Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reaffirms its recommendation that teenage girls first visit an ob-gyn between the ages of 13 and 15 in a new committee opinion published in the May 2006 issue of Obstetrics & Gynecology. This initial reproductive health visit will help teens develop a relationship with their ob-gyn before they need to seek care for a specific health issue. The committee opinion details ACOG recommendations for the scope of the visit, discussion topics, and ways to address confidentiality concerns.

The early teen years are an ideal time for an initial ob-gyn office visit that focuses on screening and preventive health care. "During these years, young teens face new issues regarding sexual and reproductive health and development on a daily basis. It's important that they develop a relationship with their ob-gyn," says Marc Laufer, MD, chair of ACOG's Committee on Adolescent Health Care. "Interaction with an ob-gyn they trust allows teens to get answers to questions that they may be too embarrassed or afraid to raise with parents and friends. Ob-gyns also can encourage teens to adopt healthy lifestyle habits that they can carry into adulthood."

Physicians can discuss normal development, menstruation, sexuality, healthy eating habits, safety and injury prevention, and date rape prevention with teens. It also gives ob-gyns an opportunity to address problems that may require early intervention such as eating disorders and weight issues, blood pressure problems, and mental health issues such as anxiety, depression, and physical, sexual, and emotional abuse.

"Teens who are nervous about receiving a pelvic exam can rest easy. A pelvic exam is rarely necessary during the initial visit, unless indicated by medical history," Dr. Laufer adds. Because ACOG recommends that young women have their first Pap test approximately three years after vaginal intercourse but before age 21, teens may visit the ob-gyn several times before a speculum or pelvic exam is needed. However, ob-gyns may recommend a pelvic exam if the teen has had an abnormal puberty (pubertal aberrancy), abnormal bleeding, or abdominal or pelvic pain.

"The first reproductive health visit is an excellent time to discuss pregnancy prevention and sexually transmitted infections," says Lesley Breech, MD, vice chair of the Committee on Adolescent Health Care. Today, more than 85% of adolescents become sexually active during the teen years - nearly one-third of ninth graders and more than 60% of 12th graders report having had sexual intercourse, and the US has the highest teen pregnancy rate of any industrialized nation. "Physicians can use the visit as an opportunity to provide teens with early and accurate information about sex. We can talk about how to use condoms correctly and the various types of contraception that are available, such as emergency contraception, before they start having sex," Dr. Breech adds. If a teen is already sexually active at the time of her first visit, she can be screened for certain sexually transmitted infections through a urine sample.

Parents are encouraged to get involved. The first visit provides an opportunity for parents or guardians to meet the physician, alleviate fears, and develop trust. Parents also can encourage a positive relationship between their daughter and her ob-gyn. Ob-gyns can greet parents and teens together to give a thorough explanation of the visit and confidentiality issues. The exam and discussion should then continue between physician and teen alone to ensure privacy.

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