A Doctor's Role in Your Daughter's Health
Why it is important to address gynecological health in adolescence.
Most parents would rather face their offspring’s double ear infection, nasty stomach virus or plantar warts than address issues of gynecologic health. However, as children grow, their healthcare needs change. For adolescent girls, a comprehensive approach to overall health includes access to information and quality care for every aspect of their bodies, including their reproductive systems. Often, however, a stumbling block to teens seeing a gynecologist is the fear that a gynecological visit automatically means having an internal pelvic exam, which is not the case. A visit with a family physician, pediatrician or gynecologist in early adolescence helps establish rapport between doctor and patient, which can prevent potential problems.
Care Down There
Adolescent gynecologic issues cover everything from contraception and sexually transmitted infections (STIs) to menstrual disorders and sports injuries. It may come as a surprise (and perhaps a relief) to many parents and teens alike that a number of these issues can be treated without an internal pelvic exam. In fact, The American College of Obstetricians and Gynecologists recommends that pelvic exams be performed on patients younger than 21 only when indicated by the patient’s medical history. No internal exam is necessary on an otherwise healthy adolescent, for example, in order to prescribe oral contraceptives or to screen for STIs, which can be done from urine samples or vaginal swab specimens.
Of course, in certain situations, such as contraceptive counseling for an intrauterine device (IUD) or diaphragm, pregnancy, abnormal vaginal bleeding or amenorrhea (absence of menstruation,) an internal exam may be necessary.
“The part that everyone is nervous about is the internal exam,” says Dr. Nirupama DeSilva, a board certified obstetrician/gynecologist with additional subspecialty training in pediatric and adolescent gynecology. Dr. DeSilva is the Director of Pediatric and Adolescent Gynecology at the University of Oklahoma at Tulsa’s School of Community Medicine. “There’s no evidence that supports the need for an internal pelvic exam in patients that are healthy and don’t have any symptoms before the age of 21.”
The Doctor’s Role
Pediatricians, family practitioners and gynecologists can all play a role in a young woman’s health care. The important thing is establishing a good relationship between the patient and a physician she trusts and with whom she’s comfortable.
Pediatricians and family practitioners are trained and qualified to deal with gynecologic health issues. Dr. Charity Pollak, assistant professor of pediatrics at OU’s Tulsa School of Community Medicine, believes they can also play a crucial role in providing relevant information to teens about sexual health and contraception. In a state like Oklahoma, which has the second-highest teen birth rate in the nation, this is no small matter.
According to Dr. Pollak, physicians should have confidential, age-appropriate conversations with adolescents about sexual health and pregnancy prevention during regular visits, asking questions of and providing resources to their patients. Unfortunately, more often than not, this doesn’t happen.
“A lot of physicians aren’t able to do this for a lot of different reasons,” she says. “The first reason would be time, and the next issue would be the sensitivity of the subject and the fact that we don’t make it part of the normal health exam.”
Dr. Pollak is working to educate and encourage healthcare providers to have these conversations with their patients and to make it a normal and routine part of their care.
“We are absolutely supposed to be having these talks with our patients,” Dr. Pollak notes. “I think if I’m an adolescent female, I’m probably not having this conversation with adults in general, so I’m not talking to my parents about it. I’m not talking to my school counselor about it. I’m not talking to my doctor about it. So, adolescents aren’t getting the best information and the best resources. I think there is a lot of misinformation.”
According to Dr. DeSilva, adolescent girls, not just adult women, can benefit from establishing a patient-physician relationship with a gynecologist. In fact, The American College of Obstetricians and Gynecologists recommends that the first visit for screening, preventative services and guidance take place between the ages of 13 and 15. This visit should focus on patient education, with discussion of topics such as anatomical development, body image, self-confidence, weight management, immunizations, contraception and prevention of STIs.
“You want her to have good care for her reproductive needs or her periods, or whatever she needs, but you don’t want her traumatized in the process,” Dr. DeSilva explains. “I think it’s important to establish a relationship with someone the teen feels comfortable with. That really makes a difference in the questions they ask and in our ability to educate them. Teens are listening. They’re looking for information, and they have questions. The more comfortable we can make them in our offices, the more willing they will be to ask those questions. Knowledge is power, and we want them to have the resources they need to make good choices.”
Both Drs. DeSilva and Pollak agree that parents continue to play an important role in their child’s health care, initiating conversations with their kids and supporting the physician-patient relationship.
“When they’re taking their kids to the doctor, parents need to encourage their kids and their doctors to have some time alone and to have these conversations,” Dr. Pollak says.
“I think there is a fear that, ‘Oh, my gosh, she would talk to somebody else and not me,’” Dr. DeSilva says. “This doesn’t mean you don’t have an open relationship with your child. They just feel awkward, whether it’s right or wrong. It’s not because you didn’t keep the door open for them or did something wrong as a parent. Sometimes, they just need an outside voice, an objective voice.”
Adolescent girls need and deserve quality care and accurate information when it comes to their health. This may be especially true in matters particular to their reproductive system. Parents and physicians can work as a team to ensure these young women grow up to be healthy, well-informed adults.
“I always say I have two patients,” says Dr. DeSilva. “I have the parent and the adolescent, and I have to meld both of their needs so that everybody is comfortable at the end of the visit. I think it’s important that parents realize they’re still involved in the process. We’re trying to help teens make good decisions with guidance.”