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| |    Gynecological Exams for Girls: When and Why by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Annual well-child visits, which serve to chart your child's growth and development as well as her general health, should ideally include a look at the child's external genitalia. When done by a trained health professional, this part of the routine physical exam can identify many problems (such as labial adhesions) before they get serious. It also allows the child to get used to being examined--particularly important, since we don’t want a young woman to fear exams and skip routine care later on in life, threatening her health if cervical dysplasia or an STD (sexually transmitted disease) develops and goes undetected. When should your daughter have her first full gynecological examination? The standard recommendation is for young women to have their first full gynecological exam around the age of 18, when they are getting ready to go to college or whenever they are considering becoming sexually active, whichever comes first. Pap tests should be begun about two years after sexual activity starts, and by age 21. Since parents are often unaware of when sexual activity is beginning, I often tell families to come for routine GYN care when their daughter turns 18, when she gets a "serious" boyfriend or when she has friends who are sexually active. Often the pediatrician or family doctor can identify which girls should be examined when they take the history at the routine checkup. The transition to adult GYN care is less abrupt if it can be with the primary care practitioner that the girl already knows. However, some girls are more embarrassed to have their full exam with their pediatrician and would rather see a new, "grown-up" doctor. Gynecological examination of younger girls Sometimes younger girls need to have an internal exam to evaluate pelvic pain, vaginal discharge, or abnormalities of the menstrual cycle. Because these issues are fairly common, many pediatricians and family doctors are comfortable and skilled with the gynecological examination of girls. You should know that in general, speculums are not used for very young girls, and special instruments and techniques are typically used for gynecological exams of teens. If your daughter needs to undergo an internal examination, feel free to ask the doctor beforehand about how the exam will be done, so you can prepare your daughter for what to expect. For exams that involve this part of the body especially, it is important for your child to know that she can say "no" and have her wishes respected. If a girl can't tolerate the exam, sedation or anesthesia may be preferable to forcing the issue in the office; sometimes ultrasound may be used as well. More information For more information on the gynecological examination of teenagers, see our article "What Teens Can Expect During a Pelvic Exam."
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