Here’s what I was taught, about teens, virgins, pelvic exams and the current thinking on timing of cervical smears.
The UK and Ireland do not usually require a pelvic exam before prescription of hormonal birth control, if a girl has periods it is usually enough to indicate that everything is present and correct. Pelvic exams are also of limited value unless there is gross pelvic pathology, if there were issues suggestive of this the family doctor (usually the person who prescribes birth control) may decide to refer to a gynaecologist for examination under anaesthesia (EUA), laparoscopy or hysteroscopy, often all three at once.
Pelvic exams are not done on virgins unless there is a pressing reason to do it, it is not and should not be a routine thing as it can be pretty traumatic. Rather than making future gynaecological procedures and examinations less stressful, it can actually contribute to or trigger psychosexual disorders.
It takes, on average, 10 years for CIN 1 to progess to cervical cancer, and 30% of CIN1 will spontaneously regress without further treatment. Add to this the fact that the hormonal milieu of teenagers makes cervical ectropia and mild dysplasia more common, and aggressive treatment of CIN 2 (which may have resolved or not progressed to cervical cancer) has implications for fertility, early cervical smears are no longer encouraged.
Early (i.e.before age of 18) cervical smears do little to reduce the incidence of cervical cancer (which is still most common in women in their 30s-50s who have never had a smear), may cause unnecessary patient anxiety, and could lead to overtreatment with subsequent complications.
A smear one to three years from when the girl first becomes sexually active, and every 3 to 5 years subsequently (if everything is normal) is considered more than adequate. All women are offered a smear at 21.
I realise that practice in the USA differs significantly, some of this is due to the fact that gynaecologists do some of the work that is done here by GPs, and some of it, such as the requirement of a pelvic exam before prescription of birth control, is due partly due to defensive medicine.
Slightly off topic, but in my experience, the *only * doctor most healthy women between the ages of 15 and 50 see *regularly * is their gynecologist.
Years ago, my insurance company changed their policy in such a way that only a GP could be a primary care physician. I spent two years having to get referrals from a GP who didn’t know me to see my gynecologist, who’d seen me every six months since I was fifteen. Just one example of the many ways in which the US healthcare system often thoughtlessly discriminates against women.
Sorry, only just got around to reading all of Eva Luna’s cites. Personally I’m surprised that the vaccine will only be offered to women.
Ano-genital warts are known to be a causative factor in the development of anal carcinoma and penile carcinoma- admittedly rare diseases, but fairly horrendous ones. I’d hope that a universal HPV vaccination scheme would be rolled out eventually.
To be fair, condoms don’t provide much protection against HPV, there are no tests to see if a male has it, and 50-80% of the population does have it.
FWIW, an 11 year old girl is perfectly capable of being a sexual being with a strong sexual response (not that having sex with an 11 year old is ever anything but abuse).
Also FWIW, I prefer and always have preferred male gynos. I’m more comfortable around men and it seems more familier to have a man rooting around down there.
Our protocol at Planned Parenthood is to recommend annual exams (pap smears) begin a year or two years after becoming sexually active. We recommend a pelvic exam with CT/GC testing three weeks after any partner change, including first sexual activity, or once a year routinely after becoming sexually active.
If a patient comes in scheduled for an annual exam who has never been sexually active, the nurses will exam them if they choose to continue and have it done, but will always have a conversation with the patient about how it’s not really necessary until they are sexually active. Unless there’s something abnormal going on, there’s not going to be anything to look at or test.
As far as the OP is concerned, while most of the young girls I see come in around fifteen, thirteen is not terribly uncommon, and I’ve seen a small number of twelve year olds. The youngest patient I ever saw was eleven, and was heartbreaking not necessarily because of the number of her age, but because of the circumstances that led her to be sexually active beginning at the age of nine, and not by choice. We are always, always professional, and medical professionalism demands a certain level of decorum and resistance to familiarity, but as my clinic manager once put it… in that situation you can toss many of the rules out the window. I don’t mean anything that would overstep HIPPA or any of the other hard and fast rules, of course, but I definitely have more of a “counselor” or heart-to-heart type conversation with very young girls than I ever would with someone older. Often these girls have never had an adult who would speak openly or honestly with them about these topics, and while I’m not their mother or sister or aunt, I am a knowledgeable, caring adult who can and will take an extra measure of time out of their day to talk with them. We are mandatory reporters, and there have been an unfortunate number of times I’ve had to excercise that role.
While sad, I definitely wouldn’t consider the OP’s story to be bizzarre, nor excessively unusual. Spend a few weeks at Planned Parenthood and you’ll hear some bizzarre stories . Keep in mind that most young kids are never going to see their family doctor if they have something going on that might be sexually related, because they know their parents are going to know absolutely everything that happens at their family doctor’s office. They come to see us because their confidentiality is held in strictest trust. I wish that differentiation didn’t have to exist, but it does.
Teenaged girls keep things from their parents despite their parent’s best intentions. At thirteen, girls are very self-conscious about their bodies, and I can totally see waiting until things were completely unbearable (worrying yourself sick the whole time) before building up the courage to ask your mother to take you to the doctor. Between the ages of 12 and 14 I went though some painful and heavy periods that, in retrospect, I probably should have seen a doctor about, but I didn’t know whether it was unusual, and I’d read a description of a pelvic exam in a magazine and to me at the time it seemed considerably more horrific than gushing buckets of blood and having nasty cramps every month. At that age I thought I’d just die of embarassment if a stranger did those things to me.
I had a more open relationship with my mother about sex than most of my peers, and I got The Talk—at 12, too late for this girl’s experience!—but while she might have been all like “You can talk to me about anything,” and “You should know you can come to me for birth control when the time comes,” when I started having sex I got my own birth control, and I didn’t tell her I was having sex for two years. I was just painfully embarrassed about talking about sex with my mother, not because of anything she did, but because I was a teenaged girl.
I don’t feel it’s warranted to judge the mother in this case, because just from the OP we can’t tell what she’s told her daughter about sex or what their relationship is like. She was there, getting her daughter medical care—better late than never. It could be that she was silent because she wasn’t as concerned about her daughter’s condition as she should have been, or it could have been because she was completely shocked and freaked out and didn’t know what to say. I mean, shit, the woman just found out that her daughter had had sex at age 11 and had a STD. I wouldn’t expect most mothers to be able to discuss the situation calmly and rationally at that point, and it could be that remaining silent was the best she could manage right then.
I am one of those women who seldom gets sick, so the only doctor I saw for decades was my OB/GYN!
I hate to say this, but the “silent mom” in the OP gave me the creeps. If it WAS abuse (and I’m not saying it was), maybe mom knew exactly what was going on…
I too went to Planned Parenthood for by birth control pills so my mom wouldn’t know. We had and have a great, open, honest relationship. But EEEEEEEWWWWW! Tell my mom I was having sex with my first boyfriend? Guh-ross!
There are many days that I thank God I have two boys. Of course, teaching them how to be men will be my challenge…
Agreed, but there are so many other things they can help prevent. I know condoms don’t equal perfect safety, but God knows they’re far better than nothing.
I have a fourteen year old daughter, and we talk about sex pretty freely, in the abstract. I’ve told her that if she wants the pill, I’ll get her the pill. But since I remember that there’s no power on earth that would have made me tell my mom that I was actually having sex, I’ve also given her the address and phone number of the closest Planned Parenthood location, and told her that they’ll set her up. I’d rather have her get what she needs without my knowledge than go without because she doesn’t want to involve me.
. Keep in mind that most young kids are never going to see their family doctor if they have something going on that might be sexually related, because they know their parents are going to know absolutely everything that happens at their family doctor’s office. They come to see us because their confidentiality is held in strictest trust. I wish that differentiation didn’t have to exist, but it does.