The first exam for a teenager

ACOG recommends that a young woman’s first visit to an ob.gyn. occur between the ages of 13 and 15 years old. This first visit should address health guidance, screening, and preventative health services. It is important to tell your patient that your discussions and exam will remain confidential. An internal exam is not necessary unless the patient is having a specific complaint. More importantly, this visit serves to establish rapport and trust between patient and doctor. This patient will be more likely to disclose important information about her health on future visits.

Initial and subsequent annual exams should include the following, according the recommendations:

• Vital signs including evaluation of menstrual cycle. This emphasizes the role of menstrual cycles in overall health status.

• Body mass index, which allows the opportunity to discuss dietary management.

• A discussion of normal adolescent development.

• A general physical exam should be performed at least once during early adolescence (12-14 years), middle adolescence (15-17 years), and late adolescence (18-21 years), but is not required at every visit.

• A pelvic exam is not required unless the patient is symptomatic.

• An evaluation of breast development.

• A training session about the external genitalia exam.

• An annual screen for sexually transmitted infections (STIs) (gonorrhea [GC], chlamydia [CT], and HIV) if the patient is sexually active. You can use urine specimens for GC/CT to avoid a pelvic exam.

• Discuss responsible sexual behavior: contraception, STIs, and emergency contraception.

• Discuss the importance of diet and physical activity. It also is important to screen for eating disorders.

• Discuss prevention of injuries: avoidance of alcohol/drugs, drinking and driving, weapons, seatbelts and helmets, and safe tattooing and piercing.

• Screen for sexual activity, depression, abuse, school performance, and tobacco, alcohol, and drug use. This can be done using a questionnaire that the patient fills out in the waiting room. It is important to go over this questionnaire during the visit.

• Check that immunizations are up to date.

In addition to your visit with the patient, it is important to address the parent or caregiver. It is recommended that this be done once during the patient’s early adolescence, mid-adolescence, and late adolescence. This can be done with the patient and the caregiver in the same room, or with the caregiver separately. Topics to discuss include:

• Discuss normal development.

• Describe signs and symptoms of depression, anxiety, and abuse.

• Discuss the benefits of maintaining normal body weight through physical exercise and a healthy diet.

• Describe parenting behaviors that promote healthy adolescent adjustment.

• Outline ways to minimize potentially harmful behaviors.

A successful first visit is the initial step toward lifelong health maintenance.

Dr. Jaspan is the chairman of obstetrics and gynecology for the Einstein Health Care Network in Philadelphia. Dr. Bohnert is a PGY3 resident in obstetrics and gynecology at the Einstein Medical Center in Philadelphia.

This column, "Adviser’s Viewpoint," appears regularly in Ob.Gyn. News.