Frequently Asked Questions
Our Jefferson Health Pediatric & Adolescent Gynecology team is here to answer all of your questions, starting with the frequently asked questions below.
What happens during the first appointment?
The first appointment will focus on any questions or concerns you or your child have. We will also discuss puberty and periods, take a general medical and family history and review overall reproductive health.
Will I/my child have time alone with the healthcare provider?
Parents stay with children at all times. Teenagers will have private, confidential time with their provider to build rapport and empower them with knowledge about their health care. At this time, we will discuss any safety concerns with the parent or guardian.
Will I need an exam?
Most patients do not need an exam. Routine gynecological visits with a breast and pelvic exam are not needed until age 21. Even if an exam is required, it is most likely external, as opposed to internal. Infection testing can be performed with a small cotton swab or sometimes by testing urine. If an exam is necessary, we will explain everything and make the experience as normal and comfortable as possible.
What is a Pap test, and will I need one?
Pap testing is rarely required before age 21, so you are unlikely to need one. A Pap test involves a pelvic exam to look for cervical cancer, using two swabs and an instrument called a speculum to look at the cervix. While it may be slightly uncomfortable, it is not scary or painful and does not require scraping or a biopsy, contrary to popular belief.
Will I need a Sexually Transmitted Infections (STI) test?
An annual STI test should be performed if you are sexually active.
At what age do periods start? When should I be worried if I have not gotten my period yet?
Periods usually start when you are 9-15 years old. While there are many reasons that periods may be late, you should schedule an appointment with us if you have not yet experienced a period by age 15 or if breast development has not started by age 13. We will ask questions about the timing and pattern of puberty, including breast development and a growth spurt in height, as well as related medical conditions, medications and family history. Labwork or imaging, such as a pelvic ultrasound or X-ray, may be needed to determine causes. Treatment depends on the reason for amenorrhea, the medical term for no periods.
Is it normal for periods to be irregular when they first start?
It is normal for periods to be mildly irregular in the first 1-2 years after they start or even for a little longer. Periods typically become more regular over time as the connections between the brain and the ovaries mature and the ovaries start to ovulate every month. You identify your periods by counting from day one of the first period to day one of the next period. You should schedule an appointment with us if your periods are closer together than every three weeks, farther apart than every three months or last more than 10 days.
My periods are really heavy and painful. What can I do to make them better?
You can first start by using over-the-counter, non-steroidal anti-inflammatory medications to help your symptoms. The best medications for period cramps are naproxen (Aleve®) 440mg every 12 hours or ibuprofen (Advil®, Motrin®) 600mg every six hours. It is best to start taking either of these medications before your cramping starts or at the first sign of pain to limit the formation of prostaglandins, the chemicals that cause cramping, headaches, nausea, vomiting and diarrhea with periods. You can also try heating pads.
If these medications do not help enough, and especially if you are missing school or activities due to periods, you should schedule an appointment to discuss your symptoms with us. You may benefit from hormonal medication to improve your periods. There are many different options, and we will work with you to figure out what option works best for your symptoms and lifestyle.
My mother had problems with periods. Does that mean that I will as well?
Not necessarily. We know that some period symptoms or reproductive conditions seem to be hereditary, but we don’t fully understand why some people have problems with their periods while others don’t. And remember, only half of your genes come from your mother! While it is good to track periods and symptoms, don’t worry too much about problems happening to you just because they happened to someone else in your family.
Is birth control safe?
Birth control is safe for the majority of people. However, some people cannot use medications that contain estrogen, such as combined oral contraceptive control pills, patches and vaginal rings. There are also many options without estrogen, including progestin-only pills, injections, an arm implant and both hormonal and non-hormonal intrauterine devices. Some medications can interact with hormonal birth control medications. While some birth control options can cause side effects, these side effects are usually temporary, and most people do not have any side effects at all. We will get a full medical and family history and work with you to figure out the safest and best options for you for birth control and management of periods.
Is birth control medicine only used for birth control?
No! Reasons to use birth control besides preventing pregnancy include irregular periods, heavy periods, painful periods, nausea and vomiting with periods, menstrual migraines, PMS/PMDD, acne, endometriosis and ovarian cysts. There are many different options for hormonal medications, and we will work with you to figure out the best choice for you.
My healthcare provider told me that I have a cyst on my ovary. Is this a serious problem?
Once you start ovulating, it is normal to form a small cyst every month. When the growth is less than 3cm, it is called a dominant follicle and is a sign that your body is working normally. When the growth is over 3cm, it is considered a cyst. Most of the time, there are not any symptoms and the cyst goes away on its own over about a month. Sometimes cysts can cause pain because they become very large or have some bleeding inside them. Most of the time, these still go away on their own. If there is any pain from the cyst, the pain usually improves after a few days. We may repeat an ultrasound in 4-6 weeks to make sure that the cyst has gone away.
Some types of cysts do not go away on their own, but these are much rarer than the normal, or physiologic, kinds of cysts. If a cyst does not go away with time or causes severe pain, especially when the pain is associated with vomiting, surgery may be needed. We can almost always perform this surgery laparoscopically and preserve the ovary.
What should I do if I can't put a tampon in?
Having trouble when you first try to use a tampon is common. Try to relax as much as possible and use the smallest tampon available. You should schedule an appointment with us if you have tried all of the usual techniques and still cannot insert a tampon, or it is very painful to insert and/or remove a tampon. You may have some extra hymenal tissue blocking the opening. If this is not the case, you may be involuntarily tensing your pelvic floor muscles. We will work with you to figure out what the problem is and how to fix it.
My child hasn’t started a period yet but has vaginal discharge. Is this normal?
It is normal to have vaginal discharge in the 6-12 months before periods start. So, the vaginal discharge is likely part of normal puberty if your child started breast development 1-2 years ago and has had a recent growth spurt in height. The discharge can be clear, white or yellow. If the discharge is green, brown or bloody or causes itching or irritation or has an odor, you should make an appointment for further evaluation and treatment.
My child is complaining of vaginal itching. What should we do?
If your child has gone through puberty, then the vaginal itching may be the result of a yeast infection. Yeast infections do not occur before puberty because prepubertal vaginas are not an environment where yeast can grow. Itching is most likely caused by irritation from hygiene problems, a skin condition or a bacterial vaginal infection. You should make an appointment for further evaluation and treatment.
Please speak with your provider or call us at 215-955-5000. You can also view additional Frequently Asked Questions about managing your Jefferson Health OBGYN visit.