Amanda Wilde (Host): A teenager's first OB GYN
appointment is a milestone and possibly a bit nerve-wracking as well. We'll
demystify the process and talk about what to expect at that first OB GYN visit
with Dr. Carla Sandy, a Kaiser Permanente physician specializing in Obstetrics
and Gynecology who sees patients at Holy Cross Health.

 This is your Best
Life Podcast, Women's Health from Holy Cross Health. I'm Amanda Wilde. Dr.
Sandy, thank you for being here today.

Carla Sandy, MD: Thank you for having me.

Host: Well, when should teens or pre-teens start
visiting the gynecologist?

Carla Sandy, MD: So there is no specific age that we
necessarily recommend a teen or a preteen come in to see a gynecologist. It's
definitely individualized to the teen or the preteen and the, the pediatrician
or the primary care physician is usually the first place where those conversations
will occur to determine if visiting an obstetrician and gynecologist, is the
next step in healthcare.

We do recommend, however, that if an adolescent, a teen or
preteen has not seen an OB GYN or a Obstetrician and Gynecologist by the age of
21, they do come in at 21 for a visit.

Host: Does it make sense to come when you're at that
point in your development in puberty, then?

Carla Sandy, MD: So it really just depends. Sometimes
as adolescents start going through the process of puberty, there can be things that
may occur. Menstrual disorders, pain that an obstetrician and gynecologist can
help guide them through. And if an adolescent is going through puberty and not
having those types of problems, it's not necessarily necessary to come in to
see an OB GYN.

Host: Got it. So how to prepare for that first visit.

Carla Sandy, MD: This actually works for any visit to
a healthcare provider or a physician. But I recommend writing down any
questions that you have about your body or sexuality or, any of the changes that
your body's going through as you go through puberty. In the past, I've had
questions like, you know, is it normal if my period doesn't come every month?
I've noticed some changes, maybe some vaginal discharge. Is that okay?
Questions about birth control and contraception and, you know, there's a lot
out there on social media and our preteens and adolescents consume that social
media, and there's a lot of misinformation out there.

So if you see a TikTok or a reel or something and you're
like I really want to know, is that accurate? Write that down. Those are great
questions to bring in. There's nothing, nothing that you can ask an OB GYN that
is embarrassing. So please come in with your questions and we will give you
accurate, honest, and timely information.

Host: Well, if your patient is a minor, how are
privacy and confidentiality handled? Because maybe some of those questions
might feel very intimate and personal.

Carla Sandy, MD: Yes. They are very personal. And one
of the things we do when someone is a minor, you know, their guardian, or
caregiver will come with them to the visit and they are usually with them in
the room at the initial part of the visit and will spend that time to establish
why the adolescent is there for care.

 And then we ask the
guardian to please excuse themselves so that we can have that conversation with
the adolescent, with the teenager to make sure we ask the questions that
frankly no teenager is comfortable answering in front of their guardian. And
then there's certain aspects of care such as contraception, sexually
transmitted infection screening, prenatal care that depending on your
jurisdiction, the age of consent is actually lower, than it is for being an
adult.

So that does vary from jurisdiction to jurisdiction, and it
is something that your healthcare provider or your physician can work through,
can talk through with you.

Host: Okay. So you will get that information as part
of the appointment, and we're talking about information and questions and
talking. What exams will you perform at that first appointment?

Carla Sandy, MD: So in general, at a very first
visit, there may not necessarily be an exam. A lot of times it is a
conversation, trying to understand are there challenges, are there problems?
And then, talking to the young person about, okay, here are some solutions.
Here's some testing that may be recommended. And so that initial visit, there
may not even be an exam at all. And then sometimes there does need to be an
exam. But what's really important to understand is that only what you're
comfortable with is done. And consent and consent means we ask you permission
before we do an exam.

Is this okay? This is what I'm planning to do, is this okay?
And once consent is obtained, we'll then proceed with an exam. Now they're
general things that happen at the OB GYN, just like at the pediatrician or at a
primary care physician's office. So, we check height, weight. We do blood
pressure check pulse and temperature, so all of those things do happen. And
then, sometimes we'll do an abdominal exam like externally, just to see if we
feel anything. And sometimes we'll just do simply an external genital exam to
look and just assess for normal development and growth.

Occasionally an internal pelvic exam may be necessary. And
again, that definitely we talk you through that to make sure that you're
comfortable with what is being done.

Host: Do you also recommend vaccinations at this
point? I know there are some in the OB GYN world, but can you talk about what
they are and what they protect?

Carla Sandy, MD: Yes, and we definitely do recommend
vaccinations. You know, vaccinations are a really important part of
preventative healthcare and one of the most important ones that's related to OB
GYN is the HPV vaccine. And that stands for Human Papilloma Virus. This is the
virus that causes the majority of cervical cancer.

And cervical cancer is a cancer that unfortunately it tends
to impact younger women usually under the age of 30. And HPV which causes the
majority of cervical cancer is a sexually transmitted infection. And the HPV
vaccine is incredibly effective in preventing acquisition or getting that
particular virus. In addition to cervical cancer, HPV can also cause certain
types of genital warts. And warts, those are not cancer, but they can be very
disfiguring. You know, they appear kind of on the outside and they don't look
good and nobody wants anything like that. And so that vaccine is particularly
important.

Often we will hear, well I'm not sexually active, so why
would I want to get that? This is definitely a vaccine that you want to get
before any possible exposure to the virus. And so we do recommend that. And
when we see pre-teens or teenagers, we see if they've had it. And we do
recommend that vaccine series. And in addition, there are other vaccines that
are routinely given between the ages of 11 to 18. Things like influenza, which
is commonly called the flu shot, the meningitis vaccine. There is the tetanus
shot and the COVID-19 vaccines of course.

And so if a teenager is not up to date on any of those
vaccines, we do recommend that they get them.

Host: Well, I think now we're armed with information
and with information we can make informed choices. What about the nerves part
of it? How do we ease our nerves about these appointments? How do we ease our
teen's nerves about this first OB GYN appointment?

Carla Sandy, MD: That is a great question and I just
want to reassure any teen or any parent that's listening to this, thinking
about their teen, that it is extremely common to be anxious and just feel
nervous about the visit and that doesn't actually go away when teenagers get
older. Visiting the OB GYN, it tends to produce some anxiety.

So, your OB GYN is often very attuned to this. We'll ask
questions, just to check to see comfort levels and read body language and can
tell when their patients are anxious. But it's also good to just let the doctor
know if you're nervous, like, Hey, this is my first time, I'm a little scared.
I'm not sure what to expect. And they will help to talk to you, to put you at
ease, to make sure we answer any questions prior to an exam. And I know
mentioned this before, but I'm going to talk about it again, consent to be
touched. Consent for exam. At any point, you can say, you know what? I don't
want to proceed or I want to stop right now. That's okay. That's okay. And
sometimes taking a break for a few minutes may be enough. Other times I've had
teens say, I think I'd like to come back another day. However, we can structure
things to make things comfortable, is what we'll do.

Host: Well, thank you Dr. Sandy for unpacking the
process of that first OB GYN appointment and empowering teens in this way as
they become adults.

Carla Sandy, MD: Well, it's been my pleasure and you
know, I just want to help to take away some of the fear around this visit. It
almost is like a rite of passage and I often have that conversation with teens
when they come in. You know, they're like, oh my goodness. I've been
researching and every person I know has told me, what you're going to do. And a
lot of it, it isn't actually what's going to happen. And so just spending that
time talking and going through that, it makes for a very successful visit.

Host: Yeah, and it is a landmark lifecycle event.
It's a good thing.

Carla Sandy, MD: Yeah, for sure.

Host: That was Dr. Carla Sandy, a Kaiser Permanente
physician specializing in Obstetrics and Gynecology who sees patients at Holy
Cross Health. For more information, visit Holy Cross health.org/maternity.
Thank you for listening to Your Best Life Podcast, Women's Health from Holy
Cross Health. Until next time, be well.