Not simply a matter of which exam is or is not performed. Today all medical practices are constantly under review to be financially efficient as well as beneficial to the long-term well being of the patient. The pressure is to find the best cost-benefit ratio with evidence based methods. Some physicians may be slow to adapt to newer methods, giving preference to more familiar and traditional techniques. There simply are fewer physicians available to treat much larger populations and they all must adopt the best clinical evidence-based policies and procedures in order to have good outcomes in alleviating human misery and suffering. So yes there are un-necessary exams performed and sometimes only because a patient demands it. There are more constraints today because there is better evidence available for preventive care or to decide a course of treatment. Periodic preventive examinations are only of limited benefit if a patient does not understand the importance of good health practices such as balanced nutrition and adequate exercise as well as all the risks associated with his behaviors. Before the onset of puberty, all pre-teen girls ages 10-12 should have a "well-girl exam," according to the Adolescent Wellness and Reproductive Education Foundation. Younger adolescents often have questions about pubertal development, and the gynecologic examination is a key element in assessing pubertal status and documenting physical findings. Routine exams are important for good reproductive health and more pre-teens have started exams because Gardasil, the human papilloma virus vaccine, is recommended for girls 11 and 12. At a minimum, examination of the external genitalia should be included as part of the annual comprehensive physical examination of children and adolescents of all ages. When teenage girls are between 13 and 15, it’s time to talk to them about female checkups. Girls who have regular periods should have the benefit of an exam to ensure that they are maturing normally. The American College of Obstetrics and Gynecology (ACOG) recommends that young women between the ages of 13 and 15 have their first gynecological visit. This visit is also a great opportunity for education and counseling. Usually this first visit does not require the young woman have an internal pelvic exam unless is there is a medical reason, for example sexual activity, very heavy or irregular menses; or continuing very painful periods and discomfort. Teen girls need a first time. But most young girls are very uncomfortable with the thought of having this type of examination. Mothers can teach their teenage daughters to take care of themselves in a healthy and positive way. Helping your daughter to feel at ease during her first pelvic exam is important. The age for a first exam varies and depends on your daughter’s needs. It can range from the pre-menstrual years of ages 7 through 10, up to the age of 16. However, a first appointment can and/or should be made in these cases:
• If the mother feels that her daughter is ready or feels that an outside person may make answering questions regarding puberty, development, sexuality and safety easier.
• If there are questions regarding puberty or concern regarding appropriate development internally, of the uterus, ovaries and tubes.
• If a young teen wants to see a gynecologist to have her questions answered.
• If the young woman wants information on birth control because she is thinking of initiating sexual activity or if she has become sexually active and wants birth control. Explain the purpose of the exam. Talk with your daughter about why she needs to have the exam and what procedures she will undergo during the medical evaluation. Explain to her that this is a normal yearly exam for adult women. Explain to her that a first visit typically does not include a pelvic exam unless the doctor feels it is necessary. Take your daughter to begin regular gynecological checkups, especially if she is or is thinking about becoming sexually active. You really cannot be certain at what age your daughter becomes sexually active. Be there to support her without judgment and ensure that she gets properly educated and protected. Talk to her openly about dating, relationships, consequences of sexual activity and to show her you understand, bring your daughter to a doctor as a teenager, regardless of whether she is having sex yet. She needs her own doctor if she has a problem, such as with her period, and for a reliable source of information and resources that encourages good choices that build the foundation for a healthy adulthood. While the common age for most girls’ first internal pelvic exams is 15, 16, or 17, many younger girls will need an exam earlier. In those not sexually active, a visit and the pelvic exam should be considered at least once in each stage of adolescence (early adolescence, ages 12–14 years; middle adolescence, ages 15–17 years; late adolescence, ages 18–20 years). The examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women’s health care. Talk to your daughter about the exam. Tell her about the procedure, and what to expect. Suggest you schedule the first exam within the first year after menses. Recommend she have the first exams with her pediatrician during middle school, ages 13-15, and then schedule her first pelvic exam with a gynecologist during high school, ages 16-17, before she leaves for college without regard to sexual activity. A young woman should have a full gynecologic exam that includes an internal pelvic exam and screening at the first sign of a possible gynecologic disorder, or as soon as she may become sexually active. Search for a doctor together. Talk to your daughter’s regular physician about performing the first pelvic exam; if your pediatrician or general practitioner can do this, the girl may have less anxiety. Pediatricians who provide primary care to adolescent girls will often address gynecologic issues, including questions related to puberty, menstrual disorders, contraception, sexually-transmitted infections and other infections. The American Academy of Pediatrics (AAP) promotes the inclusion of the gynecologic exam and recommends she have the first exam with someone she knows and trusts.
Pediatricians are comfortable and qualified to do pelvic exams and deal with sexual health issues. Young girls may need the transition from having her first pelvic exams with her pediatrician before scheduling her exam with a gynecologist. If she likes her doctor and her doctor likes caring for teens, then the best setting is often with the pediatrician who has established trust and rapport. Many girls stay with their pediatricians until they leave for college. If the doctor does not do the exam, ask him for a referral. Adolescent girls may need two "well-child" visits -- a general preventive visit with her pediatrician and a dedicated reproductive health visit to a gynecologist. This visit can be a great opportunity for a young girl to establish a relationship with a gynecologist prior to her need for a pelvic exam. The American College of Obstetricians and Gynecologists encourages parents and guardians to look at this initial visit as a prime opportunity for young girls to meet her gynecologist to help alleviate any fears, dispel myths and start creating a healthy doctor-patient relationship. Many young women continue to see their gynecologist long after graduating college. It’s very important that your daughter feel comfortable with her OB/GYN, so take on the task of finding a doctor together. Identify a few doctors that you know are covered by your insurance carrier. Another great way to find a doctor is to get a referral from one of your daughter’s friends or a family member. Give her a choice. Try to choose an older man or a woman for the first exam. You can interview a couple OB/GYN’s if she prefers. Then allow her to choose the doctor she thinks is the best fit.