Amanda Wilde (Host): As girls become young women, it's important they stay healthy and informed. We're exploring how adolescent girls can take charge of their health care with a focus on important topics like the HPV vaccine, menstrual health and more with our guest Gloria Maldonado. Gloria is a certified physician assistant who specializes in adolescent women's health. Welcome to UK HealthCast, a podcast presented by UK HealthCare. I'm Amanda Wilde. Gloria, so glad you are here. I am looking forward to being brought up to date.

Gloria Maldonado: Yeah, thank you for having me.

Host: When I say brought up to date, I know something that has emerged only in the last generation or so is the HPV vaccine. And it's become an important part of what adolescent girls are advised to do. Can you explain the importance of the HPV? That's human papillomavirus. Did I say that right?

Gloria Maldonado: Yeah, that was perfect. I am really excited to talk about this. And before I talk about the vaccine itself, I do want to talk about just the human papillomavirus. So, it is a virus that can cause changes in different cells in our bodies. And those changes can become cancerous at some point. The reason we talk about it in adolescent females especially is because it is a very common cause of cervical cancer, but it can also cause other cancers, some sort of oral or throat cancers and some anal cancers as well, in addition to some forms of genital warts. And that is because it is typically transmitted through sexual activity. And so, those are kind of the areas where it would infect and could make those changes.

And so, the vaccine is a way of preventing our bodies from developing a true infection from that HPV, and then preventing us from having this risk of cancers and changes to the cells. And it is a very effective vaccine. So, we find that around 90% of cervical cancers can be prevented with the HPV vaccine, which is huge. And we see similar rates with other types of cancers as well.

Host: Wow. So, we do know it's effective as a cancer prevention strategy. Are there some misconceptions about the HPV vaccine?

Gloria Maldonado: I think one of the biggest misconceptions that have come up with the HPV vaccine, and we saw this more when it first came out I think more than we're seeing now. But the risk that if we were to give an adolescent the HPV vaccine, that would make them more sexually promiscuous. And we see that that in itself is not true. This vaccine is typically started between the ages of 9 and 14. And oftentimes kids that age are not thinking about sex. And so, framing the conversation around our future health and preventing forms of cancer should be the conversation and I think it helps with that. There's been research to show that getting the vaccine doesn't increase the likelihood of adolescents becoming more sexually active.

Host: What about side effects of the vaccine?

Gloria Maldonado: That is another thing that I always like to talk about with patients. Side effects from this vaccine are typically are very mild. The most common being soreness at the injection site, which I feel like with any shot you get, you're going to have some of that. The other two that are maybe less common than what you would see with other vaccines are having a headache or feeling a little fatigued, but usually that only lasts for about 24 hours afterwards.

Host: So, you might have some side effects, but it sounds like they are fairly mild and definitely temporary.

Gloria Maldonado: Absolutely.

Host: So, is there ever a case where you would not recommend the HPV vaccine, seeing as it has such a high success rate?

Gloria Maldonado: No, I really don't have any situations in where I don't recommend the vaccine. And very importantly, I don't only recommend this vaccine in females. That is another thing that it used to be pushed more toward females. I can remember the commercials, from when I was a teenager, of girls doing double dutch, singing a song about being one less person without cervical cancer. So, they did a really good job marketing this toward females. females, but it is helpful also for males to have the vaccine as well. And so, I push for really all of my patients at that adolescent age to get the vaccine before they've been exposed to the virus.

Host: Well, that leads me to a further question about hygiene. Can you share some tips for promoting healthy menstrual hygiene for adolescent girls, especially those who may face some challenges in accessing menstrual products or information?

Gloria Maldonado: Yeah. Periods are one of my favorite things to talk about, which is ironic because it's a conversation that tends to make people feel uncomfortable. And I think it's important to acknowledge that. But it is also very important that we do continue to have these conversations and really normalize women's experiences because the reality is almost everyone who has a cervix and uterus is going to menstruate at some point. And so, we do have to talk about it.

And I think the first step with that is starting early, just with our kids, as they begin to develop and change, having those conversations so it is something that they're comfortable talking with people about. And then, as they start to have a period, making sure that they're very mindful about tracking when it is, I know a lot of my teenage girls, have a lot going on. You know, they're much more worried about going to the football game or hanging out with friends and maybe tracking when their period is, but it can be very disruptive if it comes what feels unexpectedly. However, it was likely right around the time that it was supposed to be there. That's one of the big things, is just encouraging them to kind of stay on top of that.

Some of the other things to think about is before we've started our period, already having that conversation about what we can use to help, like what products we want to use. The landscape for that is changing a lot. Tampons and pads were kind of the only things that I used to think about or used to see. And even what's available as far as tampons and pads have changed drastically over the past even 10 years. But now, there are things like menstrual cups that people can use, and even like period underwear, which I'm seeing to be a little bit more popular than even before. And so, making sure that our young females have a chance to explore these different options and find what works best for them when the time comes.

Host: So, talking about it seems number one and understanding what healthy menstrual hygiene really is. What are signs of menstrual irregularities or any issues that teens or their parents should be aware of?

Gloria Maldonado: One of the biggest things that comes up is teens worrying about how heavy their periods are, or how frequently they're having them. And that's why I cannot emphasize enough kind of keeping track of when your periods are. But things that I start to worry about when you come to clinic to see me is if we're having to change our pad or our tampon every two hours, if we're having really large clots, so thinking like bigger than a dime of clots frequently.

Or, on the other end of things, if maybe we were having periods regularly and now we're not, and this is longer than a year after you had started your period. So, you know, you started your period when you were 12, you're 14 now, and suddenly your periods aren't regular anymore. Now, those things are concerning and things that I would want to see someone to talk about.

Host: I think by the time you get your period, you're really forced to take an active role in managing your personal health. But yet, at what age do you, as a specialist in this field, recommend that adolescent girls begin taking an active role in managing their personal health, particularly when it comes to making decisions? Like you said before, they may even get their period like the HPV vaccine?

Gloria Maldonado: As a rule of thumb, I always encourage patients to be engaged in their care at whatever point they feel comfortable. So if I have an eight-year-old patient who comes in and can tell me what is going on why they're in for a sick visit today or why they need a physical exam or something. I love to nurture that. But really, our clinic starts at age 12. That's when we typically start seeing patients through age 25. And we will have a time where we talk with patients alone at that point to start developing those skills. Because once a child has reached adolescence, there may be things that they feel uncomfortable talking about in front of anyone. And as a medical provider, we tend to be pretty good about trying to create a space where they can provide it and asking the right questions. And that will help them in the long run, once they are adults trying to navigate working with healthcare systems.

Host: No, you are so right. Girls are often uncomfortable talking about some of these topics with anyone, but for parents who want to stay close with their kids, . What advice do you have for parents when it comes to having conversations with our daughters about women's health?

Gloria Maldonado: So like I mentioned before, I think starting the conversation early helps just so much. And of course, the conversation will change as they get older as they can understand concepts better and they have more changes in their bodies. There will be more to discuss. But the younger they are when we start these conversations and the more we have them, the less uncomfortable it will make our daughters, but also make us feel just because we're kind of used to it.

And then, making sure you have accurate information. There are a plethora of resources out there. From books to podcasts, even a quick google search. If you have a question or feel like you don't have the exact answers that you think you will need going into a conversation with them. It never hurts to just check in before starting that conversation. And of course, just making sure that everything is age-appropriate.

Host: So normalizing, but doing that in an age-appropriate way, accurate information and also modeling where to find accurate information if you don't know the information yourself. And of course, visits with the doctor. You know, as we talk about this, Gloria, I see there have been some emerging trends. So, I think that we will have a further conversation in the future of what is happening and involving in this field of adolescent women's health. But for the meantime, thank you for this information from this evolving field.

Gloria Maldonado: Yeah. Thank you so much for having me. I do anticipate changes coming, especially with the role of social media and how our kiddos are getting information. And so, I think staying on top of it and continuing to have these conversations are important.

Host: For more information, go to ukhealthcare.uky.edu/kentucky-childrens-hospital/services/adolescent-medicine or go to the UK HealthCare main page. Thanks for listening to UK HealthCast, a podcast from UK HealthCare.