When does a teen girl need a pelvic exam?

Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.

About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. The American College of of Obstetricians and Gynecologists (ACOG) published a statement in 2012 outlining rationale for speculum exams and guidelines that support waiting until age 21 years in the absence of a health problem.

Some teens will need a visit with the gynecologist during their teen years because of health concerns, symptoms, or a desire for a long-acting reversible birth control like an IUD (intrauterine device) or implant. IUDs and implants are considered first-line birth control for teens now. The experts say these implantable devices methods are “top-tier contraceptives based on effectiveness, with pregnancy rates of less than 1% per year for perfect use and typical use. These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives. Adolescents are at high risk of unintended pregnancy and may benefit from increased access to these methods.” Some IUD devices use hormones, some do not. Intrauterine devices can be inserted for up to 5-10 years depending on which type a teen chooses. In general, teens will need to see a gynecologist for an IUD placement.

The National Center For Health Statistics reported a near 50% decrease in teen pregnancy over the last 2 decades.

For routine care, teens should see their pediatrician every year for regular, routine well-teen care, teen vaccinations (including the HPV vaccine), and to obtain annual screening for sexually transmitted infections. Sexually active teen girls will need annual urine tests for gonorrhea and chlamydia and blood tests for HIV. We really want to grant teens access to private counseling, support, education, family planning, and well care during high school and don’t want them to erroneously worry about routinely having a pelvic exam.

The American Academy of Pediatrics has a statement on caring for teen girls as well. Ask your teen’s pediatrician their recommendations and if at any time you or your teen is concered about a health problem, don’t hesitate to see the pediatrician or gynecologist. Of note, ACOG recommends teens come in between age 13 and 15 years of age for prevention. However, many pediatricians are very comfortable doing all prevention care for teens. Inquire with your specific pediatrician or family practice physician if you have any concerns. Pediatricians can also explain health conditions where teen girls will potentially need a speculum exam and/or a potential referral to a gynecologist. Here are a few examples.

Reasons teens may need a pelvic exam

  • Persistent vaginal discharge that is atypical
  • Pain with peeing or urinary tract symptoms in a sexually active female
  • Painful periods unresponsive to NSAIDs –nonsteroidal anti-inflammatory drugs (ibuprofen, for example)
  • Amenorrhea (no period cycles or very infrequent cycles)
  • Abnormal vaginal bleeding
  • Lower abdominal pain
  • For an IUD device (to have the device inserted and/or removed)
  • Suspected/reported rape or sexual abuse
  • Pregnancy

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.

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  • Ron Smith

    I’ve really never understood why a sexually active girl doesn’t warrant the same gynecologic care that a sexually active woman age 21 and older requires.

    It makes no sense. But the term family planning at this age seems an oxymoron to me as well. What ‘family planning’ is there about making sure that young girls get abortions or treated for their sexually transmitted diseases as though these conditions were equivalent to the common cold. Heck some of these girls even in their mid teens are still playing with dolls, for Pete’s sake.

    In the last year, I had a young girl brought to our office by her mother. This child was sad and dejected to the point of concern that she was seriously depressed. We were startled by her demeanor and even afraid she might be suicidal. Further inquiry revealed that her mother had forced her to have an abortion just a few days before. She was about 15.

    I remain unconvinced that a provider who talks about teenage adolescent health without recognizing that these girls are still children (yes they are still children), and fails to extoll to them how wonderful are the possibilities in having a deep, meaningful relationship with a husband that can culminate in children and a family, is simply practicing anything but cold, hard medical science and with their own hidden moral filter. They are not simply ‘little adult women.’ Why is there a callousness in counseling what is best rather than prescribing what is easy for us?

    This young girl I mentioned will forever be traumatized by an action she didn’t fully understand and deal with emotional consequences she has yet to imagine.

    As a Pediatrician now for 30 years, I daily tell parents that the medicine got old long ago, but that the families are always new and fresh and exciting. Why deny these young girls that future experience simply because we made a moral judgment to simply prescribe a treatment without ever explaining to them what they risk loosing?

    Of the four cardinal virtues, the one that is needed here is courage. We are the adults in the room who can offer the alternative ‘best’ for these children. I believe that we don’t want to see these girls for ‘adult’ gynecologic issues until 21 because we have given up. They are going to be sexually active anyway. Let them deal with it, we say to ourselves.

    These girls are the future mothers of our grandchildren! They need to know what they can end up loosing later can be far more than what they are willing pay for now.

    Respectfully,

    Ron Smith, MD
    www (dot) ronsmithmd (dot) com

    • LIS92

      I’m sorry…I don’t want you to give my daughter a moral lesson on sex. That’s my job.

      • Ron Smith

        Not to be argumentative, but is very correct that it is a parents job to train their children up. My question in response would be what other entities are there that you don’t know, and have no control over, and allow without objection to provide more significant moral input into your daughter? Her friends? The school system she attends? The boys in her life? The movies or TV shows she watches?

        Certainly I must be a more significant moral threat if I want nothing from her except to enjoy a great life with family and children she loves and that will love her back, or for her to be able to make sound choices, and for her to learn to bounce back when she makes a bad choice and do better next time.

        I’m not being a self-righteous, moral prig about this. I’m explaining my conclusions as a professional Pediatrician who has sincere concerns about how I think we are ignoring the medical care of daughters.

        • LIS92

          My teenaged daughter currently has a crush on a girl and expressed arhat she is not interested in having kids. Your husband grand children speech is an insult to her and me. Does this my sex life is substandard because I may never have grand children?

          • Ron Smith

            I’m so sorry that you were offended, though I think at bottom that offense really is aimed at someone other than me. I can wish for nothing greater than you and your daughter’s good, and I can only tell you what great joy that my grandchildren have been to me. I would hope that you too would get to have that experience.

          • LIS92

            My comments are directed at you for assuming all women want a husband and children. You would counsel my possibly lesbian daughter to wait for a husband?

          • Ron Smith

            I would be suspicious that at her age, she really doesn’t know what she wants for the rest of her life. She knows what she wants right now perhaps. Like tattoos, some things leave marks that are not visible but are deep. Tattoos will go out of style like long hair did when I was growing up. Long hair is one thing, but tattoos leave marks. Life’s sexuality choices carry magnitudes more permanence. Adolescent’s feeling’s are just that… feelings. They can change easily and quickly. Isn’t it fairer to her to suggest she might not be ready to make that decision no matter what she feels just at the moment?

          • LIS92

            Isn’t it fairer to any girl to not assume that a deep sexual relationship means a husband and children?

            Are you suspicious of the orientation of all the girls you see or just the gay ones?

          • Ron Smith

            It isn’t just about sex or sexual orientation. Its about the simple fact that adolescents are swayed in all areas by feelings and form. It is the responsibility of parents to help them understand that what they want today may well be different tomorrow. Consequences from actions that are based on such fleeting feelings can leave marks, psychological or physical. The last thing anybody wants is the see a young person drive their lives over the cliff of lifelong regret by making decisions for which we know they are poorly equipped to make.

            I see this all the time in my practice, and experienced it when raising my own daughter who is now grown and facing these same issues with her children.

            Look, probably this online thread has now gone too far off topic. If you would like, I’d be more than happy to continue talking by email. Here’s my address and contact information.

            Warmest regards,
            Dr. Ron

            Ron Smith, MD
            ron (at) ronsmithmd (dot) com
            www (dot) ronsmithmd (dot) com

            543 Jonesboro Rd
            McDonough, GA 30253
            678-583-9071

          • LIS92

            “It is the responsibility of parents to help them understand that what they want today may well be different tomorrow.”

            It’s not about sexual orientation. Your original comments takes sexual issues and puts them into a box I don’t agree with. I don’t want my daughter (or my son) to see a doctor who gives them a moral lesson on sex. That’s my job. Your job is to create a safe environment, provide factual information, treat any problem that come up and answer questions.

    • buzzkillerjsmith

      Counseling is certainly your bailiwick.

      I think the poster is mainly addressing when to start paps. Age 21 is the standard recommendation. As you know, Dr. S., cervical CA in such a youngster is something few of us have ever seen.

      Obviously pts with symptoms should have the pelvic and pts who have had sex should be screened for STIs–urine GC, urine CT, HIV (universal screening is advised by the CDC; we do mouth swabs in our clinic) and perhaps with an RPR. I will admit I have not seen a case of syphilis since I left San Francisco, so I try to get a handle on risk factors when considering RPR.

  • traumadoc

    would one wait til their teen years to go to the dentist? then why would one wait so long to have a pelvic?
    the mouth as well as the vaginal vault harbors many unwanted intruders. better safe than sorry!!!

  • A Haggerty

    No woman of any age requires a pelvic exam in the absence of symptoms or issues requiring one for diagnosis. I challenge anyone to provide
    “Evidence” not anecdote or opinion or consensus, but “Evidence” that
    they do. Not for the provision of hormonal contraceptives, not to screen
    for STDs, and not “just because”. There is no valid evidence based
    reason for these sorts of exams just the weight of misguided tradition
    and paternalism in medicine, oh and don’t forget that docs do get paid
    to do them and the perception that they are need on the part of patients
    ensures yearly access to patients. AND pap tests are not pelvic exams.
    The pap test itself is like all cancers screening exams an “OPTIONAL”
    test with risks as well as benefits and lets be honest very little
    potential for benefit for the majority of women. A test which women
    should be free to accept or decline based on a full and complete
    disclosure of the evidence and real likelihood of benefit.

    • JeanArt

      How right you are and how refreshing to know that there are others out there that have gotten wise to this whole obsession by the medical world on women’s reproductive organs. By all means if a teen age girl is having SYMPTOMS that warrant a pelvic exam she should have one but as I was a healthy teen I can say I would have been traumatized had my mother taken me to a doctor for a pelvic exam. Thank goodness she had the sense to steer clear of doctors unless there was a good reason to see one. As far as screening for STDs, that can most likely be done with a urine and/or a blood test, thus no need for a pelvic exam. At least this author seems to be headed in that direction. As far as the age 21 recommendation: I see no basis in that either. Some women (gasp!) may actually still be virgins and some may have only 1 sexual partner, who has also been monogamous. I just see no reason that a woman should submit to a yearly surveillance of her genitals unless symptoms warrant it.

      • Patient Modesty

        JeanArt,
        Thank you so much for your excellent points! I agree with your points.

  • Noni

    Your post is ignorant on many levels, though I respect that you are entitled to your opinion.

    1.I feel that sometimes doctors encourage promiscuity among
    teenagers because they encourage them to look into using birth control. Doctors should encourage teenagers to abstain from sex until marriage and tell them about the benefits of abstinence before marriage .

    The highest rates of teen pregnancy come from states where Christian evangelicalism and abstinence teaching is highest. Sorry, this is not an effective way to control teen pregnancy and educating girls about birth control could be very helpful.

    2. A mother should never allow a male doctor to see or touch any of her daughter’s parts that are covered by a 2 piece bathing suit.
    Many teenage girls have been sexually abused by male doctors. I know of several women who were sexually abused by male doctors as teenagers and they are still traumatized by what happened after many years.

    How offensive. Male doctors are no more likely to sexually abuse patients than male teachers are. There are predators out there but please do not instruct women and girls that all male OBs are potential sexual predators. That is absolutely outrageous. And I doubt you know “many” victims of abuse by male doctors.

  • minti cakes

    Why does a teenage girl need to see a gynaecologist to discuss weight, body image and confidence? (ACOG statement).

    As for seeing a gynaecologist between the ages of 13 and 15 – this comes across as grooming.

  • Noni

    I do respect your opinion and concern. However, pointing out these cases does NOT mean that all male OBs have the potential to be molesters! This is offensive to the hard working, dedicated males in the OB profession. Choose female practitioners if you want but please don’t advise female patients to avoid male OBs simply because they “might” molest you.

    • minti cakes

      I would always advise female friends and colleagues to avoid all male doctors to minimise the risk of abuse. I would never trust a man who chooses to work with only female patients.

      • Noni

        Just seems excessively paranoid to me. I have so much respect for the practitioners who devote their lives to the health and well being of women.

  • jawar700

    I have never seen the word “peeing” in a medical article.

  • Ed

    Dr. Swanson, while I certainly agree girls, absent symptoms, don’t need a pelvic exam prior to 21, why are adolescent boys, absent symptoms, routinely required to submit to genital and rectal exams?

  • traumadoc

    it is a shame that there are some very immature and ignorant comments coming from the female sector,especially about male doctors. i sure wouldn’t want you as mothers of my chidren. please get some mental help.
    as a doctor without borders for half my life, i do care about females no matter what age they are. in 3rd world most pregnancy’s occur before 17 years of age….
    a pelvic exam is a routine exam just as any other and is ton be used as a weapon to prevent adult disease in such a promiscuous young society!

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