First Adolescent Gynecologic Visits

How I Practice Video Series
Nancy Fan, MD, FACOG

HIP: First Adolescent Gynecologic Visits from ACOG on Vimeo.


So I have found at this point in my practice that I get asked by a lot of patients “When is a good time to bring their daughter in for their first GYN visit?” Usually their daughter has started menstruating and they’re of teenage years. And I usually try to ask my patients first if they have a purpose to bring their daughters in, if they’re concerned about some health issue or if they wanted me to discuss with them about some sexual health issue. Most times the moms just wanted to make sure that the patient is the daughter is comfortable, the daughter knows what a gynecological exam is and what goes on. I definitely stress to the mom before they bring their daughter in to tell their daughter that they do not need a GYN exam. Also, they will not get a pap smear. Once the daughter actually comes in, I usually ask them if they want to have the mother in the room during the interview. I try to make the patient comfortable initially by asking them some of their background history, what grade are you in high school, what are you interested in, who are your friends like. And then I start asking them some of the regular interview questions. I ease in from their topics about things they’re familiar with, when did you start getting your period, how old were you, what were your periods like, how heavy are they, do you ever miss school because of your periods, to other health issues that they should be comfortable with. How many vaccinations have you received? Do you know if you received the HPV vaccine? And then I start slowly going into social questions. Because most times than not, that is what the mother and the patient expect when they come in. My purpose in interviewing a patient for a teenage visit, a well-woman teenage visit, is to make them feel comfortable with the gynecologist so that they will start developing that pattern of coming in for their annuals and feel comfortable discussing with me these kind of issues as they grow older for their reproductive health. Now once we start talking about the social issues, I do start actually with what I call the easier topics and that would be their sexual health issue. Obviously, if they’re not sexually active then I just make sure that they’re aware that when they become sexually active, if they’re interested in becoming sexually active, that they actually come talk to me first, as well as the importance of STD screening and contraception. I tell them that they are responsible adults, and therefore that they need to do responsible action. Then I go into the use of substance use during their high school years. Now, a lot of teenagers will downplay the amount of substance use, “No I never smoke, no I never drink, no I’ve never used any sort of marijuana (that is the most common type).” However, once you start asking them certain questions, you might elicit a little bit more of a history. And one tool that I like to use with my patients is the Craft questionnaire. It’s a modified questionnaire and essentially the C stands for car, “Have you ever been in a car where someone is drinking or using some form of drugs?” The R is “Have you ever used any kind of substance to relax, for the need to get away?” The A is “Do you ever do any of this while you’re alone?” One of the F’s is for “Have any family or friends told you that you need to cut back on exactly what you’re using or doing?” And the T is “Have you ever been in trouble because of something you use? Have you ever been caught smoking, have you ever been caught at a party? Have you ever been kicked out of school for one of these reasons?” If they answer yes to any of these questions, then I try to elicit a little bit more of a history. Sometimes they feel comfortable talking to me, sometimes it’s an automatic “no, no, no”, and I say “Okay, well, I’m glad to hear that because over 25% of patients your age will have been sexually active. Because over 40% of patients your age will have admitted to using some form of alcohol or substance use. And therefore, I’m happy to hear that you’re in the majority of your peers and not doing any sort of those activities. However, if you ever find yourself in a situation, if you ever find you need to speak to someone about those, you can come to me as well as use your parents or your teachers as a resource. And that is how I practice.


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