Avoiding family politics in the gynecology exam room

The exam room is not the appropriate place for family politics to play out, yet I often feel like I am a referee between mothers and daughters.

Although I'm usually happy to see mothers accompanying their teenage daughters to the first gynecology visit, it is very easy to be overwhelmed by a mother who has a plan for her daughter's care, but has not considered that her daughter might have her own questions and ideas. 

Despite this, I always try to appreciate the benefits of having a parent present. Adolescent girls are not always the best historians and often know very little about family medical history.  Many young women are nervous about the exam and are hesitant to discuss any problems that involve their menstrual cycle or genitalia. Having their mother's support can help ease patients' worries in these circumstances. 

But what is the age limit for having mom come along to an annual gynecologic exam?

I recently saw a 23 year old as a new patient. As I tried to obtain the young woman's history, her mother interrupted frequently with details from her own medical history, asking me for advice on menopause symptoms and regaling me with stories of her birth experiences. 

I tried politely to listen to the mother, but as time ticked on, I encouraged her to make an appointment with one of our providers to discuss her multiple issues.  When I was finally able to question the patient about her contraceptive practices, the young woman responded with a very vulgar remark and then explained that she was just trying to shock her mother. 

Although I appreciate supportive parents, it can get awkward when a parent becomes pushy, argumentative or belittling.  In order to provide the best care, I always insist on some time alone with each patient, regardless of age, so I can truly hear the patient's voice.   Usually after an icebreaker discussion with both the patient and mother, during which I try to build rapport and ease anxiety, I ask the mother to leave the exam room.

Obviously, there are some things many young women do not wish to discuss in front of a parent. If an exam is warranted, I give the patient the option to choose whether she wants her mom present.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.


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