When it’s time for back-to-school, there are a million things that parents have to check off their to-do list: purchasing notebooks, making sure their daughter is caught up on her summer reading, buying an expensive pair of cool shoes she begged for. But one thing many parents don’t consider when it’s time for back-to-school is thinking about taking your teen daughter to her first gynecological visit.
Letitia was a seventeen-year-old girl who had been my patient for two years. On her last visit, she launched into a laundry list of questions: the first of which was about a vaginal discharge and odor she’d been noticing over the past couple months. Letitia was still a virgin, and she had never been sexual with a partner. She’d read enough to realize that she probably didn’t have an infection because the discharge was colorless and she didn’t have any itching or burning—but she still had her concerns. “What’s the discharge? I read the vagina was self-cleaning. I’m cleaning myself with soap—is that enough? I’m confused. What’s a Diva Cup? Should I use that instead of tampons?”
Adolescence. Remember that? You probably had a lot of unanswered questions about your own body and sexuality, which is why you want to give your daughter the knowledge and encouragement to take control of her vagina (and her life) in order to empower herself on her own journey.
When it comes to talking to our teens about their sexual, reproductive, and health behaviors, it can be awkward for all parties involved—parents and teens included. Many parents (when they were teens themselves) didn’t have the experience of healthy and open dialogues about these issues with their own parents, so they don’t have a model for this type of dialogue. Where to start?
Parents, healthcare providers, and even mentors need first to create a supportive environment for their teens to talk about sex and health issues—otherwise the important questions won’t get asked.
Here are five reasons why you should take your teen daughter to her first gynecological visit:
1. It’s an important step in screening, preventative services, and other health care guidance. Many of the mothers I see worry that if they bring their daughters for an appointment and have a realistic conversation about birth control, that alone is permission to become sexually active. Seeing a gynecologist is not a catalyst for teens to have sex. The first complete and comprehensive gynecologist visit for an adolescent will set the stage for positive and informative dialogues that can help promote healthy alternatives. Basic topics for discussion between your healthcare provider and your teen include menstrual history and the importance of starting breast self-exams.
2. Preventing Sexually Transmitted Infections (STIs). Recently it has been shown that 25% of sexually active teens and young adults (15-24) acquire almost 50% of all new STIs. Women ages 14 to 19 were also found to have a 24% prevalence of HPV. The good news is Gardasil 9 HPV vaccine can prevent 90% of the HPV high risk types causing cancer—including Types 6, 11, 16, and 18 (known as the scary four). This is why I strongly suggest getting the vaccine at 12 or 13 years old, before a young woman becomes sexually active.
3. Initial consultation and a simple external examination. This “external only” pelvic exam allows the doctor to evaluate the external genital anatomy, issues of personal hygiene, and look for any possible abnormalities of the vagina and vulva. This consultation should open the door to enlightening conversations about healthy behavior and risks.
4. Crazy cramps and other conditions The Pill can prevent. I had a patient, Emily, who described “crazy cramps” that kept her home from school and prevented her from taking part in volleyball practice and games. Fortunately, I could put Emily on a low dose birth control pill to control those debilitating cramps—and she could take part in all the activities typical teenagers ought to be doing. In addition to its effectiveness in preventing pregnancy and cramps, The Pill can help with other things, including: regulate periods, lighten periods, control irregular/heavy periods, control acne, balance hormone levels, treat symptoms associated with PMS, and protect against ovarian cancer.
5. A gynecologist may uncover “other issues.” While with Emma, another teen patient, I gave her an external pelvic exam—which is when I noticed all too familiar cut marks on her inner thighs. She started to cry. “I’m ready to get help…please,” she told me. One in five adolescents has a mental health disorder—the most common being depression and anxiety—yet only half those teens actually receive health, oftentimes because they are not likely to open up to their parents. We gynecologists can be the gatekeepers for the mental health of our young women patients, and help discern between typical tween anxiety and more urgent mental health concerns that may necessitate professional health.
When I sit across from a teen in my office and look into her eyes, I always feel the impulse to wrap my arms around her and say, “You need to take control of your body in every way. Don’t be afraid to ask uncomfortable questions!”
Find a healthcare provider that your daughter can connect with—it may not be your gynecologist, and that’s okay. One more thing: I believe that our daughters are the front line of the Vagina Revolution, and if it goes as planned, the owner of an adolescent V will not grow up to earn 78 cents to a man’s daughter!