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Taking Your Tween to the OB/GYN

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Is this a good idea, or not? Dr. Jennifer Ashton sets us straight.

The Body Scoop for Girls

Jennifer Ashton, M.D., OB/GYN, is the author of The Body Scoop for Girls, available now in bookstores everywhere. The medical correspondent for "The Early Show" and CBS's "Evening News with Katie Couric" sat down with momlogic to answer our top questions.

Momlogic: One of our readers says her 8-year-old is asking where babies come from. Is it too soon to tell her?

Dr. Ashton: Where babies come from is an appropriate conversation to have considerably before the age of 10. Most young girls before that age will ask about it spontaneously, so parents have to be ready.

I have a 10-year-old daughter; when she was 8 or 9, she asked me where babies came from. I based my answer on the level of detail that was contained in her question.

I remember at one point trying to think on the fly -- trying to veil it with some kind of nonfactual information, but then I stopped myself and said: She asked a very specific question, I need to give her a very specific answer. Kids are smarter than that.

I said: "A man's DNA mixes with a woman's DNA and a baby grows."

When it comes to your response, the simpler the better, but take your cue from your child. Answer as much as they ask. If they ask: HOW does the DNA mix with the mom's, I would say: "A man's penis goes in a woman's vagina to put the DNA in there." My daughter hasn't said "What does that look like?" but if she does, I will explain that it comes in liquid form, and it is called semen.

ML: When should we take our tween or teen daughters for their first OB/GYN exam?

Dr. Ashton: I recommend what ACOG recommends: for a girl to see a gynecologist between the ages of 13 and 15. However, this is hardly ever done. Despite the fact that we have so much information on the Internet today, many pediatricians don't know this is the recommended age, and so parents don't know these guidelines.

ML: Many parents are scared to take their young daughters to the OB/GYN. What would you say to them?

Dr. Ashton: An OB/GYN is not going to speak to a 13-year-old like a 23-year-old. We have a new-age type of teenager today and that requires a paradigm shift in the way we treat those teenagers mentally and physically.

I remind parents that we're not just sex doctors, we're women's health specialists. The average age of a first period is 12 years old for Caucasian girls and 11 years old for African-American girls. You could argue that you should take your daughter to the OB/GYN when they get their first period.

At that time, we would discuss breast and bone health, how to follow your periods, hormonal imbalances, acne, and a whole realm of high-risk teen behavior. Sex is usually the last thing we talk about.

Many moms worry that an OB/GYN will say, "If you're ready to have sex, go on the pill." That couldn't be further from the truth. A good OB/GYN will tell you why you should wait BEFORE having sex.

If you don't expose a child to the sort of information a good OB/GYN will impart before she goes to college, it's really a missed opportunity. You wouldn't study for the SATs AFTER you get into college, would you? We need a more proactive approach.

ML: Many moms think teaching abstinence is unrealistic, but we'd like to encourage our girls to wait to have sex at least until they're 18. How can we do that?

Dr. Ashton
: It's really important for a mom to make their expectations for their daughter's behavior crystal clear. I often ask patients: "Has your mother ever told you, 'I expect you won't have sex til X age'?" Almost none of them have.

You need to convey that expectation to your daughters. I tell moms, "I'm the doctor, you're the mother. Medically, I think 18 is a reasonable age. But if you want to say 22, say 22 -- but say it."

A lot of the time, mothers don't say anything. They expect that a daughter will intuit these guidelines and expectations without a word. But you need to speak up.

Part of the explanation from moms needs to be medical. For instance, you could say, "This is why I think 18 is reasonable -- changes occur in the cells of the cervix before 18 that put you at higher risk for STDs."

ML: Where do you stand on the HPV vaccine?

Dr. Ashton: HPV is not a black or white issue -- reality is somewhere in the middle. I respect that individual decision whichever side the mother comes down on. I do think it is a safe vaccine. It's been given over 20 million times in the U.S., and there have been 780 questionable, serious side effects. If you're one of those 780 people, you're obviously going to feel differently -- I'm not taking anything away from that. But the statistics support that it's a safe vaccine. I do think the way it's been marketed plays off fear. In the U.S., cervical cancer is rare. In Africa, it's the number-one killer of women. Here, 4,000 women a year die from the disease. To play on these fears is a little unfair.

ML: At what age should girls get the vaccine?

Dr. Ashton: Doctors can give it starting at age 9, but I think that's too young. It's usually not needed at that age. I think closer to 18 is a much more reasonable time to give it. Gynecologists should be doing counseling for this, not pediatricians. We are the ones who treat cervical cancers.

ML: When should girls get their first pap smear?

Dr. Ashton: Age 21. So many girls who are sexually active in their teens will be exposed to HPV and will have an abnormal pap smear. But 85% of those abnormalities will go away on their own. That's why 21 is a very reasonable age.

ML: What if your teen wants to get a genital piercing?

Dr. Ashton: Remind them that it's a minor surgical procedure and needs to be taken seriously. Make sure they are going to a licensed place that uses sterilized equipment, not re-used equipment. In most states, if a teenager is under 18, they will need parental consent. I would recommend that the mother talk to the teenager about why she wants to get this done. It could be a sign there are other high-risk behaviors going on, like smoking, drinking, or high-risk sex.

ML: What are your thoughts on vaginal rejuvenation surgery for moms?

Dr. Ashton: ACOG does not endorse the procedure -- however, it's a fairly straightforward and simple procedure that almost any OB/GYN can do. For some women, it can make a big difference in how they feel, and it's pretty low-risk. I think it's fine.

ML: Anything else you'd like to tell our moms?

Dr. Ashton
: Moms must understand the power you have. Go back to the memories of your first OB/GYN appointment and how scary and nerve-racking it was. Moms can make this better. Give your daughters the power. Knowledge is power. An early OB/GYN visit is only going to lead to better health over time. It's such an incredible gift you can give.



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19 comments so far | Post a comment now
Anonymous January 4, 2010, 8:19 AM

WHY?

Jennifer Miller January 4, 2010, 9:55 AM

Wow, I TRIED to make an GYN appt for my stepdaughter when she was 14 (she’s 16 now) and I was told by my doctor’s office, “Oh no, that’s way too young… I mean, unless you think she’s at risk for having sex.” Which I replied to “Well, I actually am a little worried about that…” And still, they made me feel stupid for even attempting to make an appt for her at such a young age…

Anonymous January 4, 2010, 10:11 AM

I went to the ob/gyn when I was 17…was having sex and got the pill. But that was my first appt.
What bothers me tho is my daughters pediatrician , without warning, took down my 10 yr old daughters pants and *checked* her (not inside tho) she was MORTIFIED! I want a woman to do that to her the 1st time…I was not happy at all!

Krissy January 4, 2010, 10:14 AM

I went to the pb/gyn for the 1st time to get the pill when I was 17. and that was my first visit ever then. My mother never talked to me about sex and I wanted to go to this appt on my own.
The thing that bothers me now is that my daughter’s [male] pediatrican, without warning, pulled down my 10 yr old daughters undies and *checked her* (not inside tho)…and she was MORTIFIED! I was not too happy..and I want a woman to check her like that the first time…

Krissy January 4, 2010, 10:15 AM

(sorry for the double post the first one errored on me and didnt post lol)

tennmom January 4, 2010, 2:31 PM

My almost 12 year old has had a very quick visual-check only b/c she started her period (as I did) at 10. She also had a problem with labial adhesions when she was younger, so a ‘quick peek” is necessary once a year.
I’ve given her an instruction pamplet on SBE’s because she started wearing a bra at 10, is now in a D cup.
Both of my daughters (younger is almost 10) of what to expect from their bodies in the future and how babies come to be. I will come off with age-aprop. info as I see needed.
I’ll always remember the fear of one of my classmates (5th grade) when she started her period at school and had no idea what was happening.

Allison January 5, 2010, 8:29 AM

Taking a tween to the OB/GYN? Not a good idea, it makes them nervous and violated and there’s no reason to put a young child through that. On the other hand, if your child seems interested in sex or asks to go, then a mom should listen and take their daughter. I had to go to a gross Planned Parenthood to get on the Pill (b/c of my heavy period) when I was 16, I asked my mom for months to go to her OB and she didn’t listen.

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