“Given the high pregnancy and STD rates among adolescent girls in the US compared with other developed countries, we continue to encourage parents to bring their daughters to an ob-gyn for their first visit earlier rather than later,” said Diane F. Merritt, MD, chair of the Committee on Adolescent Health Care. “As ob-gyns, this visit gives us a golden opportunity to build trust in the physician-patient relationship and to counsel both adolescents and their parents about healthy behaviors.” Dr. Merritt stressed that the primary focus of the adolescent’s first ob-gyn visit is to provide education and guidance and does not include a pelvic exam or a speculum exam unless it’s indicated.
The scope of an adolescent’s first visit with an ob-gyn will depend on her unique needs, taking into consideration her physical and emotional development, medical history, and the level of care she is receiving from other health care providers. Puberty, normal menstruation, healthy eating habits, sexually transmitted diseases and pregnancy prevention, sexual orientation and gender identity, substance use and abuse, acquaintance rape prevention, substance abuse, and scheduling routine gynecologic visits are all important issues that may be addressed at this first visit.
During adolescence, teen girls often transition from a pediatric to a gynecologic care setting. Depending on training and experience, ob-gyns, pediatricians, family medicine physicians, and adolescent medicine specialists may or may not provide both reproductive care and general preventive care to teens. If they do, it may be difficult to provide the full range of both general and reproductive care in one office visit. “In these instances, a team approach is needed in which one physician offers general preventive care and an ob-gyn provides the necessary reproductive preventive health care,” said Dr. Merritt. “And both annual visits should be covered by insurance to ensure teens are getting comprehensive preventive care.”
In addition to the possible need for two annual well-child visits, the Committee Opinion discusses the recently-changed recommendation that adolescents and young women don’t need their first Pap test until age 21. The previous recommendation was that cervical screening begin three years after first sexual intercourse or by age 21, whichever occurred first. The American College of Obstetricians and Gynecologists maintains its recommendation that adolescent girls have their first visit with an ob-gyn between the ages of 13 and 15 to help set the stage for optimal reproductive health in the years ahead.
“We encourage parents and guardians to look at this initial visit as a prime opportunity for young girls to meet with us so that we may help alleviate any fears, dispel myths, and really start off on the right foot in creating a healthy doctor-patient relationship,” said Richard N. Waldman, MD, president of The American College of Obstetricians and Gynecologists. “This will be the beginning of a lifetime of care.”
Committee Opinion #460, “The Initial Reproductive Visit,” is published in the July 2010 issue of Obstetrics & Gynecology.
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The American College of Obstetricians and Gynecologists is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 53,000 members, The American College of Obstetricians and Gynecologists strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.