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Teen Education: Part Two

Important medical conversations, how to know what’s normal, what to expect for the first visit, and STI testing.


Waist up portrait of Asian teenage girl looking at doctor and smiling happily during consultation in doctor's office


Last week, we discussed the importance of the first gynecological visit, why the visit is important, and how to choose a healthcare provider. This week we will be discussing important medical conversations, how to know what’s normal, what to expect for the first visit, and STI testing. Let’s get right into it…

Important Conversations

In most cases, the first appointment is an opportunity for the patient to establish a relationship with her gynecologist and talk about her development.

The doctor will talk to the patient about her medical history, such as:

●    When was her last period?

●    Is she having any problems with her period, such as pain or heavy bleeding?

●    Does she have any unusual discharge, sores, itchiness, or discomfort in the vaginal area?

●    Is she, or has she been, sexually active? If so, is she practicing safe sex? Is there a possibility she could be pregnant? Would she like more information about birth control or STD tests?

The information the doctor gets from these questions helps them know which tests to run and what topics to discuss. The doctor will also counsel the patient about risky behavior like; smoking, drugs, alcohol, unprotected sex, and abusive relationships. 

Additional topics can include menstruation, puberty, hygiene, STIs, contraception, diet/exercise, mental health, etc. The conversation will be tailored to the patient’s individual needs and concerns.

Another crucial subject that is typically discussed during the first women’s wellness visit is the HPV (human papillomavirus) vaccine. HPV is a dangerous STI that is associated with the majority of cervical cancers. Medical professionals emphasize that one of the best ways to prevent HPV is the vaccine. The vaccine is typically a series of two or three injections, preferably administered when the patient is 11 or 12 years old. 

The vaccine works when put into place as protection prior to the patient becoming sexually active. The vaccine is still effective after the patient is sexually active, however, it will not work as well. If a parent or patient is anxious about the vaccine, the CDC’s website tracks the vaccine’s efficacy and safety.

Parents should emphasize the importance of being honest with their health care providers, even if they might feel a little uncomfortable. They should also remind their daughters that the health care professionals have done this many times before and everything she talks about is strictly confidential.

How to Know What’s Normal

How often should a patient see their gynecologist? Well, it depends. Sometimes a visit isn’t needed for years after an exam but the doctor will help guide the patient on that timing. However, if symptoms or issues come up, an earlier appointment should be made.

Everyone is unique, however, if a young woman isn’t displaying secondary sexual characteristics (like breasts or pubic hair) by age 13, they might need an evaluation. Additionally, if there are secondary sexual characteristics (breast and pubic hair development) but no menstruation by age 15, then coming in for an appointment is essential. 

If a young woman’s period is irregular at first, it doesn’t undoubtedly mean that something is wrong. In fact, it’s common for periods to deviate from the four-week cycle during the first two years of menstruation. 

However, it’s important to monitor menstrual pain and ensure it isn’t excessive. Although mild to moderate cramping is normal, it’s only normal if it can be managed with over-the-counter painkillers and natural remedies. 

If the bleeding is so heavy, the patient is changing tampons or pads hourly or if the patient’s pain is interfering with their daily life, an appointment should be made. Young women should also be evaluated by a doctor if they are regularly menstruating more often than once every three weeks or less often than once every six weeks.

Most parents would seek out a cardiologist for specialty care if their child was having heart palpitations. It should be the same for gynecological issues; if their daughter is having recurring gynecological problems or concerns, they should seek out a specialist to answer their questions. 

During the Physical Exam

Prior to the exam, parents should prepare their daughters by telling them what will happen. First-time patients should have an idea of what to expect and the reasons why they are going to this appointment. Moms should consider letting their daughter experience an appointment first hand by having her sit in during one of her appointments.

The first part of the exam is just a basic health checkup that most young women are already familiar with. A nurse will come in to measure the patient’s weight, heart rate, and blood pressure. The nurse or doctor may do a physical exam where they exam the patient’s neck, heart, and stomach. These basic tests give the doctor a sense of the patient’s general health and a baseline to compare to during future exams. 

Although breast cancer is very rare in teenagers, it’s still an essential part of the visit. The doctor needs to ensure proper development, as well as, check for lumps, cysts or other abnormalities. 

The patient will be asked to put on a gown for an external examination. The patient may be asked to lie down on the table, with her knees bent and legs spread apart. The doctor may also have her place her feet in the stirrups on the table. Once the patient is in the correct position, the doctor will examine the external genitalia (the vulva). They will look for sores, swelling, or other issues. 

An internal examination, or pelvic exam, is typically not performed during first-time appointments. However, it may be performed if the patient is sexually active or if the doctor is concerned about potential abnormalities. If an internal examination is recommended, the doctor will place one hand on the patient’s belly and one to two fingers inside the vagina. The doctor will feel for the size and position of the uterus, as well as, the ovaries. A speculum will also be used to open the vaginal walls to allow the doctor to see the walls and cervix of the vagina. The speculum also allows the doctor to do screening tests, such as a Pap smear or testing for certain STDs. 

If an internal examination is recommended, parents should let their daughter know that she may feel some pressure but it shouldn’t hurt. They should also let their daughters know that she can decrease any discomfort she may experience by taking deep breaths, as well as, trying to relax her vaginal and stomach muscles. 

During the pelvic exam, the health care practitioner may also take a Pap smear. This test consists of the doctor scraping cells from the cervix and testing those samples for cervical cancer. 

Pap Smears are typically recommended for women who are 21 years of age, unless they are missing work/school due to painful/heavy periods or if they have sexual intercourse first (especially if they are experiencing pain with sex). 

Additionally, the HPV vaccine is very important for young women because HPV can turn into genital warts or cervical cancer in women. It’s important to remember that even if a patient gets the HPV vaccine, they should still come in for routine cervical cancer screenings. The HPV vaccine is covered by insurance for patients between 12-24 but insurance doesn’t cover the vaccine for women over the age of 24.

STI Testing

Testing for STIs isn’t a regular part of a well-woman visit. However, girls who have been sexually active should ask for STI testing. This testing is done through blood, urine, or a cotton swab during a pelvic exam. The doctor will send the samples to the lab to check for STIs like chlamydia, gonorrhea, or HIV. 

It’s important for parents to talk to their daughters about STIs and STI tests. Young patients should understand that vaginal intercourse isn’t the only way they can get infected and these STIs can be passed through oral or anal sex. 

Parents should also ask the office staff how their daughter can get their test results confidentially. For instance, the office can call the child’s cell phone directly or wait for them to call in to get their results. 

Parents should encourage their daughters to discuss their first visit, as much as they feel comfortable. Make sure she didn’t feel uneasy and if she did, offer to take her to a different practitioner next time. Young women should continue to go in for well-woman visits annually to keep her informed and healthy. 

If you would like to set up a well-woman’s visit for your daughter, please contact our office at 530-332-9703, extension 281. We would be happy to answer any questions you or your daughter may have. 

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