Frequently Asked Questions

A Pediatric and Adolescent Gynecologist specializes in the gynecologic and reproductive health care of children and adolescents.

This type of specialist has completed a residency in Obstetrics and Gynecology, and has either significant experience in caring for the pediatric and adolescent population or has completed additional sub-specialty fellowship training.

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. This visit provides an opportunity for 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.

A visit at this age establishes an environment where patients feel confident and comfortable discussing their reproductive health in a confidential and supportive setting, and allows physicians to screen for menstrual irregularities, high risk behaviors and sexually transmitted infections.

An initial pelvic examination is recommended for patients 21 years and older. 

In patients younger than 21 who are healthy and asymptomatic, an external exam is adequate – this allows the physician to evaluate the external genitalia – including assessment of hygiene issues and abnormalities of the vulva, introitus and perineum. It provides the opportunity for education on normal anatomy. 

Speculum and bimanual exams are indicated in patients younger than 21 years old if they are symptomatic or have concerns suggestive of female genital tract, pelvic, urologic or rectal problems.

A pelvic exam includes three parts:

• Inspection of the external genitalia, urethral meatus and vaginal inroitus
• Speculum exam of the vagina and cervix
• Bimanual examination of the uterus, cervix and adnexa – in some cases, this may also include a rectovaginal exam

Any type of pelvic exam will always be performed after the patient consents to the exam and with a chaperone present.

Routine cervical cancer screening via PAP testing starts at age 21 regardless of a patient's sexual activity. This test is part of routine health care and will be conducted every three to five years based on results.

Any type of pelvic exam will always be performed after the patient consents to the exam and with a chaperone present.

A PAP test screens for abnormal cell changes of the cervix. The cervix is the lower part of the uterus (womb) which opens into the vagina. Cell changes can develop on the cervix that, if not found and treated, can lead to cervical cancer. Cervical cancer can almost always be prevented and having regular Pap tests is the key.

Patients will lie down on an exam table. The provider will place an instrument called a speculum into the patient’s vagina so they can see the cervix. He or she will then use a special stick or brush to take a few cells from the surface of and inside the cervix.  A Pap test may be mildly uncomfortable but should not be painful. You may have some vaginal bleeding afterwards.

A pelvic exam evaluates the anatomy of the reproductive tract. A pelvic exam includes three parts:

• Inspection of the external genitalia, urethral meatus and vaginal introitus
• Speculum exam of the vagina and cervix
• Bimanual examination of the uterus, cervix and adnexa – in some cases, this may also include a rectovaginal exam

If a speculum and/or internal exam is needed, patients will undress from the waist down, lay on the exam table, place their feet on foot rests and relax their knees to the side. The provider will inspect the external genitalia first, then place a lubricated speculum into the vagina. Inserting the speculum helps moves the vaginal walls to the side, so that the physician can examine the vagina and the cervix.

The provider will then remove the speculum and place one or two fingers into the vagina and one hand on the lower abdomen. The provider's hands are used to examine the size and position of the uterus, cervix and ovaries. They are also evaluating for any masses and tenderness. 

Any type of pelvic exam will always be performed after the patient consents to the exam and with a chaperone present.

STI testing is recommended for all sexually active adolescents. STI testing depends on which infection the provider is screening for. Testing may include:

• Physical exam — Your provider may look at the genitals and/or anus for any signs of an infection, such as a rash, discharge, sores or warts. This exam can be similar to a pelvic exam.
• Blood sample — Your provider may request a blood sample, either with a needle or by pricking the skin to draw drops of blood. This may be done in clinic or in a laboratory.
• Urine sample — You may be asked to urinate into a special cup.
• Cultures — Your provider will use a swab to collect samples that will be looked at under a microscope. These swabs can be obtained from your vagina or cervix. Samples that are obtained from the vagina involve inserting a small Q-tip into the vagina. A speculum exam may not always be necessary.

STI results are confidential. Our team does encourage open communication between adolescents and their parents/guardians. Our team can help patients talk to their parents/guardians

Ovarian cysts are common. A cyst is a spherical area in any organ in which an outer wall encloses a type of tissue of a different consistency than the normal tissue.  Within the ovary itself, there are well over a dozen different types of cysts.

There are two main types of cysts:

• Normal, physiologic, functional cysts
• Abnormal, pathologic cysts

Normal, physiologic, functional cysts typically do not cause symptoms and go away on their own. Cysts that are not causing symptoms, are less than 4 cm in size, are only fluid filled (have no solid components) are not worrisome.

Worrisome cysts or cysts that need further evaluation are those that cause symptoms (pain), are larger than 4 cm, have solid components or persist.

Ovarian cysts are evaluated by a history and physical exam. In addition, imaging studies (i.e. pelvic ultrasound, CT or MRI) may be needed to further evaluate the cyst.