Rachel Pasquesi, MD: I'm Dr. Rachel Pasquesi, a physician that specializes in Obstetrics and Gynecology with St. Louis Children's Hospital, and I'm a Mom Doc.

Melanie Cole, MS (Host): Hey, welcome to MomDocs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole. And you know, the first visit to the gynecologist is really a crucial moment for your daughter's overall health. And it paves the way for a lifetime of well being and understanding what those visits are all about. Dr. Pasquesi, thank you so much for joining us today. When do we take our daughter to the gynecologist for the first time? Do we do it before her first period? After? Around the same time? What do we do?

Rachel Pasquesi, MD: There are many reasons why you might want to take your daughter to the gynecologist. If your daughter is having issues with her period, if they're really heavy or if they're really painful, that might be a reason that you need to take them to an OBGYN as opposed to just a pediatrician at that time.

If they're thinking about becoming sexually active or if they are sexually active, or if they're having any other vaginal issues, discharge, and odor, things like that, that they want addressed, those would be other reasons as well too. If for some reason none of those things come up, then the first visit somebody should have with their OBGYN is at age 21.

Host: Okay. So how do we choose that OBGYN for our child? I mean, in my situation, I was delivered at a practice. I started seeing my own doctor at that same practice. My daughter was delivered there and now she's seeing my OBGYN. So it's multi generational. If someone doesn't have their own, or maybe their own is retiring, how do we pick one for our child?

Rachel Pasquesi, MD: Some people might feel more comfortable with a male or a female, so that might be a place to start. Otherwise, some OBGYNs have an interest in adolescence or gynecology. Some might have an interest in talking about contraception more or period problems, so that might be another reason you choose one or another.

Most OB GYNs feel very comfortable seeing teenagers though, and so therefore anyone should be able to talk about contraception, painful periods, other issues as I've kind of specifically mentioned, and everybody performs those well woman exams, which is the one you should go starting at age 21.

Host: Well, here's the big question, Dr. Pasquesi, and I know what I did. So for all you other parents out there, do we attend that first appointment with our teen? Should we go into the appointment? My teen said, yes, come in with me. So I got to go in and watch her have her first breast exam. And I cried, but not everybody wants their parents in there.

Do we go in to hear what the doctor says, or is it really important that they have that autonomy?

Rachel Pasquesi, MD: I think that's a great conversation to have with your teenager before the appointment. If you guys choose that mom will join you for that appointment, that can be something in which you discuss with your OBGYN when you see them. Having a period of time in which both mom and the teenager are in the room, but then also having a time during the visit in which your teenager is able to talk with the doctor without you present might be a beneficial thing as well.

Or if you guys decide before the visit that she's just wanting to go by herself, that's a very reasonable option as well, too.

Host: Well, it certainly is a good discussion to have, and they do need that private time to talk with their doctor about things they might be uncomfortable about talking with their parents or something that they maybe don't want their parents to know about. Something that it's a doctor patient relationship, and it's important to really start that relationship young so that fosters into a place of trust.

Now, during that first gynecologic appointment, what do you ask about? I mean, you don't do PAP smears right away, right? So tell us about that first appointment.

Rachel Pasquesi, MD: You're right. PAP smears aren't something that would start until 21. So if a teenager is coming before that time, usually there is a specific reason why they're coming. So obviously we would be talking about that type, to answer those questions about whatever they're coming for. So if they're coming for painful periods, asking some more questions about that, what their length is, how their flow is.

Those types of things, and then talking about treatment options as well, too. If they want to know more about their body, talking with them and answering any questions about that. Or if they're thinking about sexual activity, what they can do to prepare for it, how to help prevent pregnancy, those types of things. So there's lots of things that can be addressed, but it's mostly going to be tailored to a reason why they're coming in to see me in the first place.

Host: Dr. Pasquesi, are you seeing more teens and younger people coming in to discuss birth control with you for reasons other than birth control, for acne or painful periods or to regulate? Are you seeing that more often now?

Rachel Pasquesi, MD: Absolutely. As you had mentioned, there's so many other reasons why somebody might be coming in to discuss birth control or hormonal medications that are not just for pregnancy prevention. So, painful periods, heavy flows, acne issues, they're having irregular periods; those types of things are other reasons we would discuss all of the various options for birth control medications and find one that fits best for them.

Host: Now talk about the HPV vaccine because we're typically seeing our kids getting these through their pediatrician, but if they don't, is this something that you would discuss with them? Because as we start getting our pap smears in our twenties, this is, I mean, such an amazing tool to help prevent cervical cancer.

Rachel Pasquesi, MD: Absolutely. The HPV vaccine is recommended for everybody, starting in the teenage years with the pediatrician, but if they haven't received that vaccine, trying to recommend it and go through why it's being used for people when they're first coming seeing me is really important. So the HPV vaccine helps to prevent the spread of that virus because that virus can cause cervical cancer in the future. So if somebody hasn't gotten it by the time they're coming to see me for an appointment, making sure that they know it's a really important one and then helping to administer that to them is part of my job.

Host: And now speak to parents a minute about communication because as a gynecologist and obstetrician, you're talking to our teens about STI screening and prevention, about birth control, about hormones, about mood changes, about all of these questions that young women have. When you're speaking to parents, how do you want us to communicate with our teens to make them less nervous to come see you, to talk about these difficult topics like STI screening and prevention? Give us some words that you use when you're talking to mom and say, these are the things I want you to work on communicating with your child.

Rachel Pasquesi, MD: I think one of the biggest reasons that teenagers are nervous to come see an OBGYN is they think they might need an exam. And so I think having a mom talk to their daughter about what to expect during the exam and going through some of the questions that might get asked might help put them at ease.

So if somebody's coming in for birth control because they're thinking about being sexually active; that's not always something that requires an exam, so having that reassurance before the appointment might help the patient or teenager relax a little bit. Moms can start talking with their daughters about what their periods are like using words such as how long are their periods, how many days do they have bleeding, how many days are in between their periods, those types of things. Because those are the types of questions I ask. Also telling them that I might ask them if they're somebody that's sexually active at all, and if they have any questions about sexual activity that they want to ask me. I'm a great person to bring it up to, even if they don't feel comfortable talking to their mom about it.

Host: What great advice you just gave. You gave parents what you are asking these teens so that parents can help prepare their children for this visit. Because like we said, it's a lifelong relationship and you're with your gynecologist from your teens onward to post menopause. And so it is something that's so important.

I'd like you to wrap up, Dr. Pasquesi, with your best advice to parents and teens about that first visit with their gynecologist and what you really want them to know.

Rachel Pasquesi, MD: The first visit with a gynecologist can definitely be a little nerve wracking. So talking about what makes you nervous about it with your physician and the expectations for the visit at the start of it might really help put somebody's mind at ease. So bringing that up with them, I think is very important.

Some of the topics we discuss might feel a little bit awkward, but trying to be as open and honest with your physician is really what's going to help them figure out what's the next best steps in treatment or in terms of options for you. So trying to be open and honest and ask them the questions that are on your mind is really going to help you in the long run best care for yourself too.

Host: Thank you so much, Dr. Pasquesi, for joining us. That was great information. Very informative. And listeners share these shows with your teens because you're learning from the experts at St. Louis Children's Hospital. And this is one of those shows they can listen to and hear from Dr. Pasquesi about what to expect at that first visit.

That concludes another episode of MomDocs with St. Louis Children's Hospital. For more advice and articles, check out the MomDocs website at childrensmd.org. I'm Melanie Cole. Thanks so much for joining us today.