DEAR MAYO CLINIC: My daughter is 14 and her pediatrician recently reminded us that she should get the HPV vaccine because it can help prevent cervical cancer. That got me thinking about gynecologic health for my daughter. Are there conditions and issues that I should talk to my daughter about?
ANSWER: Taking time to discuss gynecologic issues with your daughter is a wonderful step to educate her about maintaining good health and wellness as she grows. I applaud you for being proactive.
As you may already know, most cervical cancers are associated with human papillomavirus (HPV), a sexually transmitted infection. HPV is extremely prevalent, and up to 80% of sexually active adults will be exposed to the virus during their lifetime. The immune system normally clears HPV on its own, but occasionally the infection can persist and cause precancerous changes on the cervix.
The HPV vaccine, which was approved by the Food and Drug Administration in 2006, can prevent cervical cancer, as well as vaginal, vulvar, penile and anal cancers. In addition, the vaccine covers the HPV strains that cause genital warts.
Use of the vaccine has reduced cancer rates. The vaccine is most beneficial when given before the patient is exposed to the virus, so it is recommended for girls and boys to be vaccinated between ages 9 and 14.
Research shows that maintaining a healthy diet and exercising can reduce one's risk for cancer later in life, as well as decrease risk of developing diabetes and heart disease. Make sure she is active, spends time outside and eats a varied diet with appropriate portion sizes. A daily multivitamin also can help. Although your daughter is still young, spending time to instill good habits is an important step to help her remain healthy as she grows. It’s also important to stay on top of yearly well-child visits with your pediatrician or family care provider.
It is just as valuable for her to know that she can talk with you about any concerns or issues, including mood changes and trouble sleeping, which may be common at her age.
Be sure to speak to your daughter about menstruation if she has not already begun to have her period. Also, remind her that until her cycle is regulated, breakthrough bleeding may occur, but she should not panic. Bloating or cramping may occur, as it is common for adolescents, but it is not usually a reason for concern at her young age.
If your daughter has not begun to menstruate by age 15, further evaluation may be needed. This is why it is important to talk about menstrual cycles and development during your daughter's well-child visits.
By the time your daughter reaches age 15 or 16, you may want to consider transitioning her to a gynecologist. The benefit is to provide educational information and guidance about reproductive health, as well as alleviate fears of the gynecology office. The gynecologist will review menstrual history, pubertal development and birth control options, and discuss safe sex. Many times at an initial visit, a pelvic exam is not necessary, unless there is a specific concern that needs to be addressed.
Screening guidelines are updated frequently, so whether you visit a gynecologist or another health care provider, it is valuable to talk with your daughter's provider about what tests may be timely, such as such as HPV tests and Pap smears for cervical cancer.
By the time your daughter reaches 21, she should have her first Pap test, which is an important screening exam that's used to check for abnormal cells on the cervix that could indicate early-stage cervical cancer or precancerous cells. — Dr. Aakriti Carrubba, Obstetrics and Gynecology, Mayo Clinic, Jacksonville, Florida