At what age should my daughter start seeing a gynaecologist?

Raising children is a whole feat by itself. For parents of daughters, the question of when their teenage girl needs to start seeing a gynaecologist would eventually surface. While there’s no set age on when a teen girl should officially see a gynaecologist, I recommend between 13 to 15 years of age, regardless of whether she’s sexually active or not. 13-15 is when most girls in Singapore start menstruation.

If you already have a family doctor, you might then wonder if a women’s health specialist is really necessary since both doctors can screen preventive health exams for women. That is not wrong, but a gynaecologist is better equipped to answer questions on:

• The female reproductive system, including the breasts, vulva, ovaries and uterus
• Urological or gastrointestinal symptoms
• Menstruation, fertility, contraception and pregnancy
• Sexual health concerns like libido or pain
• Preventive health exams and screenings for the future

In addition, if your daughter experiences these symptoms, a gynaecologist visit would definitely be helpful. They are:

• Delayed puberty — no breast tissue development or changes before age 14, no menstrual cycle by age 16
• Frequent painful period cramps to the point she has to miss school or other activities
• Unable to put on a tampon

The first visit

A girl’s first visit to the gynaecologist would involve answering some questions and doing some tests. Whether or not a parent needs to be in the room is entirely up to the both of you to decide, but whatever the decision is, I recommend that you give your daughter some alone time with her gynaecologist to a) share private information she might not be comfortable revealing with you around and b) get to know the doctor better to set the tone for a healthy doctor-patient relationship down the road.

Usually, I will ask questions like:

• When did you have your last period?
• Are you or have ever been sexually active (this includes vaginal, oral and anal)? Did you or are you using any form of birth control and protection?
• Are you experiencing any problems with your period, such as heavy bleeding or cramps?
• Do you have vaginal discharge that looks unusual or gives off an odour?
• Are you experiencing any sores, itchiness or discomfort in your vaginal area?
• Do you think there’s a chance you could be pregnant?

The answers I get will help me determine what tests to run and what issues to further discuss. Parents, I will need your help here to let your daughter know that I am here to help and it would be best if she could answer the questions truthfully. Remind her that the information she gives is strictly confidential.

Getting to important conversations

While your daughter’s first visit is more for me to establish a relationship with her and discuss about her development, different conversational topics will come into play. They can range from puberty, STIs, contraception to even sexual and mental wellbeing. Generally I allow patients to lead the conversation; it is usually tailored to meet her needs.

Another major topic we might talk about during the first few inpatient visits is regarding getting vaccinated to prevent HPV, a sexually transmitted infection associated with most cervical cancers. This vaccine is one of the most effective tools for HPV prevention and is ideally administered before the age of 15 or before your daughter becomes sexually active. Your daughter can still get the vaccine after sexual activity, but it will be less effective.

Carrying out physical tests

Some physical tests I may carry out include:

Basic checks

This includes measuring your daughter’s height, weight, blood pressure and heart. This gives me a general sense of her health.

External examination

This is to check her vulva to make sure there are no sores, swelling or problems associated with the external genitalia.

Breast exam

Although breast cancer is very rare in teenage girls, it is still important to conduct a breast exam to detect any lumps or cysts.

For tests like pelvic exams, they will only be conducted when warranted. At this age, a Pap smear is also not required. The current recommendation is to start Pap smear screenings at the age of 21, regardless of whether the patient is sexually active or on birth control.

Keeping a close eye on your daughter’s needs

If nothing unusual comes up during the first visit, the next visit may not be till years later unless your daughter develops issues like irregular periods or a yeast infection. Also, keep a lookout for her development; in general, if girls don’t develop pubic hair or breasts by 14, they may need further evaluation. The same goes for girls who by 16 have pubic hair and breast development but no menstruation.

Also, keep a lookout for her period — it’s normal for a girl to have irregular periods especially in the first two years of menstruation, but make sure her menses don’t come at odd intervals consistently. It is also a red flag if her period is so heavy she’s changing pads or tampons every hour.

If your daughter exhibits any of those issues, then a visit to a gynaecologist is definitely warranted.

References

1. American Academy of Pediatrics Committee on Adolescence, American College of Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz, A., Laufer, M. R., & Breech, L. L. (2006). Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics, 118(5), 2245–2250. https://doi.org/10.1542/peds.2006-2481
2. Wang, R., Pan, W., Jin, L., Huang, W., Li, Y., Wu, D., Gao, C., Ma, D., & Liao, S. (2020). Human papillomavirus vaccine against cervical cancer: Opportunity and challenge. Cancer letters, 471, 88–102. https://doi.org/10.1016/j.canlet.2019.11.039

This article was written and medically reviewed by Dr Tan Poh Kok (PK Tan), a Senior Consultant Obstetrician and Gynaecologist at PK Women’s Specialist Clinic.