UAB Medicine News
Your Daughter’s First Trip to the Gynecologist: What You Need to Know
Most girls should make their first visit to the gynecologist between the ages of 13 and 15, according to the American College of Obstetricians and Gynecologists (ACOG). It’s a safe assumption that many moms are grappling with feelings about their daughters’ blossoming maturity, so it’s no surprise that many are less than prepared to guide their daughter through their first gynecological visit.
The mother-as-mentor role ideally should start long before a daughter’s 13th birthday. According to Margaret Boozer, MD, associate professor in the Department of Obstetrics & Gynecology at UAB Medicine, the onset of menstruation is occurring at ever-younger ages. “Age 10 to 12 is typical for menarche (the first occurrence of menstruation), but it’s not uncommon for girls to start menstruating as early as nine years old,” she says.
Dr. Boozer recommends that moms have conversations with their daughters about their periods, including the physical and emotional components, as well as their role in reproduction. While irregular periods are common initially, “I also encourage mothers to be aware of whether or not their daughters establish a monthly menstrual pattern,” she says.
If you’re not sure where to start the discussion with your 8- to 12-year-old daughter, Dr. Boozer recommends the Girlology book, “There’s Something New About You: A Girl’s Guide to Growing Up,” by Melisa Holmes and Trish Hutchison. Written by an OB/GYN and a pediatrician, the book covers everything from puberty to tampons to contraception. “It’s approachable and engaging, not textbook-ish,” Dr. Boozer says.
The Informational VisitThose first conversations about menstruation lay the groundwork for later, more intimate discussions, such as what to expect during your teen’s first gynecological visit. If your daughter is not having symptoms – irregular periods, significant menstrual cramps, pelvic pain, or vaginal discharge – then the first visit may simply consist of an age-appropriate discussion. During this reproductive health visit, the doctor can dispel any myths your daughter may have, explain female anatomy, and reassure your teen that her experiences are normal. The gynecologist also can answer questions and provide information about sexual activity, contraception, and sexually transmitted infection (STI) prevention.
If your daughter’s pediatrician hasn’t already discussed the HPV vaccine with you, her gynecologist will broach the topic. According to the ACOG, there are more than 150 strains of human papillomavirus, about 40 of which infect the genitals. HPV can be spread by sexual contact and is the most common STI in the United States. HPV can lead to genital warts and is linked to cancer.
The HPV vaccine is for both girls and boys. It’s most effective when administered prior to becoming sexually active, but it’s a good idea for sexually active young people to be vaccinated as well. If your daughter is 9 to 14 years old, she can expect to get two shots that are 6 to 12 months apart. If she’s 15 to 26 years old, she’ll receive three shots.
According to Warner Huh, MD, director of the UAB Division of Gynecologic Oncology and senior medical officer for the cancer service line at the UAB Comprehensive Cancer Center, “there is no question that the vaccine works. We now have a second-generation vaccine that protects against 90 percent of the HPV infections that are associated with cervical cancer.” If broadly adopted, “this vaccine can literally eradicate the majority of cervical cancer,” Dr. Huh says.
The Pelvic ExamIf all is well, the ACOG recommends holding off on pelvic exams until age 21. However, if your daughter has unusual symptoms or irregular periods, the gynecologist may perform a pelvic exam. This typically includes an external exam of her genital region, followed by an internal examination. The internal exam may include using a speculum to check her vagina and cervix and placing one or two gloved fingers into her vagina while pressing down on her belly with the other hand in order to check her uterus and ovaries.
While most women associate gynecological visits with pap exams – swabbing the cervix to screen for cervical cancer – the ACOG recommends waiting on pap exams until a young woman is 21 years old. Similarly, it recommends an initial clinical breast exam starting at age 20 and annual clinical breast exams after age 40. For women with an average risk of breast cancer, the ACOG suggests mammograms starting at age 40 and every 1-2 years thereafter.
It’s important to talk about what your role will be during your daughter’s first visit to the gynecologist. Girls may want to have their moms by their side, they may wish to speak to the doctor alone, or both. “In an ideal world, the gynecologist would speak to the daughter alone, and then ask if she would like to have her mom come into the room,” Dr. Boozer says. “Alternately, the mom can be present initially and then step out to give the daughter a chance to engage with the physician on her own.”
Keep TalkingDr. Boozer encourages moms to keep the conversation going, even after that first gynecological visit. “It’s ideal for mothers to initiate discussions about appropriate sexual activity within a relationship, contraception, and sexually transmitted infections.” Still, many women are more comfortable with a doctor-led conversation. “That’s definitely a role that the gynecologist can play,” she says.
Noting that it’s important for girls to be confident and safe when it comes to their sexual health, Dr. Boozer says, “I worry if the conversation isn’t initiated early enough.” When you share your own reproductive health experiences and talk about her questions and expectations, you’re inviting her into the sisterhood shared by women around the globe. Indeed, your daughter’s transition through puberty – marked in part by her first gynecological visit – can be celebrated as a rite of passage that brings the two of you closer.
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