Our Daughters' Health

By taking 13-15 year old girls to a gynecologistthey are sexually active, parents are seizing an opportunity to tell their daughters, I care about your health and I respect you as a person.
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Things are much different today then they were 25 years ago. Our teenage daughters are different than we were at the same age. Somehow, however, the way in which we treat these girls from a medical and psychosocial perspective has not changed or evolved. Many physicians and parents alike are stuck in the 70s or 80s when it comes to approaching adolescent health issues, and our teenage daughters come out on the losing end of this jaded practice. A modern teen, therefore, requires a modern approach to her overall wellness!

Part, but not all, of this approach entails a comprehensive philosophy regarding the field of adolescent gynecology. Never heard of this specialty? You are not alone. In fact, many consider this to be an oxymoron! How and why should a teenager have a gynecologist? Well, nationally there are actually guidelines and recommendations set forth by the American College of Obstetricians and Gynecologists that suggest that a girl first see a gynecologist between the ages of 13 and 15. Despite the fact that these recommendations are not new, few pediatricians and even fewer parents are aware of them. Many parents still equate a gynecologist with a 'sex doctor' and feel that taking a virginal 13-year-old to see a gyn is tantamount to giving her a license to go off and start having sex. Scientific research has found this to be conclusively false. Giving girls good information about their bodies does not promote premature sexual behavior; in fact, it delays it!

Teaching teenage girls about their bodies has been my passion since I was a junior resident in Ob-Gyn, which was the time I became interested in this sub-specialty. We had just operated on a 12-year-old who had experienced a condition known as ovarian torsion, in which a cyst on the ovary forces the ovary to twist around its blood supply, cutting off the flow of blood and oxygen to the ovary. This is a surgical emergency, since if the ovary is not untwisted in time, the ovary can die, sometimes necessitating removal of the ovary itself. Unfortunately, this patient had required removal of the ovary (which was more common done 10 years ago than it is today) and had undergone major surgery in the process. The pivotal moment for me as a physician came when I observed our surgical team treating this 12-year-old no differently than we would treat a 32-year-old. After all, she had the same body parts; why not treat her like we treat all gyn patients? Well, for one thing, because teenage girls are not young women. They are caught in that nether-region between childhood and adulthood, and are different physically and emotionally from adult women. As such, I felt they should be treated differently.

Parents and doctors alike can start treating teenage girls differently in some very basic ways. By taking 13-15 year old girls to a gynecologist before they are sexually active, parents are seizing an opportunity to send some major messages to their daughters: I care about your health, I respect you as a person, I want you to understand your body rather than fear it or be confused by it, and I want you to put your health first in your life. These early gyn visits do not require a pelvic exam unless the teenager is sexually active, and are a good time to review important facts about the menstrual cycle, breast and bone health and minimizing high-risk adolescent behaviors. Many teens have no idea what a 'normal' menstrual cycle is. Many have mothers who are battling breast cancer and fear that they too will be affected by the same illness. Many teens have eating disorders ranging from anorexia to obesity and are unaware of the subsequent impact on their reproductive health, their bones and their mental health. 10-20% of teenage girls have polycystic ovarian syndrome (PCOS), a common hormonal imbalance that can affect their skin, their weight, their periods, and increase their risk of developing Type 2 Diabetes and do not know they have PCOS, how to manage it or how to minimize its risks. The list goes on and on. It becomes clear that a gynecologist, a woman's health specialist, is poised in a perfect position to advise a teenage girl about a wealth of head-to-toe physical issues that stand to have a major impact on her lifelong health and wellness!

The goal in medicine today then, now more than ever, is prevention of disease and maintenance of health. The time to take advantage of a figurative clean slate is before any pathology sets in, not after. Hopefully, by bringing our dialogue with our teenage daughters into this millennium, we can empower them at younger ages to take responsibility for their bodies and their health. By speaking their language we are showing our respect for their individuality and by teaching them the facts and not imposing myth or hearsay over their health practices we are enabling them to strive for higher levels of well-being. That's why I wrote this book for parents and teenage girls. After all, if they don't know the scoop on their own bodies, how can they keep themselves healthy?

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