Accompanying young girls on their journey towards understanding their own bodies and reproductive health is a crucial moment that must be approached wisely and with accurate information. The first gynecological visit is an important step in a young woman’s life. It is not only about prevention but also about raising awareness. This visit shouldn’t be experienced as a traumatic or overly “medicalized” moment; instead, it should be seen as a valuable opportunity.
Often, it is the girls themselves who express the need to go; other times, mothers take them to the gynecologist, perhaps reluctantly and not due to a genuine concern beyond their own anxiety. But, what is the right age to start? To clarify these doubts, we consulted Dr. Tiziana Casalena, a gynecologist at Humanitas Medical Care in Varese.
When Should the First Visit Take Place?
“Common sense should guide this decision. If menarche (the first menstruation) occurred between the ages of 11 and 13, and the bleeding is not excessively heavy, the pain is manageable with simple analgesics, and the cycles are relatively regular—even if they do not always adhere to a 28-day cycle—there is generally no cause for concern,” explains Dr. Casalena. “It may be useful to carry out a blood test and measure ferritin levels to rule out potential iron deficiency anemia. In these cases,” she continues, “the first visit may be postponed until the young woman has started to have a partner or has recently initiated her sexual activity. The first meeting with the specialist will not be invasive; it will primarily consist of counseling, which may include information on contraception, prevention of sexually transmitted infections, and healthy lifestyles. Often, it is the mothers who seek advice for their teenage daughters,” she concludes.
Important Symptoms
Some symptoms should not be overlooked. “If the cycle is extremely painful, very heavy, and limits daily life for the young woman, causing school absences or preventing physical activity, it is important to investigate further,” advises Dr. Casalena. “Underlying these symptoms could be conditions such as adenomyosis or endometriosis, which affect approximately 10-15% of women of reproductive age. A very irregular cycle, with intervals of three to four months, accompanied by severe acne or excess hair, should also be investigated, as it could indicate polycystic ovary syndrome. If left untreated, this condition can compromise future fertility and have a significant impact on the quality of life of the adolescent.”
“If menarche is delayed and has not occurred by the age of 16, it is advisable to schedule a visit,” suggests the gynecologist. “The same applies to the presence of vaginal infections. Some, like candidiasis, are not necessarily sexually transmitted; rather, they may have an endogenous origin in girls who have never engaged in sexual activity, stemming from intestinal microorganisms. Lastly, prolonged amenorrhea, or absence of a cycle, can be related to eating disorders or strict diets: in these cases, a multidisciplinary approach is essential, involving not just the gynecologist but also a psychologist and a nutritionist.”
What to Expect at the First Visit
The gynecological visit in adolescence does not necessarily entail a complete exam. “It always begins with a conversation with the young woman, respecting her pace and needs. Often, just an external genital observation is sufficient to verify normal anatomy and a transabdominal pelvic ultrasound with a full bladder, a non-invasive technique,” explains Dr. Casalena.
“Unfortunately, schools still lack appropriate sexual and emotional education. This visit can become a precious moment to discuss prevention. It is vital for girls to understand that among sexually transmitted infections, even less talked-about conditions like chlamydia can have significant consequences for future fertility. Therefore, the promotion of barrier methods is crucial.”
Among the essential topics, the vaccine against HPV (Human Papillomavirus) stands out, which is recommended starting at age 11 for both boys and girls. Administered before the onset of sexual activity, the vaccine ensures a more effective immune response and prevents about 90% of cervical cancer cases, in addition to benign lesions like warts. Before age 15, only two doses are required; thereafter, three doses are necessary. Finally, the gynecological visit can serve as an invaluable opportunity to promote breast self-examination, fundamental for learning to understand one’s own body,” concludes the gynecologist.