Dear My Little Yoni: What Do I Need to Know About Cervical Health?

“Dear My Little Yoni,  

My daughter, Sammy, has her very first gynecologist appointment coming up. I worry because she’s only 13, and I didn’t have my first gyno visit until I was 21. I’m not sure how to explain to her why these visits are necessary and that she can feel comfortable with the doctor, when I’m still nervous at the doctor’s office. How do I explain the importance of health screenings?” 

 - Jennifer 

Dear Jennifer, I understand! Doctor’s visits can induce nerves and fear in most people and with OBGYN appointments, it makes many women more nervous and concerned about their vulva appearance, smell, and even pubic hair. However, getting regular screenings is a vital part to your health. I’m happy you are supporting your daughter to begin this part of her healthcare from a young age. Doctors recommend a yearly checkup to focus on the female reproductive system, starting between the ages of 13 and 15, so you are right on target. These visits, known as ‘well-woman visits’, can catch small issues before they become big problems. These screenings help your doctor get a baseline for you so they can monitor your reproductive health over time. 

Sammy isn’t alone in her discomfort, and neither are you. You can ease her nerves by telling her what to expect in a well-woman visit. Explain to your daughter why the visit is needed, what she can expect, and talk about any questions or fears she might have. Start by discussing that a well-woman visit provides two things: information and treatment. During her visit she can get accurate information and confidential answers to her questions about sex, sexuality, puberty, self-pleasure, sexual risks, and periods. Her doctor can diagnose and treat problems, such as missed periods, and pelvic or stomach pain. (Be careful if her doctor recommends hormonal treatments such as birth control from a young age.  We now know that early hormonal treatment such as birth control can be linked to a whole host of problems later in life!) Her doctor will answer any questions she has, to ensure she leaves the appointment feeling comfortable and confident. If this is not your experience for some reason, please do more research and find another OBGYN that you feel confident and comfortable with. 

For some girls, the first OBGYN visit can be as simple as a talk with the doctor. For others, their doctor may do a physical exam, including examining the vulva and breasts. Reassure your daughter that the physical exam doesn’t take long and is a quick check to track your daughter’s development. Let your daughter know that she won’t need an internal pelvic exam and pap smear until she’s older, starting at age 21. Although if your daughter experiences heavy bleeding, painful periods, or unusual vaginal discharge, her doctor might recommend a pelvic exam sooner. Talking about these things before the doctor visit helps your daughter feel prepared and at ease.  

When choosing a health care provider, make sure Sammy’s involved. Ask your daughter what type of health care provider she prefers to see. Female or male? Younger or older? Does she want to see her pediatrician or someone new? Does she want to see your gynecologist, or would she prefer a doctor you don’t know? After you’ve determined your daughter’s comfort level; you can ask around to see who fits your family’s needs. Try asking these questions to help choose a health care provider:  

  1. What is your confidentiality policy? This allows your daughter to assess how comfortable and open she wants to be with this doctor. 
  2. What is your approach toward discussing sexual activity? Try and find a doctor with a positive approach to explaining sex and sexuality to your daughter.  
  3. Will you see my daughter each visit or will she see different providers? Your daughter may want to see the same doctor and build a relationship with them, so ask the office what their policy is.  
  4. Who else will be in the exam room? Your daughter needs to decide if she wants you there with her, or wants to be by herself. Reassure her that both options are okay with you! 

Include your daughter in this process and share the answers with her. Don’t hesitate to talk to multiple healthcare providers before making a decision. You want find the best doctor to care for your daughter and enforce positive experiences with reproductive health from the beginning. 

Even if your daughter wants you in the room during the exam, ask her if she’d like alone time with the doctor to ask questions. Teens and tweens are entitled to privacy. Alone time lets her get to know her doctor and helps her feel at ease for future visits and confident in taking her health into her own hands.  

After choosing a healthcare provider and explaining the importance of a well-woman visit, your daughter may have more questions. She'll wonder what the doctor will ask, what types of exams will happen, and what tests will be done? Answer all her questions honestly, and let her know she’s not alone in her nerves. Explain the doctor will ask the following questions:  

  • When was your last period? (If your daughter doesn’t remember, try to help her think back and better track her cycle.)  
  • Are you, or have you ever been, sexually active? (this means vaginal, oral, or anal sex)  
  • If so, are you using contraceptives to protect against STIs, and reduce the risk of pregnancy?  
  • Are you having any problems with your period, such as pain or heavy bleeding?  
  • Do you have any unusual vaginal discharge, sores, itchiness, or discomfort in the vaginal area?  
  • Do you think you could be pregnant?  

Share these questions and encourage her to have answers ready for her appointment. Her answers tell the doctor what tests to run and what issues to discuss. Remind her it’s important to answer truthfully, and she shouldn’t feel embarrassed. The doctor discusses these topics with many patients, and will keep her information confidential.  

During the exam, a couple different things happen. First, there will be a basic health check. Like a normal checkup, a nurse or assistant will measure things like weight, heart rate, and blood pressure. The doctor will examine her neck, heart, lungs, and belly to get a baseline of her general health for future exams. Before the external exam, your daughter will be asked to undress and put on a gown. The doctor will perform a breast exam. Although breast cancer in teens is rare, the breast exam is an important part of the visit. The doctor will apply light pressure to the breasts, and move their fingers in circular motions to check for lumps, cysts or breast problems. The doctor will ask her to lie on a table with her knees bent and spread apart. In this position the doctor will check the vulva to make sure there are no sores, swelling, or any other issues.  

If a pelvic exam is necessary, the doctor will place one hand on the outside of your daughters' belly and one or two fingers inside the vagina. That way the doctor can feel the size and position of the ovaries and uterus. A speculum, a tool that opens the vaginal walls, lets the doctor see the walls and cervix. This allows the doctor to do screening tests like pap smears and STI tests. A pap smear occurs during an internal examination. Gynecologists recommend pap smears starting at age 21, and then every 3 years for women in their 20s. During a pap smear, the doctor lightly scrapes the cervix to obtain a cell sample, using a spatula or small brush. They test the sample in a lab for cell abnormalities and cervical cancer. Even if your daughter received an HPV vaccination, she still needs regular checkups and pap smears starting at age 21.  

Although STI testing isn’t part of the well-woman visit; girls who have been sexually active should ask for STDI screening. Doctors do these tests with blood or urine samples, or a sample cotton swab taken during the pelvic exam. Explain the sexual risks to your daughter. Even though she may trust her partner, it’s a good idea to get STI testing. Reassure your daughter that she can get her results privately and that she doesn’t have to share the results with you if she’s uncomfortable doing so, although encouraging sharing so that she feels supported is recommended.   

After the visit, talk to Sammy about how she felt about it. If she was made uncomfortable by the doctor or nurse practitioner, reassure her that you can find a new one. Well-women visits happen every year in order to keep your daughter and her yoni happy and healthy! Explaining this to your daughter lets her know how important her vulva health is. This Cervical Health Awareness Month, we should ALL take the time to reinforce the importance of regular screenings to the ones we love. Having annual screenings allows medical professionals to catch small things before they get bigger and ensure your vulva is healthy over the years. I hope Sammy’s first well-woman visit goes well, and that she finds the right doctor to help her care for her reproductive health. Keep your Yoni happy and healthy Yoni Gang!