Photo by Getty Images
A visit to the doctor can come with a lot of questions and anxiety—and that's even more true for a teen's first gynecology exam. But it doesn't have to be an intimidating experience! From knowing when to book that first appointment to understanding what topics may be covered, there are a few basic things parents can do to help their child prepare, according to Julia Cron, M.D., chief of the Department of Obstetrics and Gynecology at NewYork-Presbyterian Lower Manhattan Hospital.
"Just like pediatricians, we have to be aware there's often two people that we're engaging with: the patient and their parent or caregiver," says Dr. Cron. "A lot of it is education and dispelling myths and helping them with the enormous transition of puberty and becoming an adult."
These are the top things parents should know before taking their teen to their first OB-GYN exam.
Finding a Gynecologist for Your Child
The first step is finding a provider for your teenager. Dr. Cron says parents often bring children to see their own gynecologist. Alternatively, parents can turn to pediatricians and family practice doctors as a resource. Family friends and relatives can provide recommendations as well. You can also search for a doctor on The North American Society for Pediatric and Adolescent Gynecology website.
When To Schedule Their First OB-GYN Appointment
There is no exact right age, but parents should generally start thinking about bringing their child to the OB-GYN around 13 to 15 years old. The American College of Obstetricians and Gynecologists (ACOG) recommends the same thing. "Most [children who menstruate] have their periods by then, they're in the later stages of puberty, and their developmental stages allow for preventative help," says Dr. Cron.
Indeed, puberty can actually start as early as 8 years old, beginning with breast development and followed by pubic and armpit hair, a growth spurt, and a period for most people who were assigned female at birth. "The tempo usually is about two years," Dr. Cron says. "After breast buds, it's usually two years until they get their periods. That's a good time to start the conversation and start talking about it."
Waiting until someone is sexually active can actually be "a little bit late" for a first OB-GYN appointment, adds Dr. Cron. "You want to be able to have those conversations with a trusted adult and conversations around sensitive healthcare issues."
That said, a child might sometimes need to visit the OB-GYN even earlier—particularly for certain medical concerns. Dr. Cron has occasionally seen children under 1 year old in her practice. "If [a child is] having problems with their reproductive organs that are causing problems with their life, then it's very reasonable to bring someone to the gynecologist," she says, pointing to issues like menstrual irregularity, pelvic pain, and even ovarian cysts.
What To Expect During the Exam
A visit to the gynecologist starts with a conversation. Dr. Cron talks to both the patient and the caregiver before asking the caregiver for one-on-one time with the child. "Over the years, I've run into people who have been a little resistant to that, but when you really explain it, that you want your child to be asking me these questions... I would say almost no parent or guardian would resist that," she says. "I think it's all about how you present it to both the patient and the caregiver."
Visits don't necessarily include a pelvic exam, and a pap smear is generally not performed until a patient is 21 years old. "We generally feel now that screening pelvic exams don't have a lot of utility and it should be an issue of shared decision making," she says, adding that symptoms like heavy vaginal bleeding or vaginal pain may indicate the need for such an exam.
Most doctors aim to be relatable and empathetic during a first OB-GYN appointment. They should explain what they're doing and why they're doing it, and let the patient ask questions along the way. According to ACOG, young people might choose to share concerns about menstruation, birth control, acne, sex and sexuality, weight, sexually transmitted infections (STIs), emotions, and more.
Preparing For Your Child's First Gynecology Visit
Dr. Cron says the first step is to normalize genitalia. "When we 'exceptionalize' the genitalia, that does people a disservice," she says. "When you talk about going to the gynecologist, similar to going to the eye doctor or the dentist… framing it in a way that this is somebody who is an expert and this is a resource for you to ask questions and get answers."
It's also important for children—and parents —to know there's nothing they can say that would be considered embarrassing. "This is what I do all day long. This is not at all embarrassing for me," Dr. Cron says. "The more comfortable your provider is, the more comfortable the patient is."
What To Know About the HPV Vaccine
HPV vaccines have been approved for children as young as 9 years old and are typically recommended around 11 to 12 years old, according to the Centers for Disease Control and Prevention (CDC). Dr. Cron says the vaccine has "been shown to be safe and effective" and has resulted in a significant decrease in the incidence of precancerous lesions.
When they start their vaccination series, children under 15 years old only need to receive two vaccines six to 12 months apart. Children who are 15 years old or older must get three doses of the HPV vaccine. Vaccination is recommended for those up to 26 years old—and after that, it might be recommended in certain circumstances. Talk to your child's OB-GYN for more information.
Making Appointments For Transgender or Nonbinary Children
Dr. Cron says gynecologists can be a great resource for transgender, nonbinary, or gender nonconforming children—as well as those who are transitioning or looking to possibly transition. "As gynecologists, we are used to talking about sensitive topics, we are used to talking about reproductive help. A lot of us do care for gender expansive patients," she says, pointing to the example of someone getting their period: "For some patients, the idea of having their period is very traumatic… As gynecologists, we are really good at suppressing people's periods and that can be transformative to a young person" who is questioning their gender.
Still, it's true that nonbinary, gender nonconforming, and transgender people can face discrimination in healthcare settings. "Research shows that many are unable to find competent, knowledgeable, and culturally-appropriate health care," says ACOG. But OB-GYN appointments are necessary for everyone with breasts, a cervix, or a vagina; they can give you invaluable information on sexual health and even prevent cancer.
Parents can help by speaking with the medical provider beforehand and making sure they understand their child's unique issue. Also, let the provider know about pronouns and preferred names for body parts, and have them walk through each exam before conducting it. Some children may benefit from bringing along a support person to the appointment.
If your child doesn't feel comfortable with an OB-GYN exam, or if the doctor doesn't respect pronouns and body part names, change to a difference provider or practice. Also know how to help combat gender dysphoria, which might arise after the appointment for some teens. Helpful resources include The Trevor Project (an organization that provides information and support to transgender and nonbinary people) and Trans Lifeline (a crisis hotline by and for transgender people).