Advice for first gynecology visits

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Women often ask me when they should bring their daughters in for their first gynecology visit. The truth is that there is no set “right time” for a first visit, but there are a few guidelines to consider. 

Until 2009, ACOG (American Society of Obstetricians and Gynecologists) recommended that adolescent women get a pap smear three years after becoming sexually active, but no later than 21 years of age. The latest guidelines now recommend that cervical cancer screening through pap smears begin at age 21, unless there is a history of an abnormal pap smear.   

I frequently hear skepticism over the new guidelines – many people feel like this is an effort to cut healthcare costs. In reality, ACOG's recommendation reflects the most current research. Studies have found that although the rate of HPV infection is high among sexually active adolescents, invasive cervical cancer is very rare in women under age 21.   

Most adolescent women with HPV and abnormal cervical cells will be able to clear the virus without treatment within one to two years. Prior to the implementation of the new guidelines, young women with abnormal paps were often treated with excisional procedures. These procedures increase the risk of premature birth.   ACOG's most recent recommendations reflect the knowledge that most abnormal cervical changes in adolescents will resolve on their own. 

Even if a young woman does not need a pap smear, she should see a gynecologist when she plans to become sexually active. Although many young women wait until after sexual debut to make their first visit, it is important to discuss contraception and safer sex practices before sexual activity begins. This is because sexually active adolescents are among those at highest risk for sexually transmitted infections. They should be tested annually and as needed.

Abstinent adolescents often need to see a gynecologist for irregular or painful periods. Birth control pills can often help these issues, as well as premenstrual syndrome and acne.

Also, many adolescents have questions that they don't feel comfortable discussing with parents or peers. An adolescent's first visit to a midwife, women's health nurse practitioner, or gynecologist is a perfect opportunity to teach self-breast exam, fertility and menstrual cycle awareness and safer sex practices.

Although there is no hard fast rule governing the timing of a first gynecological visit, establishing a comfortable relationship with a gynecology provider during adolescence can provide young women with crucial health and sexual education. 

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