Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.

About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. The American College of of Obstetricians and Gynecologists (ACOG) published a statement in 2012 outlining rationale for speculum exams and guidelines that support waiting until age 21 years in the absence of a health problem.

Some teens will need a visit with the gynecologist during their teen years because of health concerns, symptoms, or a desire for a long-acting reversible birth control like an IUD (intrauterine device) or implant. IUDs and implants are considered first-line birth control for teens now. The experts say these implantable devices methods are “top-tier contraceptives based on effectiveness, with pregnancy rates of less than 1% per year for perfect use and typical use. These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives. Adolescents are at high risk of unintended pregnancy and may benefit from increased access to these methods.” Some IUD devices use hormones, some do not. Intrauterine devices can be inserted for up to 5-10 years depending on which type a teen chooses. In general, teens will need to see a gynecologist for an IUD placement.

The National Center For Health Statistics reported a near 50% decrease in teen pregnancy over the last 2 decades.

For routine care, teens should see their pediatrician every year for regular, routine well-teen care, teen vaccinations (including the HPV vaccine), and to obtain annual screening for sexually transmitted infections. Sexually active teen girls will need annual urine tests for gonorrhea and chlamydia and blood tests for HIV. We really want to grant teens access to private counseling, support, education, family planning, and well care during high school and don’t want them to erroneously worry about routinely having a pelvic exam.

The American Academy of Pediatrics has a statement on caring for teen girls as well. Ask your teen’s pediatrician their recommendations and if at any time you or your teen is concered about a health problem, don’t hesitate to see the pediatrician or gynecologist. Of note, ACOG recommends teens come in between age 13 and 15 years of age for prevention. However, many pediatricians are very comfortable doing all prevention care for teens. Inquire with your specific pediatrician or family practice physician if you have any concerns. Pediatricians can also explain health conditions where teen girls will potentially need a speculum exam and/or a potential referral to a gynecologist. Here are a few examples.

Reasons teens may need a pelvic exam

• Persistent vaginal discharge that is atypical
• Pain with peeing or urinary tract symptoms in a sexually active female
• Painful periods unresponsive to NSAIDs –nonsteroidal anti-inflammatory drugs (ibuprofen, for example)
• Amenorrhea (no period cycles or very infrequent cycles)
• Abnormal vaginal bleeding
• Lower abdominal pain
• For an IUD device (to have the device inserted and/or removed)
• Suspected/reported rape or sexual abuse
• Pregnancy

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.