Especially for Teens

iStock 000004187444SmallTeenagers often have many questions about the changes happening to their body, about their menstrual period, about their sexuality, about birth control and sexually transmitted diseases.

For these reasons it is useful to for them to connect with a gynecologist and establish a trusting relationship in a safe environment where they can ask any questions on their mind, knowing that everything is confidential and there is no such thing as a silly or embarrassing question.

From a preventative point of view, the annual gynecology exam actually does not include a PAP smear and pelvic exam until age 21, unless a teenager requests it specifically. There is no reason for a pelvic exam and PAP until age 21. Almost every STD can be screened for in the urine or blood without a pelvic exam. PAPs to look for and prevent cervical cancer are not necessary because cervical cancer is unheard of in teenagers. Delaying the first preventative PAP and pelvic exam is also the current recommendation of the American College of Obstetricians and Gynecologists.

If there is a problem with heavy or irregular periods, or pelvic pain, or abnormal vaginal discharge, a pelvic exam may be done to evaluate. Usually this is only done to evaluate gynecologic problems for teenagers who are already sexually active. Otherwise, we evaluate the pelvis with transabdominal ultrasound instead, with a few rare exceptions in special circumstances.

So there is no need for a teenager to be fearful that they will have to have a pelvic exam if they come to the gynecologist. There are lots of reasons for teenagers to see the gynecologist and establish care, mostly to have questions answered and problems evaluated from time to time. For more information, see Your First Gynecologic Visit - Especially for Teens.

Washington State mandates that teenagers can make their own decisions, independent of their parents, and without their parents' knowledge or consent, when it comes to STD and HIV screening and management, and for anything to do with birth control or pregnancy medical needs. We do always let teenagers know that the codes and costs for the visits and tests and treatments are still accessible to whoever is the "Guarantor" of their insurance (ie whoever is paying the bills).

We encourage teenage patients and their parents to be feel free to have open conversations, non-judgmental, about issues concerning sexuality, STDs, birth control and pregnancy. When parents accompany their teenagers, we usually excuse them from the room for at least some of the time, to allow for confidentiality for the teenager and freedom to say what is on their mind, unless the teenager specifically requests that their parent stay with them.

Abnormal Periods in Teens

Periods can be somewhat irregular and at times heavy as the ovaries begin to ovulate and the reproductive processes get started. For more information, please see Your First Period- Especially for Teens. Parents and teens often wonder what is normal and what is not and when to be concerned. Here are some "red flags" that should prompt a visit to the gynecologist:

  • You are aged 15 years and have not had a menstrual period
  • Your periods were regular and occurred monthly and then they became irregular
  • Your period occurs more often than every 21 days or less often than every 45 days
  • Your periods occur 90 days apart (even if only for one cycle)
  • Your periods last more than 7 days
  • Your periods require frequent pad or tampon changes (soaking more than one every 1–2 hours)

Great Resources to Find Out More

There are many great resources for teenagers to find out more, and we encourage you to read the following: