Moms need to demystify pelvic exams for daughters

May 18, 1999|By SUSAN REIMER

A FELLOW mother told me that her pre-teen daughter asked her what a "period" was, and then wept through the entire explanation of menstruation.

"And when I told her it happened every month, she cried harder," the mother said.

Tell the child about pelvic exams, I thought to myself, and she's going to need grief counseling.

Internal exams are one of the unpleasant surprises of young womanhood. Though the onset of menstruation is now a cause for rite-of- passage celebrations among many women and their daughters, it is hard to think of anyone lifting a glass to specula and stirrups.

The reluctance of women to explain the details of a pelvic exam to their daughters is part of a chain of hesitation that puts girls at risk for an unwanted pregnancy.

We don't want to suggest it. They don't want to volunteer for it. And often that is what stands in the way of oral contraception.

"There is good research showing that adolescent girls are avoiding seeking birth control because they fear the pelvic exam," says Dr. Ann Bruner, head of the Johns Hopkins Adolescent Clinic.

While no sales job could make a pelvic exam resemble prom night, information goes a long way toward relieving fear and exploding myths. And there is a place for girls to go -- or for their mothers to send them -- to read a step-by-step description of this examination.

Seventeen magazine, which does such a responsible job of answering the sexual health questions of its readers, has posted one of its best articles on the subject on its Web site. Called "A Day at the Doctor's: No need to fear -- we've demystified that scary first visit to the gynecologist," this lengthy and detailed explanation can be found at Just click on the "love & sex" option.

The next step -- actually scheduling a gynecological exam -- is not so simple.

So many of us equate it with the initiation of sexual activity, and that stops us. Parents can't bear to think about their daughters having sex. And the daughters often avoid this kind of preparation for sex because it doesn't jibe with who they think they are ("Not me. I'm not going to have sex") or they are clinging to a romantic notion that precautionary measures will spoil the spontaneity of the act.

"If you wait until your child is 16 or 17 to talk about this, she may have already been in a situation where she had to make a decision," said Bruner. "Like drugs, by the time it is an issue for us, it is already an old issue for the kids."

And while we take our babies and toddlers and young children to the pediatrician for check-ups, we stop when they are teens.

"And that's sad because, aside from infancy, this is the time when their bodies are changing most," said Donna Behrens. A pediatric and mental health nurse for more than 20 years, she now administers a program that sets up school-based health centers in Maryland.

"In addition, there is an entire generation of teen moms who may not have had access to health care in a preventive way and may not have seen its value. Now they have kids who are growing up," she says.

Because fear and misinformation are such a stumbling block to gynecological exams and, therefore, to prescription birth control, there is a push to distribute birth control pills over the counter.

"The more logical middle road is that it should still be prescribed by a doctor," says Bruner, "because we want the opportunity to educate the patient. But someone who is healthy and has no complaints does not need a pelvic for a birth control pill prescription."

On the theory that you catch more flies with honey than you do with vinegar, Bruner and Behrens agree that removing the pelvic exam as an obstacle to birth control would give health professionals a chance to establish a non-threatening relationship with a teen girl that might prosper.

"At our clinic, we will let them be on oral contraceptives for three to six months before we tell them we'd like them to have a pelvic," says Bruner.

A fundamental reason for a pelvic examination is the Pap smear, but cervical cancer is rare in young girls. It is the host of other sexually transmitted diseases, many of which are asymptomatic, that passing out birth control pills will not reveal.

"If a girl is sexually active, she needs to have a pelvic to see if she's caught anything," says Bruner. "Let's be practical about this. Once you have teeth, you need to have them cleaned. Once you start having sex, you need to get checked."

And this gives the health professionals a chance to repeat the message that "The Pill" can prevent a pregnancy, but only a condom is effective against disease.

Adolescents aren't kids, Bruner says. "But they aren't grown up, either. They are in between. They are at risk for grown-up problems, but they may not have the grown-up skills to make the right decisions."

It is up to parents to help.

It isn't easy for us to be matter-of-fact on this charged topic. But we can try to be prepared for such a conversation and steel ourselves to be calm and non-judgmental. We can do the detective work for our daughters and find out if her pediatrician, the family doctor or a local clinic will provide the confidential, supportive, non-threatening atmosphere she needs.

Though it may be hard to get the words out of our mouths, we can say, "Look, darling. This is as awkward for me as it is for you. But here is a Web site that will give you a step-by-step description of a pelvic exam. When you begin having sex, you're going to need to do this.

"I'd rather we did this together, but if you can't bring yourself to tell me, here are two places where you will be safely and confidentially cared for."

Such a conversation is almost easy to have. And it may be a conversation that makes all sorts of other ones easier to have.

Pub Date: 5/18/99

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