Q: I am a mother of a sexually active teenager. When is the right time for my daughter to schedule her first OB/GYN appointment?
A: Teenagers who are sexually active should be seen for a variety of concerns by a physician or provider. This sometimes seems to the health care providers as if we are playing catch-up as ideally these issues would have been addressed before the teen begins sexual activity, but none the less, we are delighted they are coming to see us!
First, we want to address pregnancy prevention. Teen pregnancy is a serious matter for teens and their families, both boys and girls. The ramifications include increased likelihood of poverty, reduced educational achievement for teen mothers and their offspring, poorer health outcomes for children born of teen mothers and increased interaction with the criminal justice system and child welfare agencies. This is not a judgmental statement on my part, but simply the analysis of national data collection. Therefore, contraception is a very important topic for this visit. There are many options for teens today as well as differences in risks, benefits and effectiveness to the various options that need to be discussed to find the best option for the teen, her partner and family.
Second, the concern over sexually transmitted infections; their prevention, testing and treatment must be addressed. Today we have great testing options including urine testing for gonorrhea and chlamydia. This makes it much less threatening for teens to be evaluated for these infections, which may have devastating consequences to their future fertility and general health. We have effective safe treatment options for other infections such as Herpes, HPV, HIV. It is very important for teens to understand and embrace their personal responsibility to protect themselves with condoms.
Third, we want to discuss issues such as HPV immunization if the series has not already completed. This is an amazing immunization that is effective against a virus that is implicated in cancer cell formation. This is not just for girls, as head and neck cancers in men also contain HPV so the boys should also be vaccinated.
Fourth, we want to discuss things like personal safety, violence in relationships, sexual assault, and alcohol and drug use. These certainly are not always covered in an initial visit, but as the teen establishes a relationship with their provider, these are subjects that can be addressed in a caring, nonjudgmental way. Binge drinking and prescription drug abuse is a problem among our teens today. We also sometimes discuss the laws of our state to be sure teens know that intercourse in the State of Wisconsin is against the law until age 18. This can have serious consequences for teens and their partners.
In summary, there is a lot to discuss. We don’t often need to do pelvic exams in young women now as pap smears are not recommended until age 21 and we are able to do STD testing with urine. The exam part of the visit, quite honestly is the least important part, but the talking and sharing of information is the most useful.
By Suzanne C. Swanson MD, pediatric gynecologist, ThedaCare Physicians-Pediatrics in Neenah and Appleton.