When to visit the Gyn
The American College of Obstetricians and Gynecologists recommends that girls schedule their first gynecological appointment between the ages of 13 and 15.
Dr. Nicolle Bougas of Women Ob/Gyn in Annapolis usually sees teens for an initial visit between 16 and 18. While seeing any new doctor can be intimidating, Bougas said a first consultation doesn’t have to be nerve-wracking for a teen—or her parents.
“Unless there is something wrong—pain, discomfort or excessive bleeding—that first visit doesn’t usually require an internal exam,” explains Bougas.
Instead, she spends quite a bit of time talking with teens about their anatomy, what’s “normal” for their age or body, and educating them about issues like diet and reproductive health. She will follow that with a breast exam and a brief, external gynecological exam.
“There is so much misinformation out there,” says Bougas. “I have 20-year-olds who come in for the first time and don’t understand their bodies. I’d prefer to see them at a younger age, if only to help educate them.”
Bougas says sessions with her patients are private, which allows teens to open up about issues they may be embarrassed or fearful to mention to their parents.
Many pediatricians, such as Gage, are also trained to perform pelvic exams, but she rarely does. She is, however, called upon to help girls understand their menstrual cycles and screen and treat sexually transmitted diseases. Those treatments are confidential, and are often based on information gleaned when parents are out of the room.
“I am amazed at how many teens will straight up tell me that they are sexually active or that they have tried marijuana,” Gage says. “This gives me the opportunity to counsel about unsafe activities, talk about when it’s not safe, and how to make it safe. I also know I need to watch these kids a little closer.”
Parents who press their teens’ doctors for private information won’t generally get it. Gage and Bougas say they only pass along details about minor patients when the child is at “imminent risk,” such as when a child is having thoughts about harming himself or others.
“If there are other activities that are concerning, I encourage them to tell the parent and will offer to help them tell the parent, but I do not force disclosure,” says Gage.
That doesn’t mean parents are without their own tools.
Gage offers parents warning signs they can watch for to thwart unhealthy behaviors. For instance, a withdrawal from the family combined with falling grades and new friends the parents don’t approve of may indicate the child is involved in alcohol or drug abuse. Likewise, a loss of 10 or more pounds in one to two months may be a sign of a budding eating disorder.
Both are topics parents can raise with a child’s practitioner, who can then work with the patient to address related behaviors. She can also refer children and their parents to a range of specialists, some who cater to teen patients.
Treating acne
One doctor that many teens will become familiar with is the dermatologist.
Experts say acne, the bane of roughly 20 million teenagers, can be emotionally devastating for kids who place a good bit of emphasis on appearance. Studies show that acne sufferers can experience decreased self-esteem, problems with body image and even depression.
“The ultimate goal of acne therapy is to help clear up the pimples you have and to prevent the occurrence of future breakouts,” says Dr. Larry Green, an assistant professor of Dermatology at the George Washington University School of Medicine who practices in Washington, D.C. and Rockville. “In general, if your child is not responding to home remedies and over-the-counter treatments after one month, it’s a good idea to see a dermatologist. Dermatologists have a greater chance for long-term success if treatment is started sooner rather than later.”
Dermatologists are also important because they can speak to teens about skin cancer prevention, including appropriate use of sunscreen, limiting exposure and avoiding tanning beds. An American Academy of Pediatrics survey found that 24 percent of white children ages 13 to 19 had used a tanning facility at least once, although the intensity of radiation produced by some tanning units can be 15 times higher than the midday sun.
The American Academy of Dermatology now recommends full-body skin checks be included in an annual physical starting at age 20 because melanoma is the second leading type of cancer among women in their 20s.
As teens get older and their medical team grows to include various specialists—whether dermatologists, gynecologists or even orthopedists to treat sports maladies—it’s important to keep a medical “home,” doctors agree. That’s been key for the Malones, whose family also includes a 7-year-old daughter and a 5-year-old son.
“I think after several years with a family, you get to know the dynamics of a family that can influence heath issues and mental health issues,” Gage agrees. “As kids transition to adult responsibilities—jobs, kids, marriage—then it’s time to transition.”
