Who Needs Gynecology Care?
by Dr. Ann L. Engelland
(February 9, 2005) Rachel, 14,
has been having periods for a year and a half, but they
have become increasingly irregular. It’s wreaking
havoc with her travel soccer schedule.
Susan, 17, has a serious boyfriend away
at college and would like to discuss birth control pills
before he comes back to Mamaroneck for spring break.
Paulina, 15, has had unprotected
sex and read something in Teen Vogue magazine at the
office that scared her. She wants to be tested for sexually
Annie, 15, has had severe menstrual cramps
for the past year. She is now missing school 2 or 3 days
out of a month. She is afraid something is wrong.
All of these teens need help. Where to turn? Whom
When it comes to gynecological care, adolescent girls
and their parents are full of questions: When should girls
have their first gynecologic checkups? With whom?
When do they need a Pap test? Whom can they approach for
First of all, let’s dispel the notion that a girl
only needs “gyn care” once she becomes sexually
active. Care of the female body, including examination
of the external genitalia, should be part of routine pediatric
care from birth on. As girls enter puberty their bodies
change and concerns can be addressed at each visit. As
girls grow up, their “genital” care becomes “pubertal” care
and eventually “gynecologic” care, encompassing
physical as well as social and emotional concerns, sometimes
years before they are actually having intercourse.
All girls should have the opportunity to discuss their
periods and their sexuality.
Beyond the routine, any teen engaging in intercourse
(or other risk-prone sexual behavior) should be seen by
If mothers initiate the visit, there should be an open
discussion with their daughters about the choice of doctor.
Parents need to find a doctor the teen can relate to, and
one who is comfortable covering adolescent psychosocial
and sexual issues. Girls often balk at seeing or talking
to their Mom's gynecologist
Many pediatricians and family practitiioners are capable
of doing routine gynecology care. It is often a matter
of personal interest and experience, so a parent might
start with a child’s doctor and ask if an appointment
is appropriate. Some adolescent medicine doctors refer
to themselves as “psychogynecologists” because
routine sexuality and gynecologic care are part of their
those teens who require strict confidence and/or have limited
insurance or funds, all I can say is, “Thank you,
Planned Parenthood!” I have found the quality of
care to be consistently good and caring. Counseling is
available and teens are assured of confidentiality. Paulina,
who had unprotected sex and is worried about sexually transmitted
infections could be tested at the nearest Planned Parenthood
Clinic in New Rochelle across from New Roc City. She would
also be counseled about “the morning after pill” or
So what is involved in a first time gynecology
As with all clinical encounters, an
interview and discussion should precede the exam. This
is an opportunity for the teen to express worries, questions,
and concerns. This is the time for the clinician to ask
the questions that will determine the nature of the ensuing
examination. The discussion should also touch on subjects
that are psychological and emotional rather than strictly
gynecological. Some important questions might be: “What
is your boyfriend like?” “Have you ever had
non-heterosexual sex?” “Is sex pleasurable
for you?” “Have you had any unwanted sex
experiences?” and “Do you have any questions?”
Next, the patient provides a urine specimen, undresses
and is examined. There are essentially three parts to the
- 1.Examination of the external genitalia: doctors
look for normal anatomy, rash, infection, and signs of
abuse. Many girls have dermatologic complications of
shaving and this is a good time for some guidance on
this new fad.
- 2. Examination with a speculum is next: In position
on a special examination table, the patient is draped
in a way that protects her modesty and privacy, and a
plastic or metal speculum is inserted into the vagina.
With an attached light, the vagina, and cervix are examined.
This is when a swab for a Pap test and for sexually transmitted
illnesses is taken.
- 3. Then there is the “bimanual exam,” when
a gloved and lubricated finger is inserted into the vagina,
and with the other hand on the abdomen, the clinician
is able to evaluate the size and shape of the ovaries
and the uterus.
The whole thing takes under five minutes and, if done
well and with preparation, is neither painful nor disturbing
for most young women. I always recommend that girls schedule
their first exam as a routine one, done in a place they
know and trust, so that they don’t have their first
experience with strangers in a glaring, cold emergency
department somewhere at a time when they may be in
pain or frightened.
My next column will focus on the Pap test and talk about
the newest guidelines and reasons to do Pap tests in teens.
Dr. Engelland has a practice in Mamaroneck devoted
to Adolescent Primary Care. She can be reached at
Have a teen health question? Use the form below to send it to Dr. Engelland. Please note: Dr Engelland cannot respond privately to individual queries online. Comments are welcome and anonymous questions may be answered in future columns. Serious medical problems should be referred to your own physician.
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