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When Is It Appropriate to Send Pediatric Patients to an OB/GYN?

October 29, 2019
Written by

Geri Hewitt, MD, answers a common question from pediatricians about gynecologic care for young female patients.

The American College of Obstetrics and Gynecology (ACOG) recommends that young women have their first visit with an obstetrician-gynecologist (OB/GYN) between the ages of 13 and 15. Making sure that first appointment is with a pediatric gynecologist can have added benefits. Specific symptoms (vaginal bleeding or discharge, abnormal appearance of genitalia) or abnormalities (congenital anomalies, chronic disease impacting reproductive health, or ovarian masses) may necessitate earlier referral.

These visits provide an opportunity for anticipatory guidance regarding reproductive health care (including an age-appropriate discussion of anatomic development, body image, self-confidence, weight management, immunizations (particularly the HPV vaccine), contraception and sexually transmitted infections). This visit is also an opportunity for the doctor to establish a relationship with the patient and parent or guardian, discuss normal and abnormal pubertal development, dispel myths and misconceptions surrounding weight, development and sexuality and help adolescent girls become comfortable with their changing bodies.

A physical exam to point out normal development and identify areas of concern is often performed to the patient’s comfort level. Although this will include a visual examination of the breast and genitalia an internal examination is not typically performed and the child and parent may decline an external visual examination if she feels uncomfortable. Invasive testing of the reproductive organs is also not recommended in this age group. Screening for sexual transmitted diseases can be done through urine testing. Pap smear screening begins at age 21. Contraception and/or hormonal therapy can be initiated without a pelvic examination.

Pediatric and adolescent gynecologists undergo additional specialized training after residency to learn to care for medical and surgical gynecologic problems in girls and adolescents such as:

  • Ovarian masses
  • Congenital problems of the reproductive system
  • Abnormal uterine bleeding
  • Menstrual and pelvic pain
  • Contraceptive issues in medically complex patients
  • Gynecologic problems in pre-school age children

Although adult gynecologists treat many of these conditions in older women, differences in the anatomy of children make the advanced training of a pediatric and adolescent gynecologist valuable in the care of girls and adolescents.