Family Matters

Teen Girls Should Stick With Pediatrician for Pelvic Exam

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Adolescence is awkward, no doubt, and there are few places where that’s as obvious as the pediatrician’s office.

Many are the times I’ve seen a sullen teen skulk into a waiting room brimming with toddler push toys and Dr. Seuss books to await the doc. Dum Dum lollipops and Barbie stickers no longer hold appeal; waiting for their name to be called alongside newborn infants and shrieking preschoolers feels vaguely disconcerting and maybe even a little embarrassing. I remember being that kid, stuck in that hazy no-man’s-land between baby doctor and primary care physician. (More on Why Being Poked and Prodded Is a Good Thing)

Girls have it even worse. When it comes time for the inaugural and inevitable pelvic exam, who should do the honors?

A new paper in Pediatrics recommends that teen girls are probably best off sticking with the doctor who’s been seeing them since they were in diapers. Pediatricians are more than equipped to deal with issues surrounding puberty, menstrual disorders and contraception, state the authors, Paula Braverman and Lesley Breech, who wrote the report as members of the American Academy of Pediatrics’ (AAP) Committee on Adolescence.

What’s more, most teens don’t actually need a full pelvic exam, complete with speculum. With new ways of testing for sexually transmitted diseases, for example, there are fewer reasons to do Pap smears, which are a major reason for pelvic exams. Recently, the American Congress of Obstetricians and Gynecologists (ACOG) updated its Pap guidelines; in most cases, a woman doesn’t need an initial Pap until her 21st birthday.

It’s not that the American Academy of Pediatrics is trying to put gynecologists out of business. In certain situations — a mass, for example, or an abnormal Pap smear or pregnancy — referral is warranted. (More on Profiling Student Cheaters: Are They Psychopaths?)

But in most situations, say the authors, pediatricians can successfully complete a pelvic exam “when conducted without pressure and approached as a normal part of routine young women’s health care.”

“A pediatrician is someone who in general has followed a patient since birth,” says Braverman, a pediatrician with a specialty in adolescent medicine at Cincinatti Children’s Hospital Medical Center. “Rather than sending them to someone they don’t know, a patient may be more comfortable having the exam done by someone they know in a familiar clinical setting.”

What do you think your teenage daughter would prefer?

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