When I was an ob/gyn resident in the 1980's, our program provided care at a community teen clinic. Young women were mostly seeking cycle control and contraception, usually wanting to start birth control pills. The supervising physician instructed us to do full pelvic exams, including pap smears and rectovaginal exams, even though some of these teenagers were not yet sexually active. The exams were almost always normal.
The teens were very nervous, in some cases, terrified about the exams, and it took determination and courage for them to follow through with their appointments. Our university-based residency saw this "service" as community outreach, but the thoroughness of our approach, standard for that time, was probably a barrier to care for many frightened young women.
Because of new adolescent health care guidelines from the American College of Obstetrics and Gynecology (ACOG), today's teens can expect a much less intimidating first gyn visit. Since most teens are unlikely to have pelvic abnormalities, ACOG says physicians don't need to perform a pelvic exam at a first gyn visit unless an individual's medical history suggests there may be abnormal findings.
Many teens seek cycle control and/or reliable contraception, and oral contraceptives (OCs) are usually a good choice. In most cases, OCs can be safely prescribed after a thorough medical, family and social history, and a blood pressure check.
ACOG now recommends doing a first pap smear at age 21, regardless of a young woman's sexual history. We can screen for chlamydia, a common infection in sexually active young women, with a urine specimen.
The main threats to adolescent health are risk-taking behavior and unhealthy lifestyles. ACOG recommends a first gyn visit for girls aged 13-15, so ob/gyn physicians can back up parents in encouraging good choices. Our clinics then become a safe place for teens to go for reliable information and resources that build the foundation for a healthy adulthood.
