First visit to the gynecologist

The first visit to the gynecologist is a difficult time for both the young patient and her parents. However, according to the recommendations of the Polish Society of Gynecologists and Obstetricians, it shouldn't be delayed. The first visit should take place between the ages of 12 and 15, usually when the teenager has already had her first period.

When should you make an appointment with a gynecologist?

Should you make an appointment with your daughter to see a gynecologist if there are no noticeable symptoms and the baby appears to be developing normally? We asked gynecologist Dr. Urszula Gąsowska-Giszczak.

"If everything is normal and the body isn't sending any alarming signals, it's recommended that a child's first visit to the gynecologist take place after their first period, or at the latest before they start having sex. This is a time in a girl's life when she has many questions about the structure of the external genitalia, the appearance of her breasts, and proper hygiene, especially during her period. The first visit to the gynecologist is also an opportunity to encourage the patient to keep a menstrual calendar, marking the first day of each period and the duration of bleeding, as this habit is very helpful in diagnosing and treating various gynecological problems, both in young and mature patients."

Don't delay consulting a gynecologist if you experience disturbing reproductive symptoms. In such situations, you should see a specialist immediately.

When should you not wait to make an appointment with a gynecologist for a teenager?

– You should see a gynecologist as soon as possible if you experience lower abdominal pain, which may suggest developmental defects or other anatomical changes in the reproductive organs, most often functional ovarian cysts, but also cancerous lesions, which are fortunately rare in this age group. Inflammation of the vulva or vagina may also be a cause of the pain. Menstrual irregularities or painful periods are also reasons for girls to visit a gynecologist.

Menstrual disorders in girls

– Problems such as irregular cycles are very common in girls. If they persist beyond two years after their first period, the cause should be identified.

Primary amenorrhea is the absence of pubertal signs by age 13, or the absence of menstruation by age 15, with the presence of pubertal signs, such as a pronounced female figure, normal breast development, and hair growth. Causes of amenorrhea include uterine malformations, even the absence of the uterus and vagina, hymenal atresia, vaginal atresia, or cervical atresia, genetic syndromes (e.g., Turner syndrome), hormonal imbalances, eating disorders, or intense sports training. There are many causes, so a visit to a gynecologist with a teenage girl can be invaluable.

Another significant gynecological problem in children, often hindering their daily activities, is adolescent bleeding. It is usually a functional disorder and occurs as a result of uneven shedding of the endometrium during anovulatory cycles. It is rarely the first symptom of congenital bleeding disorders. It manifests as heavy and prolonged bleeding, usually at irregular intervals, often leading to anemia, and such a condition absolutely requires treatment. It is essential to restore normal menstrual cycles and treat the girl's anemia; in extreme cases, blood transfusions are necessary.

Very painful periods should not be ignored, as they may be a symptom of endometriosis, which also occurs in teenagers.

Do older teenagers who have started sexual intercourse or are planning to do so in the near future also come for a gynecological visit?

– Of course. In such cases, the purpose of a gynecologist visit is usually to use contraception. Prescribing contraceptives requires the consent of a legal guardian if the patient is under 18. Contraceptive counseling involves conducting a thorough interview with the teenager and her guardian to rule out contraindications to hormonal contraception and selecting the form of contraception that best suits the patient's lifestyle.

In patients who have been sexually active for more than a year, it is recommended to take a Pap smear from the cervix, preferably with an assessment of the presence of the HPV virus.

If the patient reports symptoms of a genital tract infection or the gynecologist notices such symptoms during the examination, it is necessary to take a bacteriological swab and, in justified cases, test for sexually transmitted diseases and start appropriate treatment.

An extremely important part of a visit to a teenager planning to start having sex or after sexual initiation is to make her aware that contraception does not protect against sexually transmitted diseases and that she also needs to use condoms consistently.

What does an examination at a pediatric gynecologist look like and how do you prepare a girl for a gynecological visit?

"The most important thing is trust and a good relationship between a daughter and her mother. A teenager who is "forced" to see a gynecologist for an appointment that concerns very intimate matters for the young woman often refuses to discuss her problems and then avoids gynecological visits for many years. It's important that the mother doesn't describe to the girl what an adult gynecologist visit looks like, because a teenager's visit often looks different. A thorough medical history is a crucial part of the visit; girls don't always require a gynecological examination; often, an examination of the external genitalia or an abdominal ultrasound and hormonal tests, such as a simple blood draw, are sufficient."

Thank you for the interview.