I am convinced most women view visiting their gynecologist somewhat like having a root canal…with no clothes on! This is a completely rational reaction as no “normal” woman relishes the necessary but unappreciated ritual. You arrive on time and two hours later Nurse Ratchet puts you in a room cold enough to hang meat and then tells you to disrobe and put on a napkin. By the time the doctor arrives you are so cold your skin has changed to an eerie shade of light blue: you look like a Smurf in a togo. The doc asks you to scoot down…then scoot down some more and well, you know the rest. Actually the whole thing takes only a few minutes and is not as bad as, say, an
IRS audit, but I am a male so what do I know! I understand it is different on your side of the speculum.
So given this exam is something you relish passing on to your beloved daughters, much as you would Malaria or Scabies, when should a young woman be exposed to this sisterhood right of passage? The American College of Obstetricians and Gynecologists recommends a young woman’s first visit to the gynecologist be between the ages of 13-15. Before you and she run screaming from the room, let me reassure you that those guidelines are rarely followed and, in my opinion, somewhat misguided. I understand that Ivory Tower practitioners denote this visit as a “preventive” ,but I don’t know many 13 year olds who are comfortable talking herpes and contraception. The College clarifies that no exam is needed at this impressionable age, but that then raises the question of its true necessity. Unfortunately there are those folks who need a thorough and graphic discussion of various reproductive health topics at this age, as 14% of 15- year olds and 75% of 19- year olds admit to having at least one episode of intercourse.
I know if I had told my daughters at thirteen they were headed to the gynecologist, they would have booked a slow boat to Australia. Now, to be certain, anytime a young woman is having issues with her period, needs contraception, or specifically has questions about her health she should have unlimited access to a compassionate, non intimidating physician, but for most that will come a bit later. The same national organization recommends starting Pap smears and exams at 21, and I think this is more realistic. I certainly am not naive enough to assume women under the age of 21 are not having reproductive or gynecological issues, witness the unplanned pregnancy rate in this country, yet if a young woman is not sexually active, has no period issues, and has no specific gynecological concerns, I think 21 is a reasonable time to initiate gyn visits.
Much of the anxiety in both mothers and daughters regarding gynecological health revolves around knowing what is normal and what is not. There are definitely genetic predispositions that would make mom’s and daughter’s experiences somewhat similar, but that is not necessarily the case. For example, the median age for the onset of menses is 12.4. That means there will be plenty of young women who start cycles at 11 and also some who don’t start until 14. In general, a girl needs to be evaluated if she has not begun developing breast buds by age 13 or hasn’t started her cycle by age 15. The average time between cycles for young women is 32 days, but that can vary wildly, especially in the first few years of menstruation. A flow lasting longer than seven days or requiring more than 3-6 pads or tampons a day is considered excessive. You can see this is somewhat subjective, so each woman’s situation should be individually assessed and analyzed.
There a number of common scenarios that change both the cycle amount and regularity, especially during the teen years. Two frequent influences are stress and weight change. Worrying about midterms, making cheerleading, or the soccer playoffs can wreak havoc on cycle regularity. Any change in weight (usually by at least 5-10 lbs) can also affect regularity and amount. Vigorous exercise (take note you cross country runners, gymnasts, and swimmers) can cause what is known as exercise induced amenorrhea, or lack of cycles. Many a pregnancy test has anxiously been checked by those whose unending athleticism led to missing a period. The good news is that most of these irregularities resolve with stabilization in weight or a reduction in stress. A more rare but serious cause of irregular cycles is eating disorders like anorexia and bulimia.
The goal of an effective young women’s health program is to provide education, advice, counseling, and compassionate care. The age at which you begin your interaction with the system is largely dependent on your individual needs and health history.