• Mayo Clinic Q & A

    Mayo Clinic Q and A: When your teenager needs to see a gynecologist

a smiling young teenage girl outside

DEAR MAYO CLINIC: My daughter is 13, and her pediatrician recently reminded us that she should get the HPV vaccine because it can prevent cervical cancer. That got me thinking about gynecologic health for my daughter. She began her menstrual cycle at age 12, but I'm unsure if there are conditions and issues that I should talk to my daughter about or when to have her visit a gynecologist.

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 HPV, a sexually transmitted infection. Up to 80% of sexually active adults will be exposed to the virus.

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 primary care provider.

It is just as valuable for her to know that she can talk with you about any concerns or issues. This includes mood changes and trouble sleeping, which may be common at her age.

Although she has already begun to have her period, be sure to speak to your daughter about menstruation. Also, remind her that until her cycle is regulated — which can take many years — breakthrough bleeding may occur, but she should not panic.

Bloating or cramping also may occur, as it is common for adolescents. But it is not usually a reason for concern at her young age.

If your daughter begins to develop any issues, such as painful or worsening cramping, or significantly increased bleeding, further evaluation may be needed.

If there is no sexual activity, having your daughter visit with her pediatrician or general practitioner during annual well-child visits should suffice for a few more years. You may want to consider transitioning your daughter to a gynecologist when she's 15 or 16. 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 a specific concern needs to be addressed.

Screening guidelines are updated frequently, so whether you visit a gynecologist or another health care professional with your daughter, it is valuable to discuss what tests may be timely, 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. This test could indicate early stage cervical cancer or precancerous cells. — Dr. Aakriti Carrubba, Obstetrics and Gynecology, Mayo Clinic, Jacksonville, Florida


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