Many of my patients ask me when they should bring their daughters in to see me for their first gynecological visit. As with so many other facets of life, the real answer is, "It depends."

The American College of Obstetricians and Gynecologists (ACOG) recommends that adolescent girls make their first visit to a gynecologist for screening and preventive counseling between the ages of 13 and 15. The content of this visit will vary with the individual patient because it will depend on the girl's needs and her physical and emotional development. However, you and your daughter should know that a pelvic exam will NOT be included as part of the visit except in those rare instances where the doctor believes it's really needed.

What will happen at my daughter's first visit to the gynecologist?

ACOG recommends that doctors perform the following procedures when an adolescent female between the ages of 13 and 18 comes in for a visit:

• A detailed history and physical

• Chlamydia and gonorrhea testing if the patient is sexually active

• Testing for HIV, Hepatitis B and C, and syphilis if the doctor believes it's warranted

• A discussion of nutrition, the menstrual cycle, sexual activity and practices, depression, exercise, contraception, and STD prevention

• Immunizations:

° Tetanus/Diphtheria/Polio vaccine once between the ages of 11 and 16

° Hepatitis B vaccine (if the patient was not vaccinated previously)

° Human Papillomavirus (HPV) vaccine

° Meningococcal conjugate vaccine before entry into high school (if the patient was not vaccinated previously)

Although these recommendations are clearly good ones, I rarely see any young women between the ages of 13 to 15 for a first preventive visit unless they have ongoing gynecological issues. I think this is largely due to the fact that most pediatricians do such an outstanding job of providing medical care and advice to their female adolescent patients.

Regardless of any age guidelines or any health issues, you should definitely bring your daughter to a gynecologist if you suspect she has become sexually active. Similarly, even if they are perfectly healthy and are not sexually active, I encourage all moms to bring in their daughters before they go off to college. As I noted earlier, if your daughter is not sexually active, she likely will not have to undergo a pelvic exam.

The reason I choose college as a particular milestone is because it's a time of new independence for many girls and, with that, the freedom to make their own choices. This freedom often includes decisions about whether to become sexually active. Therefore, it's important for girls to hear the straightforward facts about the risks and hazards of sexual activity. (As you can see, paying for tuition isn't the only thing you have to worry about when your daughter goes off to college.)

When I meet with these young women, I talk to them candidly about sexually transmitted diseases and the options they have for birth control[1]. I also give them information on the HPV vaccine (if they have not already been inoculated), and I start the vaccination series, which can then be finished at their schools. Even if they are not

Regardless of any age guidelines or any health issues, you should definitely bring your daughter to a gynecologist if you suspect she has become sexually active.

planning on becoming sexually active soon, I let them know that they can call me for birth control during the year in case they discover they need it. I have found that the student health centers at most universities are excellent about providing these services as well.

If a young woman still is not ready to come in for a visit by the time she's 18 and she is not sexually active, then I tell the mother that a pelvic exam and a Pap smear[2] test are strongly recommended by age 21.

When I meet with young patients for the first time, they often want their mothers present for the interview and the exam. If a young patient is brought back to my office by herself, I always inquire whether her mother has accompanied her. If she has, then I make sure to ask the daughter what her preference is. Sometimes a girl is too embarrassed to ask that her mother accompany her; sometimes the patient definitely doesn't want her mother to be present; and sometimes the mother is simply trying to let the daughter make her own decision and do the visit by herself without asking the daughter what she actually would prefer. It's important to figure out the right approach for each patient.

If the mother is not present during the interview and exam, but she is present in the waiting room, I ask for the daughter's permission to bring her back at the end of the appointment to see if she has any questions. (Otherwise I usually get an awkward phone call from the chagrined mother later that day inquiring about the visit.) I always ask adolescent girls if I can speak with their mothers about their visit and the results of any tests I've conducted. In most cases the girls readily consent.

A mom's critical role in her daughter's life doesn't stop at the threshold of a doctor's office.

  • [1] Various forms of medications, devices, or practices that help prevent pregnancy.
  • [2] The sample of cells taken from the cervix during a speculum exam. Historically, the cells were smeared on a slide for interpretation in the lab. These days, the cells are released into a vial with liquid, cleansed, and then interpreted.
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