DEAR MAYO CLINIC: Our family doctor recently suggested that our 14-year-old daughter be seen by a gynecologist. He said he recommends this for all girls her age. Our daughter is not sexually active, so I'm wondering why she would need to see a specialist. What would the appointment involve?
ANSWER: Many teenage girls have health questions and concerns that involve gynecologic issues. Generally, those issues can be managed through a primary care provider. A referral to a gynecologist may be useful, however, when a specific concern calls for specialty care, or if routine gynecologic care is not provided in the primary care setting of family medicine or pediatrics.
During the teen years, the most common medical concern for girls is their menstrual cycles. It's normal for girls to have irregular cycles for the first year or two after they start getting their periods. But unpredictable periods may raise questions about what is normal.
Also, painful periods are a real problem for many teens. They are the No. 1 cause of school absences for teenage girls. Cramps, bloating, tender breasts, headaches, fatigue, mood swings and food cravings can all affect girls around the time of their period. If home care remedies don't help, a health care provider may be able to offer more effective treatment, as well as answer any questions your daughter may have about her menstrual cycles.
Sex is another primary teen health concern. Your daughter needs accurate information about sex and the impact that choosing to be sexually active could have on her health. Addressing sexuality, birth control and the risks of having sex during the teen years is an important part of providing her with the guidance she needs to make well-informed choices about sex.
If you have not already done so, you also should talk with your teen's health care provider about having her vaccinated against human papillomavirus, or HPV. HPV is a sexually transmitted infection that causes most cases of cervical cancer, a cancer that can destroy a woman's fertility and may be life-threatening.
The HPV vaccine has proven to be a safe, effective anti-cancer vaccine. It's recommended that all girls receive this vaccine before they become sexually active. The U.S. Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for girls 11 to 12 years old.
In addition to discussing these topics, as part of her visit, an external genital exam and a breast exam should be done to assess your daughter's development and anatomy. A pelvic exam is not necessary, unless there is a gynecologic problem that calls for it. Current guidelines do not recommend Pap smears for most teens. They generally begin at age 21.
Addressing gynecologic health questions and concerns is important for teens. If your daughter's primary care physician does not offer gynecologic care, an appointment with a gynecologist who specializes in teen health is a reasonable approach at this time. -- Patricia S. Simmons, M.D., Pediatric and Adolescent Gynecology, Mayo Clinic, Rochester, Minn.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to firstname.lastname@example.org. For more information, visit http://www.mayoclinic.org.)