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Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast, featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole and I'm so glad you could join us today for this excellent topic we're discussing. It's something that I just went through recently with my daughter and I know parents out there listening, this is something we're all going to go through. Joining me today is Dr. Jhansi Reddy. She's an Assistant Attending Obstetrician Gynecologist at New York Presbyterian Hospital Weill Cornell Medical Center. And she's an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medical College, Cornell University. Dr. Reddy, I'm so glad to have you. And we're talking today about the first visit to the gynecologist for our daughters. So when, when do we do that? Do we do it at 13, 15, 16? When we think they're ready? When do we bring them to see you for the first time?

Jhansi Reddy, M.D. (Guest): Thank you for having me on. And I do think that it's a challenging question. Traditionally, obstetricians and gynecologists have seen pregnant women or women who are over 21. But I think there is now an emerging need to kind of address the reproductive issues of younger kids. And so here at Weill Cornell, we've been really working collaboratively with the pediatricians to figure out when the appropriate time is.

And for every child and every parent, that's a different time. Some kids want to come in when they're first starting to menstruate, learn about the reproductive process. For other kids, it's when they become sexually active and they're looking to talk about contraception. And so typically we encourage parents to bring it up with their pediatrician and try to figure out when the right time to make that transition over to us in obstetrics and gynecology.

Host: Thank you for that. So what can we expect at that first appointment? Is it an educational experience, more than medical necessity? Do they get a pap smear? What is that first appointment like?

Dr. Reddy: So the first appointment can be really scary for a lot of people, but I think it's important to understand that we don't do a pelvic exam or a pap smear until much later. Typically pap smears are starting at age 21 and a pelvic exam is really reserved for patients that are having very heavy bleeding or very painful periods. And so for the first visit, it's really more of an educational experience to talk about their menstrual cycle, changes that they may be experiencing during puberty, to talk about reproductive health, and so we do a breast exam. We do an abdominal exam. We do a very basic physical exam that they may experience, with their pediatrician as well.

Host: I remember mine. And I must admit that I cried and I might cry now thinking about it, but I remember the breast exam and teaching her how to do it herself and all of those things. Now, this is a question I asked my daughter. So, I'm asking you now, and if it's typical, should a mom go into the appointment with her daughter? My daughter said yes, and she wanted me in there with her, but I imagine that not every daughter does.

Dr. Reddy: I think it's important to have a two part component to the appointment. I usually encourage moms or parents, either parents to come with their child so that we can go over what's going to happen during the appointment, to go over the history. And then I think it's also important to have a little bit of alone time with the patient to talk about things that they may be private. They may feel nervous about asking their parents about, so we like to have sort of a private session as well.

Host: Well I'm glad you pointed that out because I think that that's important to note for girls so that they feel like you are their patner in what's to be their next journey. And as they leave their pediatrician's office after they've turned 21 or 22, you're still there and probably for the rest of their lives. So, tell us a little bit about the first appointment. You mentioned around their first periods. That for some people, what if they're a late bloomer or they haven't had it yet? Those kinds of concerns. Are they something that you work on and discuss? Do you tell them it's normal? What happens in that case?

Dr. Reddy: Absolutely. So, puberty can be a challenging time for lots of kids and the age at which they experience can vary quite a bit. But it's also important to point out that I often will see young girls for other conditions as well. So, if kids have acne or if kids have painful periods, heavy periods. It's also an opportunity to talk about medications like oral contraceptives and how those may be of benefit. So I often will see a lot of kids coming in to see me before they go to college or things like that.

Host: Well, that's a good point you just made. So do you work with the pediatricians of these young ladies? And when you're talking about menstruation, is this something that is addressed? If a girl is having issues with it, if it's like you said too heavy or not frequent enough, is this discussion had with the mother around, just with the daughter, cause that's a medical situation.

Dr. Reddy: There are some definitions for too frequent periods, too heavy periods. And so we get into a little bit of that with patients and parents. I think it's important when I see a young adolescent to also have the mom there, to help educate both of them about what is sort of considered normal, because a child may have a different perception of what's considered normal than a parent. And then after we have that discussion, I usually have the mom leave the room and talk to the daughter as well about that.

Host: While we're sticking to menstruation here, how do we help our daughters through their first period? And I mean, I remember my sister helping me through mine because I came from a huge family. But what do you want us to know about teaching our daughters about tampons that early, or pads or what to do at school? Do you talk to us about that? Because moms need that lesson as much as daughters.

Dr. Reddy: Absolutely. So I think, there's been a lot of information and changes in sort of menstrual hygiene products and a lot of innovation, which has been exciting. I know kids are a lot more environmentally conscious now, and so we have period underwear. There are Diva Cups. There are pads and tampons and every child and parent goes through a transition period of what is appropriate. And that can change over time. Kids are a lot more athletic now. They're swimming, they're dancing. And so, you know, trying to figure out the right hygiene product is really important. And that's something that we absolutely address, when they come in to see us. I think pediatricians also do a tremendous job of that as well.

Host: Well they definitely do. And can you discuss the HPV vaccine Dr. Reddy? Because I know it's something you get at your pediatrician's office, but because it involves the reproductive system and especially for girls, you know, it's something that they don't know how to discuss sometimes with their parents. Is this something you can discuss with them?

Dr. Reddy: Absolutely. So human papilloma virus or HPV vaccine, is something that we're trying to educate the general population about, but we start to vaccinate kids earlier to prevent disease later in life. So the current recommendation now is for a two shot series in adolescents less than 15. It's a vaccine at time zero and six months. And then for kids over 15, it's a three shot series. So the goal of the HPV vaccine is to reduce the chances of throat and cervical cancer. So, we encourage parents to talk both to adolescent girls and their sons about the HPV vaccine, because it, it is recommended for both girls and boys.

Host: Tell us about other services that are available at Weill Cornell Medicine in obstetrics and gynecology for young girls. You mentioned that some girls you see, it's for acne. And I know that, that was one of the reasons my daughter wanted to go to the gynecologist and talk about contraception. So, tell us a little bit about your breadth of services that you offer.

Dr. Reddy: Absolutely. So there can be a tremendous breadth of services that we offer here at Weill Cornell in collaboration with our pediatricians. So, we talk to girls about contraceptive needs, and it's important to think about contraception in two components. One as providing contraception, but two, it can have an improvement in their quality of life for acne, which can be something that can be really distressing to kids, heavy periods, painful periods.

So not all kids who are sexually active are taking contraception. They may be taking it for other reasons as well. At Weill Cornell, we also see patients that have a lot of hormonal conditions such as polycystic ovary syndrome, acne, which we talked a little bit about. And there can be kids that are really suffering with very painful periods. A condition that we are learning more and more about is something called endometriosis, and patients that have very painful periods may be suffering from that. And so oral contraceptives can help with that as well.

Host: This is great information, especially for parents that are nervous to bring up some of these things with their children. Maybe haven't really gotten used to having those kinds of talks, and it's encouraging to know that you're there to help them. Can you wrap it up your best advice, Dr. Reddy for bringing our daughters in for their first gynecology office visit. I mean, it's a really exciting kind of melancholy time for parents, but can you tell us what they can expect and offer your best advice for getting that done?

Dr. Reddy: So I think it's really important to make the appointment less scary. I know that coming to see a doctor and specifically an obstetrician and gynecologist can seem scary, but it's important to highlight to both parents and kids that the initial visit is really an opportunity for kids to ask and learn about their body, there's going to be no invasive, physical exam that's going to occur at that time. And it's really an opportunity to start a lifelong experience with a physician to talk about their reproductive needs.

Host: Beautifully said, Dr. Ready. Thank you. And I know that my gynecologist, now my daughter's gynecologist also delivered her and one day will deliver my daughter's baby. So, it's really a generational thing for you doctors. And I think it's lovely. And that first appointment in my opinion is very sweet and something that we remember as parents.

So thank you again for joining us. To learn more you can visit Weillcornell.org/primarycare and Weill Cornell Medicine continues to see our patients in person as well, as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast.

We'd like to invite our audience to download subscribe, rate, and review Kids Health Cast on Apple podcast, Spotify and Google podcast. For more health tips, please go to weillcornell.org and search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole. Thanks so much for listening.

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