Adolescence and puberty can be full of unknowns for teens (and their parents) but it’s important to know you are not alone and it’s just a natural part of getting older.
At Advantia Health, we have providers who specialize in providing gynecologic care through every stage of your reproductive life, from adolescence to menopause, and doing so in a reassuring environment.
Care and Specialized Services for Pediatric Gynecology
The pediatric and adolescent gynecology specialty typically operates closely with pediatricians to assess and care for the needs of girls and teens between the ages of 0-19, an age group that accounts for 23% of the female population.
Adolescent gynecology specialists are trained in caring for patients’ reproductive health needs specific to teens, but oftentimes care for them well into adulthood.
How Pediatric Gynecology Is Different
To provide pediatric gynecology care, physicians trained in obstetrics and gynecology or pediatrics receive additional training through a fellowship program or specialty certification from the American Board of Obstetrics & Gynecology. They may also pursue ongoing education through organizations such as the North American Society for Pediatric and Adolescent Gynecology (NASPAG).
This education equips them to perform specialized techniques and use special instruments, manage developmental disorders, diagnose and treat rare gynecologic conditions, and most importantly, provide empathetic and compassionate care to children and adolescents. They also provide support and education to their caregivers, and assist with care for children who may have other complex health conditions.
Unique Gynecological Needs
Because young children do not yet produce estrogen, they may be more likely to experience certain injuries and infections within the female reproductive system. Pediatric and adolescent gynecologists can help treat these conditions, as well as others that are unique to pre-pubescent girls.
Common Gynecologic Conditions for Adolescents
The average age for menarche (start of menstruation) is 12 years and 9 months in the U.S., but most gynecologists recommend teens establish gynecologic care between the ages of 13 and 15.
In addition to providing education about puberty, menstrual cycles and healthy behaviors, adolescent gynecologists regularly provide care for common gynecologic conditions experienced by teenaged girls such as:
- Irregular periods, including those that are consistently longer than 7 days, periods arriving at intervals either shorter than 21 days or longer than 45 days, and those accompanied by heavy bleeding or severe menstrual cramps or pain (dysmenorrhea). These often result from hormonal imbalances, which means there are a number of treatment options available.
- Sexually transmitted infection (STI) screening and treatment, as up to 1 in every 14 young women between the ages of 14-19 contract an STI, often after their first sexual experience. Teenage girls most commonly are affected by chlamydia, trichomoniasis and human papillomavirus (HPV) infection. Routine STI screening can typically be done without a pelvic exam.
- Ovarian cysts, which can be common in teenagers due to varying hormone levels. Often they resolve without being detected or causing any problems. However, ruptured cysts can cause severe pain and potentially serious complications, necessitating medical attention.
- Hormonal imbalances can cause symptoms such as fatigue, depression and/or anxiety, premenstrual syndrome (PMS), sudden weight gain, and acne, in addition to irregular periods. Various lifestyle changes, supplements and other treatment options are available, depending on symptoms.
- Endometriosis, a disorder that can cause heavy periods, back or pelvic pain, fertility challenges, and pain when urinating or having sex, has no known cure. However, numerous treatment options can help alleviate symptoms and lower the risk of complications from the condition.
- Delayed or early puberty, which can be caused by an underlying medical condition, genetic conditions, environmental factors, hormonal abnormalities or medication, but may also occur for reasons that are unknown. Treatments to correct underlying issues or delay development for early puberty, or help start puberty in cases of delayed puberty, may be an option, depending upon the individual circumstances.
For adolescents, we also treat a wide range of gynecologic disorders and conditions that are experienced by adult patients, including UTI testing and treatment, endometriosis, urinary incontinence and miscarriage.
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- View conditions we treat
What gynecologic services do we provide?
- Endometrial biopsy
- Cervical cancer screening
- Colposcopy
- LEEP
- Gardasil vaccination
- STD screening and treatment
- Vaginitis testing and treatment
- UTI testing and treatment
- Contraceptive counseling and management
- IUD insertion and removal
- Nexplanon insertion and removal
- Depo Provera injections
- Oral contraceptive management
- Emergency contraception
- Pregnancy confirmation
- Pregnancy options counseling
- Preconception counseling
- Vulvar lesions and vulvar biopsy
What gynecologic conditions do we treat for adolescents?
- Irregular periods
- PCOS
- Painful periods / dysmenorrhea
- Heavy menstrual bleeding
- Fibroids
- Adenomyosis
- Endometriosis
- Delayed or early puberty
- Endometrial polyps
- Abnormal pap smears
- Ovarian cysts
- Emergency contraception
- Pregnancy confirmation
- Miscarriage
- Ectopic pregnancy
- Infertility
- Urinary incontinence
- Pelvic organ prolapse
- Vaginismus
- Painful sex / dyspareunia
- Vaginal dryness
- Vulvodynia
- Vulvar dermatoses and itching
- Vulvar lesions and vulvar biopsy
- Bartholin’s gland cyst / abscess
What gynecologic surgeries do we perform?
- Hysteroscopy
- Polypectomy
- LEEP
- Dilation and curettage
- Myomectomy / fibroid removal
- Hysterectomy – laparoscopic, vaginal, and abdominal
- Tubal ligation / sterilization
- Ovarian cyst removal
- Endometriosis excision
Does Your Child Need a Pelvic Exam?
For an initial reproductive health visit, which is recommended between the ages of 13 and 15, there is almost always no need for a pelvic exam at an initial gynecologist visit—the goal is just to have a conversation with the teen, usually both with a parent and also one-on-one.
A pelvic exam may be necessary to perform some procedures, or to support diagnosis and treatment of some conditions if symptoms warrant the exam.
FAQ
When should an adolescent first visit the gynecologist?
The American College of Obstetricians and Gynecologists (ACOG) recommends that an initial reproductive health visit take place between the ages of 13 and 15. This visit is an opportunity for a teen to establish a relationship with a gynecologist, to address any concerns that may have come up in terms of puberty, menstruation, or other issues, and to begin to give anticipatory guidance about health topics for the teenage years. There is almost always no need for a pelvic exam at this visit—the goal is just to have a conversation with the teen, usually both with a parent and also one-on-one.
What are pap smears? When do they start? Who needs to get one? How often?
Pap smears are a screening test for pre-cancerous cells of the cervix. They are done by using a speculum in the vagina to see the cervix, and gently scraping the outside of the cervix with a plastic brush to retrieve a cell sample. They are recommended to begin at age 21 for everyone with a cervix, regardless of whether or not they are sexually active. If the results are normal, they are usually done every 3 years (or up to every 5 years over age 30 if done with HPV testing). We still recommend seeing a gynecologist annually, even if you are not due for a pap.
What kind of cycles are normal for teens? Isn’t it normal for periods to be irregular in adolescence?
Some irregular periods can be normal, especially for the first few cycles after periods start. However, after a few months periods typically become more regular. While the normal cycle length for adults ranges from 21 to 35 days, the normal range for adolescents is anything from 21 to 45 days (counting from day 1 of one period to day 1 of the next period).
We recommend that teens track their periods using an app to see if their cycles are within the normal range. Sometimes irregular periods can be a sign of a hormonal imbalance called PCOS, other times they can be due to a teen being very thin or athletically active. Sometimes they are just how a teen’s cycles are, and often regulate over time.
When should I be worried if my teenage daughter isn’t showing signs of puberty?
There can be a normal variation in when puberty occurs. The average age of menarche (first period) is between 12 and 13 years old, and usually occurs within 2-3 years of breast budding. Medical advice should be sought if a teen has not begun any breast development by age 13 or has not gotten her period by age 15 (or within 3 years of breast development).
What options are there for teenagers with very painful or heavy periods?
Lots of options! 1 in 4 teens have severe pain with periods and have missed school due to their period. We believe that girls shouldn’t be left out or left behind because of periods! We will work together to find the method that works best for each individual.
The wide range of options available include:
- High-dose NSAIDs (like ibuprofen or naproxen)
- Hormonal medications like birth control pills, IUDs, or Depo shots. Hormonal options are safe for teens and are usually very well tolerated with minimal side effects.
- Treatment can even extend to surgery in rare cases when there is a high suspicion for endometriosis and other options have not helped.
Can teenagers get an IUD? Does it hurt? What about the arm implant?
Yes, IUDs are a great form of contraception for teenagers, and we can also use them to control painful and/or heavy periods. The insertion is done in the office and is a bit crampy but only lasts a few seconds. In rare cases, we can also offer insertion with anesthesia if needed. We also offer the arm implant (Nexplanon) in our office as well. Both are great options and we would be happy to discuss them more at an office visit or telemedicine appointment!
If I want testing for sexually transmitted infections, do I have to have a pelvic exam?
No! All routine STI screening can be done without a pelvic exam—gonorrhea and chlamydia can be tested through urine, and the other tests (HIV, syphilis, Hepatitis B / Hepatitis C) are blood tests. We do not routinely screen for herpes unless someone is having symptoms.
I’m a trans, agender, genderfluid, genderqueer, or nonbinary teen or young person. Do I need to go to the gynecologist?
There are several reasons why trans, agender, genderfluid, genderqueer, or nonbinary teens and young people may visit the gynecologist. One common reason is menstrual suppression. This may include using hormonal medication to help with painful/heavy periods or to try and stop periods altogether. Other reasons may include STI testing, contraception, HPV vaccination, or (starting at age 21) pap tests. While we do not prescribe testosterone, we are available to serve as a resource for teens seeking gender-affirming gynecological care and are able to make referrals to gender-affirming primary care providers who do.
How will I know that I will feel safe, respected, and comfortable in your office as a trans, agender, genderfluid, genderqueer, or nonbinary teen?
We unequivocally support you in your gender identity and self-expression and are committed to providing a non-judgmental and supportive space where you can seek gynecological care free from harm. We understand that medical contexts, and gynecology offices, in particular, can and have been hostile environments for trans, agender, genderfluid, genderqueer, and nonbinary young people. We are committed to referring to you with your specified name and pronouns, avoiding unnecessary exams, using anatomical language that is comfortable for you, and working together with you to make sure you get the care you need.
