# Teen/preteen girls- gynecologist?



## doulatara (Jun 20, 2006)

I feel a bit embarrassed to say that I don't know when it is appropriate for a first visit to a gynecologist. I saw my primary care physician and didn't see a real gynecologist until I was on my own, but my mom was never very on top of our medical care.

Is it after the first period? When a girl is thinking about becoming sexually active? Or just when she feels ready?

I know there are midwives in my area who also do well woman care...would it be appropriate to take a preteen/young teen to a midwife instead of a gynecologist? Or will a family doc suffice?

Help me out here. Thanks!


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## MCatLvrMom2A&X (Nov 18, 2004)

I have no intention of taking dd to a gyno. unless she has an issue that would need one.

I didnt see a Dr. for a gyno exam until a week before I got married at 22 and only then so that I could get the depo shot.


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## Phantaja (Oct 10, 2006)

I've always understood that a girl should first see a gynecologist when she first starts habing sex, when she turns 18, or if something abnormal is happening with her reproductive system (extremely painful periods, odd vaginal discharge, unexplained low belly pain, etc) whichever comes first.


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## just_lily (Feb 29, 2008)

I too have always heard the rule of thumb of 18, when sexually active, or if there is an issue.... whichever comes first.

But I wouldn't necessarily think that it needs to be a gynecologist per se, unless there is an issue. I am in Canada and family doctors handle most things unless there is a reason a referral to a specialist is needed. They definitely do pelvics, PAPs, and birth control which is all most young girls will need (again... unless there is an issue).

I actually went to a Sexual Health Clinic the first time I needed BCPs, and they did my exams as well. So that is also an option if there is one in your area.


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## eclipse (Mar 13, 2003)

I don't think there's any need for an internal exam in a non-sexually active girl, in absence of any specific concerns.


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## One_Girl (Feb 8, 2008)

You start seeing them when you first become sexually active. A family practitioner can do the same tests in the office. I used to see our nurse practitioner for my check-ups because my FP was a guy. My friend had periods that only came every six months and that kind of thing did require a gynecologist.


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## Bellabaz (Feb 27, 2008)

Diddo here for 18, sex or issues. But again I don't think it needs to be a gyno. A midwife is fine or family doc. I didn't have a vag exam until I was 22 or 23. I went to a gyno. I should have started earlier but I didn't know too much about that stuff and no one to really ask. Plus my first college roomy went right before college when she turned 18 and scared me a bit with her story of it. Live and learn I guess.


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## MAMom (Mar 24, 2005)

Quote:


Originally Posted by *doulatara* 
I know there are midwives in my area who also do well woman care...would it be appropriate to take a preteen/young teen to a midwife instead of a gynecologist? Or will a family doc suffice?

Help me out here. Thanks!

Yes, absolutely! I think it's a wonderful age to introduce women to all of the advantages of midwifery care.


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## harrietsmama (Dec 10, 2001)

I would recommend a visit with a midwife, she can start a relationship with her, no exam needed, just a consult to say when you are ready, here is what we will do, this is what I will use, etc.


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## rose123 (Oct 20, 2010)

Yes. That's embarrassing.I don't think think there is need to go to gynaecologist for the first period issue. That's quite natural and you can consult at your family or that lady you mentioned.


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## karanyavel (May 8, 2010)

Quote:


Originally Posted by *doulatara* 
I know there are midwives in my area who also do well woman care...would it be appropriate to take a preteen/young teen to a midwife instead of a gynecologist? Or will a family doc suffice?

I would definitely go with a midwife when it comes up (e.g., your DD is thinking about becoming sexually active). Either that or Planned Parenthood (I've had nothing but wonderful experiences at PP).

--K


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## Ruthla (Jun 2, 2004)

My daughters still go to the pediatrician for their checkups, and both are well into puberty. I don't think there's any need for pelvic exams until a girl/woman is sexually active, or if she's considering sexual activity (say, to get birth control prior to having sex the first time.) I'm really not sure about the recomendations for young women (say, 18-25 or so) who are not sexually active. It didn't apply to me, but it may apply to one or both of my daughters.

I switched to my mom's doctor (who at the time did GYN care as well as regular checkups) after I became sexually active at age 16. The way insurance is currently set up, I need to see my PCP for everything but GYN care and then the GYN for the pelvic exam. I assume that a sexually active teenager would need to see the pediatrician and the GYN on two separate visits.

It would be nice if all 4 of us could see the same Family PRactice dr, but that's not the way they do things here. I need to see an "internal medicine doctor" and they need to see a pediatrician.


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## Sarai18 (Sep 17, 2008)

Quote:


Originally Posted by *Ruthla* 
I assume that a sexually active teenager would need to see the pediatrician and the GYN on two separate visits.

My two older girls had their first pelvic exams and got BC from the nurse practitioner at the pediatrician's office when they became sexually active - I'm thankful they could see someone they already knew!


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *just_lily* 
But I wouldn't necessarily think that it needs to be a gynecologist per se, unless there is an issue. I am in Canada and family doctors handle most things unless there is a reason a referral to a specialist is needed.

Ditto.
I've seen an OB/GYN for some of my prenatal "care" (not with my first, but I had to see a consulting OB after my first c-section). That's the only reason I've ever seen one. Most people I know have never seen one, except for the OB part of their specialty.


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## mamabeca (Oct 3, 2004)

My FP does kids, adults, teens, pelvics, breast exams, everything. We could all go to see him, and we all like him a lot. I, personally, love seeing a mw when I can, though!


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## philomom (Sep 12, 2004)

I sent my daughter at 16. She had a list of questions for the doc.... some of which, she did not want to ask me. She got on birth control pills even though she is not yet sexually active. Her friends convinced her it makes periods lighter and easier to deal with. I'm cool. That's her business.

BTW, I also went at 16 because I did want to be sexually active and was wanting to be on the pill. My mom was all squirmy about the whole thing but she didn't try to stop me.


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## chiromamma (Feb 24, 2003)

I know this goes against all we've been taught but I see no reason for internal exams (GYN, midwife, GP) unless there is an issue or risk of having been exposed to an STD.
I didn't have a single one during any of my pregnancies and don't intend to subject my daughter to them just because she reaches an arbitrary age or becomes sexually active.
Sexual activity does not equal STD exposure.
DD's been educated about her body, the risks of hormonal birth control, condoms, etc. She knows she can come to me when she feels ready to have sex so we can buy condoms.
Dr. Mendelson, best known for his book _How to raise a Healthy Child In Spite of Your Doctor_, also wrote a great book called, _Male Practice_ about the generally abusive and manipulative nature of women's health care.
It is an old book but unfortunately, things have not changed much. In most cases, they've gotten worse.


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## Chicky2 (May 29, 2002)

I will not take any of my girls until they are ready to be sexually active, and at that point, we will visit my midwife. I feel the whole experience is so much more gentle and understanding with a midwife. A midwife will be "with woman", physically, emotionally, etc., and I really believe in the whole philosophy. If she ever felt a gyno were necessary, I would wholeheartedly trust her advice. I also had the bestest midwife in the world, though, so I may be a bit biased.


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## phathui5 (Jan 8, 2002)

chiromamma, do you do Pap smears?


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## Oubliette8 (Apr 15, 2009)

Quote:


Originally Posted by *phathui5* 
chiromamma, do you do Pap smears?

I know that wasn't aimed at me, but I do not. I posted a bit about why I don't over on this thread- http://www.mothering.com/discussions...847&highlight=

False positives are pretty common in young women due to natural changes as their bodies mature. Other countries don't even start screening until 25. And cervical cancer is pretty strongly linked to an STD, which means its not indicated for virgins. There is also no reason to require a pap smear to obtain birth control (the two have very little to do with each other)

If I had a daughter, and SHE wanted care, I'd bring her. But I wouldn't otherwise encourage her to see a gyn or get screened. We'd discuss the risks and benefits and she could decide. I think genital health is a really personal thing. A teenager is old enough to make their own choices. I know I would have been mortified if my parent had ever forced me to have a genital exam. I guess forced might be a hard word, I mean, if my parents had said "we made you an appt with the gyn" I wouldn't have felt I had any choice in the matter or the ability to say no. My mother DID make an appointment for my younger siblings, and I know they were very unhappy with the situation. I guess, I think being open about risks and benefits and allowing them their own choice in the matter is the best option.


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## ErinYay (Aug 21, 2008)

Quote:


Originally Posted by *Oubliette8* 
And cervical cancer is pretty strongly linked to an STD, which means its not indicated for virgins. There is also no reason to require a pap smear to obtain birth control (the two have very little to do with each other)

You kind of contradicted yourself- almost 50% of 20-25 year old women who are sexually active have HPV. I personally had a very fast-developing cancer-causing strain that went from a perfectly good pap to a cold cone biopsy in 6 months where CIN-3 cells (precancerous cells that are the last stop before full cancer) at 25.

Paps for women who are sexually active *are* needed regularly to ensure the US doesn't end up with a huge mortality rate for cervical cancer. Brazil, for example, has a low pap smear rate and a high death rate due of cervical cancer. Compelling women to get a pap in exchange for birth control is one of those "greater good" kind of things, and an individual good if you're one of the unlucky ones who has cancerous HPV.


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## justKate (Jun 10, 2008)

Quote:


Originally Posted by *doulatara* 
I feel a bit embarrassed to say that I don't know when it is appropriate for a first visit to a gynecologist. I saw my primary care physician and didn't see a real gynecologist until I was on my own, but my mom was never very on top of our medical care.

Is it after the first period? When a girl is thinking about becoming sexually active? Or just when she feels ready?

I know there are midwives in my area who also do well woman care...would it be appropriate to take a preteen/young teen to a midwife instead of a gynecologist? Or will a family doc suffice?

Help me out here. Thanks!

Well I'm one of the lucky ones that got to see lots of a GYN and have surgery with one before becoming sexually active. Just after turning 14 I had a cyst rupture on an ovary--this was ~'94, so no laproscopic surgery for me--major abdominal instead. Lots of exams, lots of pain. Missed 3 weeks of school. Put on BC pills thereafter to help with periods. Not sexually active for more than a year after that, FWIW.

So with that experience in mind, I would not take my DD to the GYN until she either asked to go or it was apparent that she was sexually active. I think (and this is just me) that check ups are a part of being an adult, so if you're going to be sexually active, you have to be responsible and get check ups. I think a midwife is a great idea--I've seen a lot of different care providers and have always found that midwives are more respectful and don't hurt me. They (IME) don't leave you in a paper gown in the freezing exam room with nothing to read for an hour, either.









I'm not big on well baby visits and decline paps/procedures during pregnancy, but I think an annual exam for a sexually active teen is appropriate. OP, it looks like your DD is ~12ish? I don't think it's too young to have a basic conversation about it, but no need to take her yet!


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## Oubliette8 (Apr 15, 2009)

Quote:


Originally Posted by *ErinYay* 
You kind of contradicted yourself- almost 50% of 20-25 year old women who are sexually active have HPV. I personally had a very fast-developing cancer-causing strain that went from a perfectly good pap to a cold cone biopsy in 6 months where CIN-3 cells (precancerous cells that are the last stop before full cancer) at 25.

Paps for women who are sexually active *are* needed regularly to ensure the US doesn't end up with a huge mortality rate for cervical cancer. Brazil, for example, has a low pap smear rate and a high death rate due of cervical cancer. Compelling women to get a pap in exchange for birth control is one of those "greater good" kind of things, and an individual good if you're one of the unlucky ones who has cancerous HPV.

I'm sorry you had to experience that. I hope you are feeling better now.

Yes, being sexually active is a reason to think about getting screened. What I meant was, birth control and cervical cancer screening should not be linked because health wise, they do not immediately effect each other. A pap smear is not a screening test that rules out contra-indications for taking BC. A pap smear is a screen for cancerous changes of the cervix. It has nothing to do with your suitability for taking contraceptives. Might it be a good idea to have a pap smear if you are sexually active with a non-virgin partner? Yes, its something you should consider.

However, greater good or not, I do not think requiring cancer screening of every woman who wants birth control is the way to go. Its paternalistic. Women are perfectly capable of examining the facts, considering their risk factors and making their own decisions. Also, not all women on birth control are sexually active. Many women take it for other reasons, like heavy menstrual bleeding, irregular periods, etc.

I am also aware that a large percentage of sexually active people have HPV. However, most strains of HPV are fairly harmless. Only a very small few cause cancer, and not everyone who gets those strains will develop cancer either. According to the CDC, most healthy people clear HPV from their bodies all on their own without any special treatment.


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## mclisa (Jul 26, 2004)

Girls don't need pap smears in their teens (for the most part), so she has time to wait. She might have need for birth control and hopefully she feels comfortable letting you know that. Then you can discuss from there.


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## chiromamma (Feb 24, 2003)

Quote:


Originally Posted by *phathui5* 
chiromamma, do you do Pap smears?

I do not have routine paps. I reluctantly succumb to them every 5 years or so as part of a physical for my life insurance policy.
I was diagnosed with cervical cancer linked to HPV in my 20's.
I gave the gyns their shot at "curing" it, only to have it become more invasive. After that I took full responsibility for my reproductive health and healed it on my own with Network chiropractic and lifestyle changes.
Despite dire warnings, and horrible prognoses, I have given birth at home to 3 children and remain extraordinarily healthy.
I am adamantly opposed to gardasil.


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## angelpie545 (Feb 23, 2005)

I'm wouldn't take a teen to the GYN unless she was sexually active. I don't think there's much need, and GYN visits can be traumatic and embarrassing tfor young girls. IMO, it's much better to have a gentle mother/daughter talk about sexuality and what the OB/GYN role is. Where available, I'd much rather take my daughter to a midwife for well-woman care. They tend to be more gentle and are able to take more time to talk to their patients.


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