When should my daughter have her first gynecological exam?

44585402_Mother-daughterOne of the most common questions asked is “when should my daughter have her first gynecological exam?” The answer may be a surprise to many since the recommendation has recently changed from starting at age 18 to age 21.

Annual screening with Pap smears before age 21 significantly increases the number of unnecessary procedures on young girls. Even if HPV is detected in the teenager, most cases will spontaneously regress within one to two years. For these reasons, the age was changed.

As for the 1st adolescent visit, it is recommended to occur between 13 and 15yrs. Relationship building and counseling are the essential components of this visit. A pelvic examination is usually not necessary unless medically indicated after pertinent information is ascertained.

Certainly, there are many reasons to see the gynecologist prior to age 21. For instance, heavy periods that cause missed time from school and/or extracurricular activities, significant anemia from irregular menstruation, debilitating menstrual cramps that are unrelieved by over the counter medications, genital irritations, contraception and referral by your Pediatrician, to name a few. Another situation may be a visit scheduled by a single dad with young daughters, just to begin the conversation.

For the mature women, the annual visit usually encompasses recommendations regarding family planning, healthy diet and exercise guidelines, immunizations, testing for sexually transmitted infections, osteoporosis prevention, menopause counseling and referrals for colorectal screening and mammograms. Furthermore, most women know that the annual exam is a private setting to discuss the most personal issues involving their relationships and sexuality if so desired.
In our office, we encourage our patients to bring their daughters to the annual exams. In this way, they can observe and witness that their mothers are not tortured in the process and that our office affords a comfortable, non-clinical environment.

For those women who have been having their annuals but realize that time has passed in the blink of an eye, and are now several months or years overdue, embarrassment and hesitation should be farthest from your mind. Your healthcare provider only wants the best for you and usually will not scold you, but will welcome you back with open arms.

I find that most women are immersed in caring for the entire family and pencil themselves in at the very bottom of the to-do list unless a problem arises. In that same light, parents should accept medical recommendations as if the conversation were about their children. In that way, they are more likely to remain up to date with their own care.
As of March 2012, new recommendations on cervical cancer screening were published by the American Cancer Society and the United States Preventative Task Force. Recommendations from the American Congress of Obstetricians and Gynecologists soon followed and were released in September 2013. The current recommendations are: for women between the ages 21-29 years, Pap smear should occur every 3 years; for women 30-65 years, Pap may be obtained alone every 3 years or if combined with HPV testing, it is recommended every 5 years; for women who are over 65 years, no screening is recommended, even if you have a new partner unless you have a history of moderate or severe cervical dysplasia.

 

If you had a hysterectomy, you may still benefit from cervical cancer screening. This recommendation will be based on the indication for your hysterectomy, whether you still have your cervix and if you had a history of moderate or severe dysplasia. The high-risk patient may need closer follow-up. Women who are immune-compromised, have a history of cervical cancer, or were previously exposed to the drug diethylstilbestrol (DES) are examples of high risk patients.

Remember, these are recommendations and may not be appropriate in all situations. Make your appointment today and discuss your personalized plan with your physician.