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HOW TO TALK TO YOUR DOCTOR

Jessica and her mother first came to see me about a year ago. Jessica was thirteen, a flute player with a friendly face and short, glossy dark hair. Later I learned she had a radiant smile, too… but she definitely wasn't smiling when I walked into my office. She and her mother were sitting rigidly in front of my desk, waiting to talk to me about Jessica's painful cramps. They both looked like they'd rather be having their teeth drilled by a student dentist with a jackhammer.

I didn't take it personally. I'm used to being the only person in the room who isn't nervous on a first visit. Typically new patients like Jessica worry they'll have to put their feet up in the stirrups for a pelvic exam. Their parents worry that they're giving their daughter a green light for sex just by mentioning the word "gynecologist"—let alone taking her for a visit. "So what's going on?" I asked.

I listened to Jessica describe her cramps, with her mom adding a few details now and then.

"OK," I said. "I think I can help. And don't worry—I don't need to do a pelvic exam."

"Really?" asked Jessica. I could almost see her white knuckles unclench.

"You don't have to use that metal thing?" She meant the speculum, the instrument used in pelvic exams to gently open the vagina.

"Nope," I said. "We won't need that until you're twenty-one, or until you're sexually active—which I hope won't be until you're at least eighteen." I explained that very strong medical evidence suggests that it's much healthier to postpone sex as long as possible. From the corner of my eye I could see her mother relax. A few minutes later we were all laughing and chatting. BFFs!

Not bad, I thought. Five minutes into the visit, they both feel better. And we haven't even stepped in the exam room yet!

I just love my job.

Here are a few more things I tell all my new patients to help them feel a little better about the process. Understanding what to expect from your first visit can make your job and your gynecologist's job a lot easier.

1. You shouldn't be embarrassed.

All I do, every day, is take care of girls and women. We've all got the same parts. I've given birth, I've delivered babies, and I look at female anatomy all day long. To me looking at a vagina is so not a big deal. In fact, I'd rather look at a vagina than a foot (sometimes vaginas are much cleaner than feet!). If you take away just one thing from this book, remember this: Please don't ever feel embarrassed or ashamed of your body. Go ahead. Ask your doctor anything. She (or he) wants to help you but can't unless you say what's on your mind.

2. Anything you tell me is confidential.

By law I'm not allowed to tell your parents if you're sexually active or not. They can pound on my door and beg and plead, stalk me with phone calls or spam me online, and I'm still not going to tell them whether or not you're having sex.

There are only two conditions where I do have to break patient confidentiality:

If I feel

• your safety or someone else's safety is at risk, I need to tell your parents and I might need to report my concerns to the appropriate agency or authority.
• If you have chlamydia or gonorrhea, the lab that processes the tests will automatically report it to the state health department. Your name will go on file as someone who has that particular STD, so the department of health can keep track of who gets what and make sure that everyone who needs treatment gets it. (Most of my patients find this rather alarming—and one more good reason to wait until at least eighteen before becoming sexually active.)

3. I trust you—but I'm not a psychic.

I expect that you'll be honest with me about what you're doing or not doing so I can treat you appropriately. If you tell me you're a virgin, I'm going to believe you . . . and I won't give you the same treatment as a girl who's sexually active. And if you don't tell me about problems you're having— itching, burning, discharge, whatever—I won't be able to help you. Bottom line: If you're not honest with me, you won't receive the right medical treatment, and I won't be able to help you stay healthy. So don't be shy: Tell me what you're up to.

4. I don't need to do Pap smears or pelvic exams until you're sexually active.

That's a huge relief for most of my patients. But once you've had vaginal intercourse, you need to let me know—then it's time for what my patient Jessica called "that metal thing" (the speculum). As long as you're a virgin, I probably won't need you to put your feet in the stirrups. Most of my patients find this another very good reason to hang on to their virginity as long as possible.

5. Exams won't hurt.

One last thing to keep in mind. When you do finally need the stirrups and the speculum during your exam, please trust me that if the exam is done correctly, it really shouldn't hurt.

AN M.D. OF YOUR OWN

Many parents and girls don't realize that teens need both a pediatrician and a gynecologist. The pediatrician helps with health issues affecting kids of both genders. The gynecologist advises on issues specific to girls' growing bodies. Of course, good pediatricians know all about girls' issues, too, and can even perform pelvic exams. But—and of course I'm biased!—I think gynecologists like me, with specialized experience, offer girls special expertise and knowledge that only come from seeing patients like you all day, every day.

Unfortunately, many parents don't take their daughters to the gynecologist until the girls are about to leave for college. By then their daughters have missed the chance to learn about their bodies from an early age and to get important information and advice when they need it—like what you can do in your early teens to protect your breasts and bones for the rest of your life and how to make great decisions about sex. I don't blame parents: Many just don't want to think about the fact that your body is maturing, so it doesn't occur to them that you now also need a doctor who treats grown-ups, not just a pediatrician.

If you don't have a gynecologist of your own by the time you're in your mid-teens, talk to your parents about finding one. This might be a little awkward, especially if you think they'll think you're asking because you're sexually active (BTW, if you are, it's even more important to find a gynecologist soon). Here are three strategies to persuade your mother or father to help you find a great gynecologist when you're in your mid-teens… and hopefully long before you need one.

STRATEGY 1. Show your parents this book. Say "Mom (or Dad), the doctor who wrote this thinks it's a great idea to wait as long as possible for sex." (Your parents will really like that.) Then add, "I'd love to see a doctor like her. Can we find one?" You might also mention that adolescent gynos are not just "vagina" docs: We're the physicians who know the most about breast problems, bone health, period problems, and hormonal issues. What more could your parents ask for?

STRATEGY 2. Blame the cramps. If you have menstrual cramps, this is a great—and not too embarrassing—reason for seeing a gynecologist. This is the twenty-first century, after all, and suffering is out. Say "Mom (or Dad), these cramps are really bad and my friend So-and-So saw a gynecologist for hers, and it really helped. Can I do that?"

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