usually start being offered by pediatricians when both boys and girls are around ages 11 to 12. HPV is what is most commonly associated with cervical cancer or abnormal Pap tests. So that vaccine essentially is a vaccine against cancer.”

What can a young woman expect during her first GYN visit?

The idea of a first-ever pelvic exam and Pap test can be daunting for any teen girl. So, Beebe said, it may help your daughter to know that this will typically not be involved in her first GYN visit.

“You don't necessarily need to have a pelvic exam at your first visit, especially as an adolescent,” Beebe said.

When discussing a first GYN visit with a teen, Beebe suggests presenting it as a time to bring up any private health concerns. Emphasize that a GYN is someone who specializes in helping women with their reproductive health – even the questions they might feel embarrassed to ask. A common issue that brings teens to a GYN, Beebe said, is periods that are painful enough to cause absence from school.

“We usually won't even need to get them undressed for that visit,” she said. “I will just talk with them about their symptoms. And so they can be a little bit less freaked out about the idea of coming to a gynecologist, knowing that they may not, and most likely will not, need a pelvic exam.”

If a teen does need a pelvic exam, Beebe said she explains everything involved so that the patient knows what to expect and to help her feel as comfortable as possible.

“A pelvic exam would classically include looking at the vulva and the vagina, looking at the tissue,” Beebe explained. “When it's their first pelvic exam, I'll show them the speculum and kind of jokingly say, ‘Hey, this might look kind of like a medieval torture device, but it's basically just a little duckbill that lets us look inside the vagina.’”

A reason that a teen might need a pelvic exam would be a concern such as painful urination or abnormal bleeding. Otherwise, the physical exam will just include vitals like weight, height and blood pressure.

Following her first visit, your teen will want to continue seeing her GYN annually, and her doctor will assess her changing needs each time. Typically, a first pelvic exam will occur either at age 21 or when she becomes sexually active. Clinical breast exams, where the doctor feels the breast tissue for lumps and abnormalities, typically begins at age 25 for women with average breast cancer risk.

How can I help my teen prepare for her first GYN visit?

One of the most valuable ways to help prepare your daughter for her first GYN visit is to simply encourage her to speak up. A GYN office is a safe and confidential space to bring up questions. It’s OK and even welcome to ask about private topics concerning sexual development.

“There are confidentiality protections for adolescents and they are able to seek testing for sexually transmitted infections as well as contraception without parental consent,” Beebe said.

If your daughter is nervous, encourage her to write down her questions and bring the list with her so that she doesn’t have to remember them on the fly.

Talking your daughter through what to expect, and informing her of any important things she should know about her family medical history, will help ease both her mind and yours as she approaches this important step in her personal health journey.