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Well-Woman: Screening for Women Ages 13-18 Years

American College of Obstetricians and Gynecologists (ACOG)October 13, 2014Articles

Annual assessments provide an excellent opportunity to counsel patients about preventive care and to provide or refer for recommended services. These assessments should include screening, evaluation and counseling, and immunizations based on age and risk factors. The interval for individual services varies. The American College of Obstetricians and Gynecologists recommends that the first visit to the obstetrician–gynecologist for screening and the provision of preventive health care services and guidance take place between the ages of 13 and 15 years.

These recommendations, based on age and risk factors, serve as a framework for care which may be provided by a single physician or a team of health care professionals. The scope of services provided by obstetrician–gynecologists in the ambulatory setting will vary from practice to practice. The recommendations should serve as a guide for the obstetrician–gynecologist and others providing health care for women and should be adapted as necessary to meet patients’ needs. For example, the presence of certain risk factors may influence the need for additional assessments and interventions. The policies and recommendations of College committees regarding specific aspects of the health care of women have been incorporated; they may differ from the recommendations of other groups.

Ages 13-18 Years: Screening

Well woman teenHistory

  • Reason for visit
  • Health status: medical/surgical, menstrual, reproductive health
  • Family medical history
  • Dietary/nutrition assessment
  • Physical activity
  • Use of medications, including complementary and alternative medicine
  • Tobacco, alcohol, other drug use
  • Emotional, physical, and sexual abuse
  • Sexual practices (including vaginal, anal, and oral sex; sexual orientation, number of partners; contraceptive use; exchange sex for drugs or money)

Physical Examination

  • Height
  • Weight
  • Body mass index (BMI)
  • Blood pressure
  • Secondary sexual characteristics (Tanner staging)
  • Pelvic examination (when indicated by the medical history)
  • Abdominal examination
  • Additional physical examinations as clinically appropriate

Ages 13-18 Years: Laboratory and Other Tests

Periodic

  • Chlamydia and gonorrhea testing (if sexually active)
    (Urine-based sexually transmitted infection screening is an efficient method without a speculum examination.)
  • Human immunodeficiency virus (HIV) testing (if sexually active) (Physicians should be aware of and follow their states’ HIV screening requirements. Visit the Centers for Disease Control and Prevention for more information.)

High-Risk Groups (See High-Risk Table for more information.)

Ages 13-18 Years: Evaluation and Counseling

Sexuality

  • Development
  • High-risk sexual behaviors (number of partners, exchange sex for drugs or money)
  • Preventing unwanted/unintended pregnancy
  • Postponing sexual involvement
  • Contraceptive options, including emergency contraception
  • Sexually transmitted diseases—barrier protection
  • Internet/phone safety

Fitness and Nutrition

  • Physical activity
  • Dietary/nutrition (including eating disorders and obesity)
  • Multivitamin with folic acid
  • Calcium intake

Psychosocial Evaluation

  • Suicide: depressive symptoms
  • Interpersonal/family relationships
  • Sexual orientation and gender identity
  • Personal goal development
  • Behavioral/learning disorders
  • Emotional, physical, and sexual abuse by family or partner
  • School experience
  • Peer relationships
  • Acquaintance rape prevention
  • Bullying

Cardiovascular Risk Factors

  • Family history
  • Hypertension
  • Dyslipidemia
  • Obesity
  • Diabetes mellitus
  • Personal history of preeclampsia, gestational diabetes, or pregnancy-induced hypertension

Health/Risk Assessment

  • Hygiene (including dental), fluoride supplementation
  • Injury prevention
    Exercise and sports safety
    Weapons, including firearms
    Hearing
    Occupational hazards
    Recreational hazards
    Safe driving practices
    Helmet use
  • Skin exposure to ultraviolet rays
  • Tobacco, alcohol, other drug use
  • Piercing and tattooing

Ages 13-18 Years: Immunizations

Periodic

  • Diphtheria and reduced tetanus toxoids and acellular pertussis vaccine booster
    (Persons aged 11 through 18 years who have not received Tdap vaccine should receive a dose followed by tetanus and diphtheria toxoids [Td] booster doses every 10 years thereafter. Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid-containing vaccine. See the Centers for Disease Control and Prevention for more information.)
  • Hepatitis B vaccine (one series for those not previously immunized)
  • Human papillomavirus vaccine (one series for those not previously immunized, ages 9–26 years)
  • Influenza vaccine (annually)
  • Measles–mumps–rubella vaccine (for those not previously immunized)
  • Meningococcal conjugate vaccine (1 dose at age 13-18 years if not previously vaccinated.
  • Persons who received their first dose at age 13-15 years should receive a booster dose at age 16-18 years)
  • Varicella vaccine (one series for those without evidence of immunity)

High-Risk Groups (See High Risk Table for more information)

  • Hepatitis A vaccine
  • Pneumococcal vaccine

For more information on immunizations, visit the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices site and the College’s immunization webpage, http://www.immunizationforwomen.org.

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