Access to Confidential Care Promotes Gynecologic Care in Teens


NEW ORLEANS — The interval between sexual debut and initiation of gynecologic health care was substantial in a recent study of urban adolescent girls, but access to confidential care predicted more timely gynecologic care, M. Diane McKee, M.D., reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

More than 800 high school girls participated in the anonymous, self-administered, computer-based survey. Nearly 45% reported that they were at some point sexually active, and of these, 45% had received gynecologic care, which for the purposes of this study was defined as a pelvic examination.

The mean interval between sexual debut and gynecologic care was 11 months, but the range was 6 months before sexual debut up to 6 years after sexual debut. Only about 4% had a pelvic examination before sexual debut, and for the remaining sexually active girls, a negative consequence (such as pregnancy or a sexually transmitted infection) was strongly associated with seeking care.

The interval between sexual debut and gynecologic care was more than 2 years when no negative consequence occurred and slightly more than 1 year when such a consequence did occur.

“Gynecologic care in adolescents is largely reactive,” said Dr. McKee of Albert Einstein College of Medicine, New York.

After negative consequences were controlled for, three other factors emerged as predictors of the interval between sexual debut and gynecologic care: access to confidential care (odds ratio 3.1), high self-efficacy for accessing confidential care (odds ratio 2.1), and disclosure of sexual activity to any clinician (odds ratio 1.7).

Confidential care was defined as having at least part of routine visits conducted without parents present.

In the absence of these factors, the median interval between sexual debut and gynecologic care was approximately 3 years.

Other findings from the survey underscore the need for better patient education. Nearly 80% of respondents said they have a regular source of care, and 60% said they had an opportunity for confidential care for at least part of their last clinical visit. But only 52% said they received safe sex counseling. Of the 45% of respondents who were sexually active, only 27% had informed any clinician of that fact.

More than 25% of the sexually active girls had been pregnant or had a sexually transmitted infection in the past year.

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