Updated guidelines for teen gynecologic care

The American Congress of Obstetricians and Gynecologists in June recommended adolescent girls have their first visit with an ob-gyn between the ages of 13 and 15 to help set the stage for optimal gynecologic health. This visit does not necessarily include an internal pelvic exam. Last month the American Academy of Pediatrics released a policy statement outlining when teenage girls may stay with their pediatrician for routine care. Our guest blogger today, pediatrician Dr. Carly Wilbur, illustrates for us the guidelines.

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Last week, I saw a 14-year-old young lady who suffered painful menstrual cramps. Her mother wanted her to see a gynecologist, but my patient was reluctant. At my office, we have a room that is dedicated to providing gynecologic care, including pelvic exams, that contains a proper exam table with stirrups. The patient, her mother, and I discussed reasons that some adolescents can have their gynecologic health managed in the pediatrician’s office and some teenagers get referred to gynecologists.

Many pediatricians can handle:

Routine/annual gynecological exams, including a Pap test, in sexually active patients
Vaginal/cervical cultures used to diagnose new conditions (some general pediatric offices are even equipped with a microscope to aid in their evaluations)
Acute gynecologic concerns such as vaginal discharge, itching, or a change in menstrual flow

Reasons for a referral to a gynecologist include:

The patient has pelvic pain and needs further evaluation of her ovaries, fallopian tubes, or uterus
Patient and pediatrician have failed to find a birth control pill that is acceptable (too many side effects or unacceptable side effects) and thus require expert opinion of a gynecologist regarding oral contraceptive pills
The patient engages in high-risk sexual activity
Pediatrician does not provide gynecologic services
The patient becomes pregnant

This family opted to have me perform my patient’s first pelvic exam since I was familiar to her and this brought her some comfort.

Carly W. Wilbur, MD, FAAP

Suburban Pediatrics, Inc.

Rainbow Babies and Children’s Hospital

Cleveland, Ohio