I came across a local article that said female preteens/teens should see their gynecologist when they first become sexually active, or when they turn 18, whichever comes first.

However, perhaps because Western values are different, the American College of Obstetricians and Gynecologists recommends that girls first see a gynecologist when they’re between the ages of 13 and 15. Virgins usually won’t get a pelvic exam, but a regular health exam and a frank discussion about her development are to be expected.

I first saw a gynecologist when I was already in my 30s to get a pap smear, because I just read somewhere that it was something I should do. My next visit was for my first checkup when I was pregnant with my first child. I learned then that I had polycystic ovary syndrome or PCOS, something more common now in women of childbearing age having fertility problems.

Could there have been something I could have done to prevent or treat it, or anything else I should have known, so it could have been addressed in my youth?

Although I can now Google it, the point is moot, and my daughter is growing up fast and I want to be as prepared.

Vaccine

So, at what age should parents bring their daughters to a gynecologist?

“There is really no routine checkup necessary for preteens or teens who present no complaints or symptoms. But a cervical cancer vaccine can be given as early as age nine,” said Dr. Maria Imelda Antonia Almeda-Fernando, a fellow at the Philippine Obstetrical and Gynecological Society in Biñan Doctors’ Hospital and Asian Hospital and Medical Center.

“If menses occur monthly, then become irregular, a consult is needed. If you suspect your child to be sexually active, then it’s time to see your gynecologist whatever age she may be,” she added.

What should parents and their daughters expect on their first visit?

“Expect a lot of talking as we try to establish rapport and gain the trust of your daughter,” said Fernando. “The examination is personalized, depending on the reason for the consult. We do not always have to examine her private parts, but it may be warranted if, for example, there is complaint of delay in menarche (to check for possible genital tract anomaly), vaginal discharge or pruritus, abdominal mass, suspected pregnancy or history of sexual abuse. In the case of the latter, having the mother or a trusted relative around is helpful.”

What are the most common issues of preteens/teens who come to see you?

“The most common is irregular menstruation. In the clinic, you usually see the panicky mother with her preteen or teenage daughter. Often, there is nothing to worry about.”

What are some things you wish parents of female preteens/teens knew about their daughters with regard to their health?

“That it’s normal to have irregular menstruation the first two years after menarche, or the first time they ever get their period, as it becomes ovulatory or regular thereafter,” said Fernando. “And no, they are usually not pregnant, nor will this cause fertility problems in the future.”

But if you do suspect that your daughter is sexually active and are worried about pregnancy and/or sexually transmitted diseases, Fernando said it is highly unlikely that she will disclose this to her doctor with a parent hovering around.

“It’s okay to excuse yourself so we can have a one-on-one with your daughter (after you’ve aired your concerns). Do not worry, as we will let you know when we need you in the room or during examination,” said Fernando.

How often should they go and for what procedures/reasons?

“Only if they have complaints, at least annually if they’re already sexually active. We usually see patients in the preteens as referrals from our pediatrician colleagues. With the advent of cervical cancer vaccination, we now see patients routinely at a younger age.”

The HPV (human papilloma virus) vaccine can help prevent cervical cancer. “HPV is responsible for over 99 percent of cervical cancer cases. Cervical cancer is still the second most common cancer among women. In the Philippines, 12 Filipinos die every day from it. HPV infection is sexually transmitted, but studies show that early vaccination, as soon as nine years old, offer higher protection rates than giving it later in life or after the woman’s sexual debut.”

Misconceptions

The HPV vaccine is administered as three shots within six months. The price depends on the doctor and the brand of vaccine, and costs about P3,000-P5,000/shot.

Any typical misconceptions or fears about bringing one’s daughter to see the gynecologist that you think should be clarified?

“Parents usually worry about menarche being too early or too late for their preteens. It is of concern only if menses have not begun by 15 years old. Puberty starts with thelarche or breast development. If menses have not started within three years of thelarche, or if there are no signs of pubertal development, then this warrants further investigation.

“In relation to HPV vaccination, giving it to your child is by no means an encouragement for them to have sex early. It is to protect your child from HPV infection,” she said.

“And, no need to wax or shave or have a pedicure before your appointment because we OBs don’t really care,” said Fernando. “In fact, irritation may result from shaving and waxing since the skin of the labia is delicate.”

Reschedule if you have your period on the day of your appointment if you plan to get a pap smear or your complaint is, say, vaginal itching, because it would then be hard to examine. For prolonged bleeding or irregular menses, see a doctor right away. —CONTRIBUTED