Surgeon Marc Laufer is chief of the Division of Gynecology and co-director of the Center for Young Women's Health at Children's Hospital Boston. He specializes in pediatric and
adolescent gynecology and gynecologic surgery.
In the May 2006 issue of Obstetrics & Gynecology, the American College of Obstetricians and Gynecologists (ACOG) reaffirmed its recommendation that teenage girls first visit an OB/GYN between the ages of 13 and 15. Here, Dr. Laufer talks about this recommendation, as well as confidentiality concerns and the gynecologic exam.
Why did ACOG decide to take a new look at teen girls' first OB/GYN visits?
In the past, ACOG has recommended that 13- to 15-year-old women see a
gynecologist, but gynecologists weren't
seeing a large number of girls when they were that young. So ACOG reiterated the importance of this timetable and more clearly defined the goals of a young
woman's first reproductive health care visit.
What is the purpose of this visit?
We want teens to establish a relationship with a gynecologist for their future reproductive health care. This lets the gynecologist address issues that may not be addressed by a teen's primary care provider and helps ensure that a young woman knows where to turn for
information and care relating to pelvic pain, irregular periods, sexually
transmitted diseases, contraception and other issues.
Why can't a primary care physician (PCP) address gynecological concerns?
In an ideal world, all gynecological issues would be addressed by a teen's PCP. Some pediatricians are excellent at addressing these issues, and Children's has specialty services for teens in the Adolescent Medicine Practice. But in many
communities, patients' needs are not being met. So ACOG views this as an opportunity for 13- to 15 year-olds to establish a relationship with a
physician who is specifically interested in the gynecologic health of young women. It's important to note that the
reproductive health care visit does not replace routine visits with the patient's PCP. Rather, this visit will complement the primary care provider's visit.
What happens at the first OB/GYN visit?
The first visit is educational. We discuss a girl's lifestyle and health habits,
including nutrition, exercise, social
activities, smoking, medications and use of other substances. We also take a
menstrual, reproductive and family
history. Family history is very important, since there are, unfortunately, some
medical conditions that are genetically-based, such as polycystic ovarian
syndrome, endometriosis and breast and ovarian cancer. But there are things young women can be doing to try and avoid these conditions and help improve their long-term health.
Does the first OB/GYN visit involve a physical exam?
The initial reproductive health visit doesn't typically involve a pelvic exam, but if a girl is having abdominal pain, for example, or if there are concerns she could have a mass or tumor, then she may need a physical exam or further
gynecologic assessment, such as an
ultrasound. Similarly, concerns about vaginal discharge, menstrual cramps or need for contraception would prompt a physical examination.
What advice do you have for girls who are nervous about their first visit?
The most important things she should realize are that she doesn't have to feel uncomfortable and that the visit is meant to help educate her. Most adult women have a long-term, trusting relationship with their gynecologist and this visit will help establish that relationship at an
Are these visits confidential?
How are parents involved?
It is important to establish trust and the idea of confidentiality at the first and all other health care visits. For all
reproductive health care visits, we like to meet with the parents or guardians and the young woman at the same time. Then we like to meet with the
teenager alone to hear her concerns and get together again with her parents at the end of the visit for summarization and to make a health plan. Ideally, we establish a confidential relationship with limits that are clear to both the teen and her parent(s). We want to let the young woman know that what she discusses with her gynecologist can be confidential if she chooses it to be. The visit is about making sure she feels comfortable and letting her parents know we all have the same goals: to ensure their daughter is healthy, stays healthy and is acting responsibly.
How does a teen and/or her parent find a gynecologist?
There are several ways, including self-
referral, through their PCP or through the family's health insurance network. Before making an appointment,
families should ask the gynecologist's office if they have experience providing teen reproductive health education visits and whether they have a particular
gynecologist with teen training.
Where can young women or parents find more information?
The Center for Young Women's Health
at Children's has a great Web site,
www.youngwomenshealth.org, with a lot of helpful information on young women's health and preventive health care,
including gynecologic exams.