One of the most nerve-racking doctor’s visits of my life was my first visit to my gynecologist when I was just 17 years old. I was headed off to college in a few months, and my mother thought it was the right time for me to develop a relationship with a women’s health care provider. I played it cool and acted like I was completely unfazed. Truth of the matter is I was terrified, mainly because I had no idea what to expect.
I asked my mother some questions and she answered them honestly, but I was still incredibly nervous as I sat in the waiting room. Flash forward 26 years. I am now a gynecologist myself (I never would have believed that when I was 17), and some of my favorite visits are with my teenage patients. I find that every one of them is nervous about the visit for the exact same reason I was…fear of the unknown. So I decided to write this blog for all of the young women out there who are putting off the inevitable in hopes of easing worries and making that first visit more enjoyable and productive.
At the latest, you should schedule your first visit with a gynecologist once you become sexually active or by age 21 which ever comes first. However, the best approach is to schedule your first visit somewhere between ages 13 and 15. I’m sure that this seems awfully young to you, especially since most young women are still seeing their pediatricians at this age. It is young, but there is so much more your OB/Gyn has to offer you then just a breast examination or a pap smear. We can offer suggestions to control and treat your heavy, painful or irregular menstrual cycles, discuss contraceptive options, offer screening for sexually transmitted infections, and provide immunizations against human papilloma virus, just to name a few. Your gynecologist is the place to go to talk about issues around your general health and sexuality. Establishing this relationship early on in your life means that you can be proactive about your health care and get professional help in making difficult decisions as you enter adulthood.
So that brings us to the all-important question. The elephant in the room that keeps most adolescents away from the gynecologist: “Do I have to have a pap smear?” The answer before you hit age 21 is NO. The best news is that if you have no gynecologic symptoms, you do not need a pelvic exam at all. Why is that? Because we can test for sexually transmitted infection through urine and blood tests. Also, there is no need to have an examination of your internal genitalia before starting on any type of contraceptive.
What about your privacy? Will your gynecologist talk to you parent or guardian about your personal health information? Once you turn 18, you are considered an adult and are fully emancipated from your parents in terms of your health care. But even before you reach this milestone, it is possible for you to have a completely autonomous relationship with your health care provider and expect privacy with regard to health care discussion that happen between you and your physician. Most physicians will ask an adolescent’s parent or guardian to excuse themselves from the room at some point during the office visit, allowing you time to ask personal questions that you may feel uncomfortable sharing in front of your parent or guardian. It is important to always answer your doctor’s questions as honestly as you can, even if you feel embarrassed, since your answers will determine what services and medications will be offered to you. There are some instances where it may be necessary for your doctor to violate patient-physician confidentiality, such as mandatory reporting of sexually transmitted diseases to state authorities.
If you would like to be tested for sexually transmitted infections or start on oral contraceptives, it is important to remember that these details may be reflected on the insurance statement from your doctor or pharmacy visit. If you want to keep this information completely private, it may be necessary to pay for certain tests out-of-pocket or go to a free clinic in order to ensure confidentiality.
The relationship that you develop with your gynecologist can be one of the most important health care relationships you will have throughout your adult life. This is likely the same person who will care for you when you become pregnant later in life and share with you the joy as you become a parent. It is important that you take the first step and schedule the appointment. We are here waiting to take care of you.
Dr. Susan P. Raine, JD, LLM, MEd is an Associate Professor and Vice Chair, Global Health Initiatives, Center for Medical Ethics and Health Policy Department of Obstetrics and Gynecology– Baylor College of Medicine Houston, TX