Often, people associate gynecologists (GYNs) with adult female reproductive care (gynecology) and obstetricians (OBs) with prenatal, labor and delivery and postpartum care of expectant mothers. However, the OBGYN specialty provides various services that begin during adolescence and continue throughout all stages of life.
For parents and guardians, it may be unclear when or why they should take their teenage daughters to a GYN or OBGYN. Any time after a girl begins menstruating, especially if she’s experiencing problems, would warrant an appointment, according to Suzanne Bovone, M.D., a board-certified OBGYN with Obstetrics and Gynecology of San Jose, part of Pediatrix® Medical Group.
We recently visited with Dr. Bovone to address some of the most common questions about adolescent GYN care.
What age do you recommend girls begin routine GYN care, and why?
I recommend that girls around 14 to 16 have an initial visit to begin the patient-doctor relationship. The majority are fine to stay with their pediatricians, who do an excellent job at managing things like the beginning of menstruation, regular periods, acne and body-image issues. Once it’s out of their wheelhouse, they are referred to us. Many girls come in for painful or irregular periods, irregular bleeding, acne and other issues.
What is involved in routine GYN care?
The teens I see are generally with their mothers or guardians. Unless there is a medical need, I don’t do a physical exam during the first visit. Girls are nervous when coming in, so it’s important that we use that time to visit, address any needs and start establishing a relationship so they feel comfortable.
I start by discussing confidentiality with the parent and patient because I want to set the tone that everything said between the patient and physician is confidential. We discuss what brings them to the initial appointment so they can express any concerns that need to be addressed. I also educate the patient and parent throughout the visit.
Toward the end of the first visit, I have the parent step out so I can ask more personal, confidential questions. This allows me to speak confidentially with the patient about sexual activity, sexually transmitted infection (STI) prevention, alcohol, drugs, bullying, etc., to help ensure her safety. Our conversation stays between us and is not shared with the parent.
I also explain to the patient and parent that if the patient is hurting herself or someone is hurting her, I need to alert the authorities. We talk about insurance and that parents may see bills for lab tests, prescriptions and those types of things, even if it’s confidential between patient and physician.
Additionally, I visit with the parent and patient to get the medical history because kids may not always know their medical histories or that of their parents. However, it’s essential to have that information and the patient’s vaccination history so we can provide the best care.
What are some common GYN-related health issues facing girls under 18?
The most common issues relate to periods — painful, heavy, irregular, premenstrual syndrome (PMS), mood changes, acne, etc. Other issues include the inability to use certain feminine products and understanding their bodies, contraception and going over all the contraception methods, weight-related concerns or eating disorders, which can affect their periods. If their pediatrician refers them to me due to a potential eating disorder, we work together to get to a diagnosis. If they are severely calorie-restricted and exercising, their body fat may go down to a level where they no longer have periods. We see this with athletes who may not have an eating disorder but are exercising at a level that their body fat is deficient. In these instances, we talk about bone health and how young girls develop their maximum bone strength during this time. Therefore, we may want to supplement with estrogen to help ensure they maintain bone health. We also screen patients to determine if there is an eating disorder or body-image issues and, if so, we make sure they receive proper mental health treatment.
How do you create a safe, comfortable environment for your young patients?
I like to set the tone at the beginning of the first appointment that this is more than a doctor’s visit; it’s a relationship built on trust and confidentiality. It’s essential that a patient and physician are a good fit for each other. That’s what helps build trust and lasting relationships.
In addition, I create a confidential space for them to share any of their concerns. I want them to know that I’m available to them whenever they need me, even if it’s after hours. I let them know I don’t do a physical exam until they are 21 unless there is a clear reason. That’s when we start cervical cancer screenings and pap smears, regardless of sexual activity.
It's imperative for our patients to know that they are in control of their health, and we must have their consent for anything we do. I explain everything about the first exam, so they always know what to expect, why we do specific exams and the importance of preventative medicine. If they come in for a specific issue, like a breast mass, I always explain what types of tests are available, so they know all their options for reaching a diagnosis.
Honestly, it’s just setting the tone that this is a safe space and that everything they tell me is confidential, I’m accessible to them, there are no silly questions and I’m open to discussing anything with them, such as sexual identity. I ask lots of questions to get to know them, and I want them to feel comfortable asking me questions or talking to me openly. Building trust in the relationship early on is vital.
Why is it important to provide personalized care to this age group?
It starts with building the relationship because you are dealing with intimate details and asking personal questions. There may be times when the patient has difficulties sharing issues with the parent, and we help facilitate that as well. This level of trust sets the foundation for the patient's relationship with me and any future physicians, so establishing trust early on is vital. The goal is to ensure the patient feels safe and supported and feels she has a safe place to go to under any circumstances.
Preteen and teen pregnancies have continued to decline during the past 30 years. What counseling and education do you provide this age group to promote pregnancy prevention?
Educating patients about pregnancy and STI prevention is essential, so I like to cover both topics simultaneously. Even though some contraceptives have multiple purposes, I like to inform patients about all the different options, show them each type, help them understand how and why they are used and their pros and cons. Even if they aren’t currently looking at contraceptives, I like to put it out there, so they know their options and have that level of education when they are ready.
I also educate them about other uses of contraceptives. For example, birth control pills can help reduce heavy bleeding, PMS symptoms, acne and cramps, decrease ovarian cancer risks and help regulate irregular periods.
Then, we segue into the STI talk. I explain that if they’re using any of these certain products, they aren’t protected against STIs. We talk about using condoms 100% of the time, whether they use other forms of contraceptives or not.
What should parents know about routine GYN care for their daughters?
Parents who take their daughters for GYN care, especially if they are experiencing female issues, are simply supporting their children. It sets the foundation for good personal health care practices and supports them in a huge milestone in life. Making that introduction earlier rather than later helps them understand what type of doctor they need to see for female-related issues. Moreover, educating them early on is better for their overall health.
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