Pediatric and Adolescent Health: Visiting the Gynecologist

Pediatric gynecology focuses on conditions of the female genital tract such as the uterus, ovaries, vagina and vulva. We provide a comprehensive evaluation and specialized treatment for girls of all ages. Commonly, we think of gynecology as limited to sexually active women. However, girls of all ages have conditions related to their genital tract than can require evaluation and management. We also see girls who are diagnosed with cancer and who will be having treatments that may affect their menstrual cycles and fertility in the future. Finally, we work closely with other healthcare providers to care for complex medical and developmental conditions that can affect girls during their development.

The American College of Obstetrics and Gynecology recommends that an adolescent first see a gynecologist between the ages of 13 and 15 years. This visit typically does not include a pelvic exam, but instead is a time for the adolescent to get to know and trust a physician. The physician should use this visit to screen for health problems and risk taking behaviors and counsel the teen as appropriate.

Even though it is a good idea for an adolescent to see the gynecologist every year after this initial visit, a pelvic exam still is not needed unless a problem or complaint arises. When the adolescent becomes sexually active, it is important she is tested yearly for sexually transmitted diseases such as Chlamydia, gonorrhea, and HIV, but frequently these tests can also be performed without a pelvic exam. A complaint such as an unusual discharge or pelvic pain usually does require a pelvic exam for diagnosis and treatment.

In a patient who has painful periods or irregular periods, a thorough evaluation is necessary and may or may not require a pelvic exam.

An adolescent who desires a prescription for birth control prior to beginning sexual activity should be praised for her foresight and maturity. Prior to prescribing any medications the physician must take a complete history and perform a physical exam, but a pelvic exam is not required. Similarly, a pelvic exam is not required for an adolescent to receive a prescription for emergency contraceptives, but any sexually active adolescent should be encouraged to be tested for sexually transmitted infections.

Pap smears (which require a speculum exam) are needed routinely once the teen has been sexually active for 3 years. Occasionally this test is performed sooner than 3 years after sexual intercourse as physicians’ practices vary based on a number of factors including the risk status of their patients.