Transcription:
Preparing for a First Trip to the Gynecologist

Intro: Another informational resource from UK Healthcare. This is UK HealthCast featuring conversations with our physicians and other healthcare providers.

Caitlin Whyte: Welcome to UK HealthCast from the University of Kentucky healthcare. I'm your host Caly white preparing for that first trip to the gynecologist is a big step in both the child heading to the doctor and the parent's life. So to help make that visit a bit easier. We are talking with Dr. Wendy Jackson. An OB GYN at UK Healthcare is Kentucky Children's Hospital. Doctor, to start us off at what age should a child have their first gynecological exam? And why is it so important to establish this care early?

Wendy Jackson, MD: Well, according to our governing body ACOG, the first gynecologic exam or visit, and we refer to that as the initial reproductive health visit should occur between ages 13 and 15. And the reason why it's so important to establish care is because we want to allow the patient to have that initial reproductive health visits gonna provide sort of preventive healthcare services, educational information, and guidance. And then we'll focus shifting gears onto any problem focused areas or concerns that they have at that time.

Caitlin Whyte: So what can parents and guardians do to help prepare their child for this first visit?

Wendy Jackson, MD: Well, I imagine that the thought of a first gynecologic exam from one of my adolescent patients is somewhat daunting. So parents or guardians can sort of deescalate that fear by sharing some of the basics. They can let the patient know that they're going to the type of doctor that specializes in caring for women. That physician is called a gynecologist and we're actually going to one that specializes in taking care of teenagers. The purpose of the visit on that day is going to be whatever concern the adolescent has or just to establish care. So if any problems arise in the future, you have a doctor that you can see regarding those areas that are concerning to the adolescent and can do so in a safe space where they don't feel overwhelmed.

Caitlin Whyte: And then what would you tell a young person to expect during their first visit to a gynecologist?

Wendy Jackson, MD: Well, the first visit is dependent upon the chief concern of the patient. And for us today, if we're referring to the initial reproductive health visit, then that sort of starts off by collecting a history about sort of when they experience menarchy or periods, we'll collect some history about that. We'll make sure everything is checking out okay. And if they have any other gynecologic concerns, we will address those and then shift gears into preventive care.

Caitlin Whyte: Wonderful. So what are some other topics that are important to discuss during the first visit? I know it's kind of based on why maybe that first visit is happening, but is there anything you kind of always touch on?

Wendy Jackson, MD: Oh, absolutely. For sure. I'm a gynecologist, so I wanna know all about periods, so I will ask them when they had that first period? And actually how often the periods occur? How many days they last and from a quantitative perspective, how many toiletries they require? So I can make sure that they don't have excessive flow. I often ask them about cramping. We refer to that as dysmenorrhea in the gynecologic world. I wanna make sure that they have had their human papillomavirus vaccine.

So we sort of discussed that and what the benefits of the vaccination are and then whether or not they have a need for contraception. And if they are sexually active, are they aware of emergency contraceptive options? Where are they from a mental health perspective? And then of course always reviewing in those who are sexually active, say sex practice.

Caitlin Whyte: Of course, of course. Can you go over just some of the special gynecologic needs of this age group specifically?

Wendy Jackson, MD: Oh my goodness. Of course. Cut me off if my list is too long, let me say but we'll start off with just explaining to the adolescent patient, some basics about confidentiality. And in creating that safe space in the room, they're often fearful to disclose too much information that they feel like a guardian our family member might find out about. So we review confidentiality. It is a vulnerable time for them as they're embarking along pub development and their anatomy is changing.

So I often spend time educating them on their personal anatomy as I'm reviewing the physical exam. If we're doing a GYN exam, explain it to them what normal is becoming comfortable with just using. Language and the appropriate terminology for the different body parts that they have. We often review menstruation facts and really what consists what makes up a normal period, whether or not they have immunization needs.

We talk about substance use. We talk about mental health. We talk about healthy relationships. We talk about physical activity screening for eating disorders can happen. And then of course, I mentioned with the last question, always making time and space for discussions about the need for contraception, as well as infection screening.

Caitlin Whyte: So you mentioned that confidentiality, how can we encourage children to speak openly with their doctor about any questions or concerns they may have? I'm sure it could be kind of almost embarrassing at first for them.

Wendy Jackson, MD: Yes. So I often have them fill out a questionnaire while they're waiting to come back and see me and it sort of delves into different aspects of their life. Everything from education, mental health, nutrition, physical activity. So on and so forth relationships. And when they fill out that questionnaire, I might not always get the truth. If a family member is sitting beside them. So what I will often do in the clinical arena is address whatever concern that the family has, the day that they come in to see me. And then at the end of the visit, we sort of shift gears and I make that transition.

And I just, I'm very relaxed when I let the guardian and the patient know that there comes a time at adolescent visits that we like to pause and allow the adolescent, regardless of how open they are with their family members, to have an opportunity to engage in conversation with me in private. And then I say there are some things we're a little bit uncomfortable asking about in front of people. And this allows my patient that I'm advocating for to have a safe space to discuss those topics. I've not had a single guardian or family member refuse to leave the room.

Caitlin Whyte: Mm-hmm, that's always good to hear. So once we got this first visit down, how often should adolescents return for routine gynecological exams?

Wendy Jackson, MD: Right. So I tell them everything else is checked out. Akay, you know, schedule a follow up visit for one year, I'll see you annually. And then I sort of let them know when things change at those annual exams when they can expect to have a pap smear, that sort of thing. But if they have any concerns prior to that one year, they definitely need to feel comfortable coming back because everyone who is listening to this will know that an adolescent life can change from day to day. One year may be too long. It maybe they need to see me in one month. Maybe they became sexually active two weeks after I saw them for an annual exam. Right. And they need screening or they need contraception. When at that initial reproductive visit, they didn't think they needed that.

Caitlin Whyte: So you mentioned going to a physician who specializes in adolescent gynecology, what are some advantages to finding that kind of provider?

Wendy Jackson, MD: Right. So I think a pediatric adolescent gynecologist is a physician that's well versed in the management of conditions that impact the adolescent gynecologic patient. And it really is not to say that other physicians, other general OB gys can't manage the condition. It's just that the pediatric adolescent gynecologist has specialized training to deliver the care in such a manner. That's adolescent friendly.

Caitlin Whyte: Absolutely. Well, doctor we've covered a lot here. I'm sure some people are feeling at ease with all of the tips you gave us, but is there anything that we haven't addressed? Anything that we missed, that you want parents and their teens to know before heading into this first visit?

Wendy Jackson, MD: Oh, absolutely. Just a couple of, of tidbits of information here. I actually have four things that I would like to just advertise to folks. Oh, wonderful. The first thing is just dysmenohrea or painful periods. If the patient's periods are so painful that heat and ibuprofen or an NSAID medication, aren't really helping them. And your daughter is missing school, that's abnormal. And we can address that issue with hormonal management so that she can have an improved quality of life.

That's point number one, number two, we refer to this as menorage. If those periods are really long and they're heavy, they, they go beyond seven days. They require more than six toiletries per day. Then please consider having this young lady evaluated to make sure there's not an underlying cause that's contributing to this condition. Point number three is the HPV vaccine. I would just encourage anyone who is listening to the podcast and the child doesn't have a contraindication to the vaccination to just consider having your child vaccinated.

To protect in the future from cervical dysplasia or sort of those precursor cells that can lead to cervical cancer. And then my last and final point, because I do staff, a teen pregnancy clinic, I always emphasize contraception and access to contraception. So if your daughter or child is attending a regular preventive care visit, this is a wonderful opportunity that allows for them to receive effective contraception that fits their needs and can be tailored to them and their past medical. And it's important to know that this allows for prevention of unplanned pregnancies in our adolescent. And that's my last and final point.

Caitlin Whyte: Well doctor, thank you so much for your help. Like I said, I'm sure this put a lot of families at ease. For more information, you can visit Kentucky Children's Hospital's websit at ukhealthcare.uky.edu. And that wrap up another episode of UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all of the other University of Kentucky Healthcare podcast. I'm Caitlin Whyte. Staywell.