When Should I Take My Daughter to See a Gynecologist?

By Daphne N. Shaw, M.D.

If your daughter is anything like mine, seeing an article with this title will likely send her slinking to her room, cheeks flushed. Kinda like when my dog disappears the moment he catches onto the fact that a visit to the vet is in the works.

But the question of when to take your daughter to a gynecologist is an important one, and, like other discussions of puberty or the birds and the bees, the same teens who might redden and squirm will likely be very thankful (inside) that you asked.

The answer to this question will vary from pediatrician to pediatrician. But my short answer as to when to take her to the gynecologist is as follows:

1. If she has a breast/gynecologic issue your pediatrician feels would benefit from a gynecologist’s input
2. Possibly if she is thinking of becoming or has become sexually active, although talk to your pediatrician first
3. When she is 21, at the absolute latest

Let’s break this down.

1. If she has a breast/gynecologic issue your pediatrician feels would benefit from a gynecologist’s input

We pediatricians — according to the American Academy of Pediatrics— should be seeing your child or teen yearly for well-child checks. At these visits we will discuss many topics including puberty, menstruation, sexuality and contraception. Checkups also involve a physical exam of the entire body, including a look at an adolescent’s breasts and a brief external look at her genitalia (not a full, dreaded pelvic exam, mind you, but still rather unpopular) in order to check on pubertal development and to screen for any other issues or abnormalities in these areas. Adolescent visits often frequently include some time when it is just the doctor and nurse talking with your teen (with you out of the room). This separate time allows teens to begin taking some ownership of their health visits, gives them a chance to bring up whatever more delicate concerns they might have, and to perform those more private parts of the exam.

If issues come up at these visits or at any point — issues such as heavy or irregular periods or somewhat slow, fast, or atypical growth or puberty— your pediatrician will help determine next steps. Sometimes, worries can be normal variations and might need simply to be watched and followed for a while. Asymmetric breast development (even in boys) and mildly irregular cycles for the preteen (particularly those new to having periods) often get better on their own. Other times, issues may veer further from the norm, and your pediatrician may feel it necessary to order lab tests and/or imaging. Depending on how the evaluation goes, your doctor may refer you to Cook Endocrinology and/or Gynecology.

2. Possibly if she is thinking of becoming or has become sexually active, although it’s still good to talk to your pediatrician first

As discussed above, as per the American Academy of Pediatrics, we pediatricians should be seeing your daughter for yearly well-care visits, incorporating an assessment of growth and puberty, a full exam, and anticipatory guidance. Similarly, the American College of Gynecologists and Obstetricians recommends a first visit to the gynecologist for girls between age 13 and 15, in order for the ob-gyn to do much the same thing. So there is some overlap in the services and roles which pediatricians and gynecologists can provide for a young teen. Following the letter of the law (that is, seeing both doctors) is always an option, as our colleagues in ob-gyn can be a wonderful part of the village helping to care for your child. Some of them have contraception education down to an informative yet entertaining art! That said, if your daughter is already having regular care through the pediatric office, and if she is also getting detailed education about sexuality and contraception choices at home, school, church, or through other groups, she may not need to see a gynecologist for that first introductory visit in addition. I leave that choice to you.

After laying the groundwork for future well-woman care, however, the next time to consider taking your teen to the gynecologist is if she is thinking of becoming sexually active or — less ideally—has taken that action already. If we have indeed moved from the theoretical “here’s what a person needs to know about birth control” to the actual “here’s what YOU need to know and start doing NOW with regard to birth control,” it is still a good idea to begin the discussion with your pediatrician. Pediatricians want to be kept in the loop and can provide information about the risks and responsibilities of sexual activity, options for birth control, and guidance for next steps.

There is variability between pediatricians as to whether or not they prescribe birth control pills (or COCs, combined oral contraceptive pills), though many do. Even still, most pediatric offices do not provide the full gamut of contraceptive options (such as hormone injection, IUD, or implants) available through a gynecologist. If other contraceptive options might be better suited to your particular adolescent, it would be a good idea to see a gynecologist.

3. When she is 21, at the absolute latest.

This AGE 21 bit is going to be for some girls and their parents the best news all day! In fact, let’s all do a little happy dance, as it is a fairly recent and welcome change (through the recommendations of ACOG, the American College of Obstetricians and Gynecologists), that a girl/woman’s first pap smear (for cervical cancer screening) does not have to be until age 21. What this means is that for a lot of girls (those who are without gynecologic symptoms, problems, or infections), the much despised first full pelvic exam (with stirrups and speculum— yeah that!) can be delayed to age 21. Hooray!

The recommendations used to be for earlier pelvic exams, pelvic exams at least within three years of sexual activity, and for pelvic exams prior to starting birth control, but things have changed. Internal pelvic exams are in most cases not needed before the initiation of pills or any other contraception with the exception of IUDs. So — big sigh of relief all around!

Of note, an important exception to the age 21 pap smear rule is that girls who have HIV or are immune-compromised need to start seeing a gynecologist regularly and getting pelvic exams when they become sexually active.

Well, that’s all, folks! Hope this gives some insight into when to take your child to the gynecologist. Now, come to think of it, when DOES the dog need his next vet visit, and where did he go?