It is a moment many mothers fear, dread, or at least anticipate: The moment you learn your daughter is sexually active.
There will be a million thoughts going through your mind at that time – from concern about your daughter’s health, both emotional and physical, to sadness over the loss of innocence, anger at society or panic at this new world.
Regardless of your internal reaction, what your daughter needs most is for you to listen, guide and protect. One of the ways you can ensure your daughter’s health is by bringing her to a gynecologist. Not only will a visit help you protect her from sexually transmitted infections (STIs) and pregnancy, but also it will help her develop a good relationship with a provider who will be there to answer her questions and make sure she’s healthy for years to come. It can also offer you some support in a situation where you may not feel like you have all of the answers.
As an OB/GYN, I believe that first visit with a teen and her mom is an important one. Yes, it’s a new phase in your relationship, but that doesn’t mean it’s a bad phase. I’ve seen mothers and daughters grow closer as they are able to communicate more honestly through this first visit. In fact, going to a gynecologist for the first time is somewhat like a rite of passage for many girls and their mothers.
However, times have changed in the past few years and, what a mother may have done during her first visit may not be the same as what happens today. In fact, today’s visit should be much easier on your daughter. That is because the American College of Obstetricians and Gynecologists, the leading source of information on OB/GYN health, has recommended against the use of routine pap smears and internal pelvic exams on patients under 21 unless there are symptoms. This recommendation goes for all patients – even if they’re sexually active. However, an internal pelvic examination may be appropriate if issues or problems are discovered in the medical history (such as abnormal bleeding, pelvic/abdominal pain or abnormal discharge).
In this day and age, when it seems that testing is the best way to prevent diseases such as cancer, it may seem counterintuitive not to conduct tests such as pap smears. However, research has proven the tests at this age are unnecessary. Once a woman becomes sexually active, she has an 80 percent chance of acquiring human papillomavirus, or HPV, in her lifetime. Ninety percent of the time, it’s going to clear on its own. Cervical cancer is a very slow-growing disease that can take more than a decade to form from HPV, meaning even if HPV doesn’t go away on its own, it is still many years before it becomes cervical cancer. The treatment for HPV carries the risk of causing cervical incompetence and miscarriages in the future. This is why one of the best preventions from HPV and cervical cancer is the HPV vaccine.
Therefore, if we go down the path of the pap smear and the treatment for the abnormal pap, we may be unnecessarily doing procedures on the cervix that may make it difficult to carry a pregnancy later in life.
Even though we won’t do an internal exam, we will do a general examination, a visual breast examination, and an external pelvic examination. We will test your daughter for sexually transmitted infections (which we can do with a urine sample or vaginal swab). We will also discuss contraception options. It is incredibly important for your daughter to be using contraception if she is sexually active. We will work together to find the best kind of birth control for your daughter that has the least side effects and the strongest chance of success. We also strongly encourage the use of condoms, regardless of their relationship status, to help protect your daughter from sexually transmitted diseases and pregnancy.
Lastly, at the visit, we will have an honest conversation with your daughter about sex and her body. It is important for us to build a strong relationship with your daughter. You will find you have a partner to support you in your efforts to protect her, and she will know she has a medical expert who can help her traverse the sometimes bumpy and complicated road ahead of her.
According to a 2009 Center for Disease Control and Prevention survey of Maine high-schoolers, a quarter of ninth-graders, more than half of 11th-graders, and two-thirds of 12th-graders have had sexual intercourse. It may be cold comfort, but if your daughter is sexually active, at least you are not alone in learning how to deal with this new development.
The best advice I can give is to be honest, open-minded, and supportive. We are here to assist you and keep your daughter healthy and safe.