First Visit to the Gynecologist? Here’s What You Should Know
Firsts in life can be scary.
Whether it’s your first day at school, first time riding a bike, first sleep over away from home, or first time driving a car, fear of the unknown can make both kids and their parents more than a little uneasy.
Seeing a gynecologist for the first time is another milestone moment that can cause anxiety for new patients.
To demystify the experience, calm nerves and help you prepare for the appointment, we asked South Shore Health OB/GYN Kristin E. Gold, MD to explain what teens and their parents can expect during that first gynecologic visit.
At what age do you recommend patients first go to the gynecologist?
The American College of Obstetricians and Gynecologists (ACOG) recommends adolescents see a gynecologist for the first time between ages 13 and 15.
With that said, I think there are some young women who could wait longer if they felt more comfortable coming at an older age and had no gynecological complaints.
What is the goal of this first visit and what are some of the concerns you address with patients?
Part of the goal is to make patients comfortable coming to a gynecologist and comfortable with us as providers.
I find the biggest anxiety young women have when coming to the gynecologist is that they may require a pelvic exam. Since the recommendations regarding timing of initiation of Pap smear (a test for cancerous and precancerous cells on the cervix) screening has changed, this allows us to defer routine gynecological pelvic exams until age 21, if there are no other complaints that warrant an exam.
Issues we discuss with patients include menstrual management, contraception, human papillomavirus (HPV) vaccination and screening for sexually transmitted infections (STIs).
A visit with a gynecologist is a chance for the patient to have an open discussion on these topics, talk about treatments for period issues and get an understanding of what’s normal and what’s not. It is also an opportunity for providers to let patients know that we deal with these issues and they can come to us with their concerns going forward.
What exams, tests or vaccines can patients expect during their first visit to a gynecologist?
Based on a patient’s concerns, we offer screening for STIs including gonorrhea and chlamydia.
We also can provide the Gardasil vaccine protecting against HPV, the most common sexually transmitted infection, which can cause certain kinds of cancer for both females and males.
HPV vaccination is recommended by age 11 or 12, and often patients get the shots from their pediatrician before they see a gynecologist.
Still, there are many teens and even adults (the FDA recently recommended the vaccine for women up to age 45) that haven’t had the vaccine. In fact, only about 50 percent of adolescents have completed the Gardasil series.
Patients can be nervous about seeing a gynecologist for the first time. How do you allay their fears and make them more comfortable?
It’s important to make sure the patient knows that they are in charge of everything that goes on and that I won’t do anything that they aren’t comfortable with me doing. They can bring a friend, their sister or their mom if they like.
I do try to carve out time to specifically talk to the patient alone and give them a safe space to discuss any concerns they have and to answer their questions.
While I offer patients screening for STIs, I don’t typically do a full gynecologic exam at a first appointment, unless the patient has a complaint or problem requiring it. Also, if an exam is recommended it is up to the patient if they feel comfortable proceeding with that recommendation, they can decline any exam or test – they are in control.
If I anticipate a patient will need a pelvic exam at a future appointment in the next year, I make sure I go over it with them during an earlier visit so they’re prepared. I show them the speculum and other equipment, explain the process and counsel them about what to expect for the exam. That way it’s much less scary to them.
Fear of the unknown or not knowing what’s going to happen next is the worst part for most people. I tell patients what’s happening next so there are no surprises.
Beyond reproductive health, what are other common topics you cover with young patients?
Safe sex, substance (alcohol and drug) use, bodily autonomy, anatomy and sexual function and gender identity are some of the other topics addressed.
Patients need to know we are comfortable talking about all of these issues, that it’s a safe place to discuss them, and to access additional resources if needed.
We also screen patients for mood issues such as anxiety or depression which is very common in that age group.
Contraception is another important discussion I have with patients. At a time in their lives when adolescents are stepping away from family and finding themselves, this is an opportunity to inform patients what they can do to protect themselves from disease or unwanted pregnancy.
Is the information minor patients share with their gynecologist kept confidential?
Legally speaking I don’t have to share information about contraceptive counseling or STI screening with a patient’s parents, but confidentiality is complicated with electronic medical records and billing.
Parents with access to the patient’s MyChart account can log in and see my notes and will get a bill if the patient is covered under their health insurance.
There is a way to block or omit the notes so they cannot be seen over the MyChart system, but the notes do remain in the medical system’s health records. Another option is to have the patient transition the MyChart account over to themselves with their own login information to keep their records private.
We strive to keep counseling confidential but there can be challenges with an online health portal -- for patients and parents.
How would you describe your approach to patient care?
I see it as a partnership where shared decision making is important. I’m here to listen and to give patients information and recommendations -- not to judge them.
I want to provide a safe place for patients to come and discuss any concerns, and to empower them to make informed decisions about their health.