How do different nations approach a girl's first gynecological exam

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I'm very curious.
Because I grew up in the United States with a very health conscious mother who worked as a nurse, I had yearly check-ups from the age of five and at the age of sixteen was taken to a gynecologist for my first pelvic exam just to make sure everything was right and developing according to plan.

I was not sexually active yet - that's not why my mother took me - OH HELL NO- I was not seeking a prescription for birth control.
My mother took me just to get the low down or a base line on what was up down there and in there, and as a result, I took myself for many years for my yearly exam. Just to make sure things were alright - you know - you can't SEE yourself what's going on, so you ask this person called a gynecologist to do it.

Fast forward thirty years. Now my own daughter is eighteen and we're living in England. I can't seem to get a referral for a gynecological check-up for her come hell or high water.
What has spurred me to act on my inclination to do so is that this week-end she had rather severe abdominal pain. And I realized, 'Hey - I've never taken her for an internal - she's got a boyfriend - you know...we've had the birth control talk and she's taking care of that so I asked her, 'Olivia - when you went to get your birth control did they do a pelvic?' She looked at me blankly. So I said, 'You know - an internal exam?' fully expecting her to say that they had and apparently they hadn't.
They give these pills out on the basis of the girl's answers to several questions- does she smoke, how regular is her menstrual history, etc.
They didn't even do a blood pressure reading or listen to her heart.

So I take her to the GP today and he doesn't do a pelvic either - although she has pain radiating from her abdomen down her left side to her pelvis. So I ask him, 'What do I need to do to get her a pelvic exam?' He says, 'I don't think she needs one.'
I say, 'Maybe you don't - but for my own peace of mind, as she's sexually active and of childbearing age and because of my own cultural background which has convinced me of the efficacy of preventive care and check-ups- I'd like her to have one. I will pay for it, of course'.

He says, 'Well I don't see the reason for it,' and then I get sassy and say, 'Well I don't see the reason for eating brussel sprouts at Christmas...that's not my custom but a pelvic exam and yearly gynecological check-up on girls who are sexually active and of child bearing age is something I'm accustomed to being able to access and would like to have - so how do I specifically get one for my daughter?'

He gives me the name of three private hospitals, neglecting to tell me that when I call to try to schedule my daughter an appointment the woman will tell me that I cannot schedule an appointment unless I have the GP's referral.

Which he has just neglected/knowingly refused to give me.

So I explain the whole situation to the woman and say, 'Really, it's just for my own peace of mind and I'm more than willing to pay for it,' and she answers, 'We don't want you to waste your money and we don't think it's necessary for a girl your daughter's age.'

And I'm like, 'WHAT?!' So if she wanted to have a nose job and I wanted to pay for it, you're telling me that you'd not take my money? I'm sure they would. But when I want to ascertain that my daughter's reproductive organs are healthy and in working order - they won't let me WASTE MY MONEY?!

So far today - I've been unable to get my daughter an appointment for a pelvic exam even if I want to pay for it. They'll give her braces for her teeth and birth control pills, but they won't do a pelvic exam to make sure she's healthy inside.

I guess I'll have to wait for our next trip to the US and take her to my sister's gynecologist.

What the hell?! Is this how it is in other countries? And I'm not talking about the socialized medicine aspect of it. I'm talking about being able to see a doctor for a check-up that you will pay for yourself because you want to see a doctor for a check-up.
I'm also specifically interested if, in other countries, girls are prescribed birth control without a physical exam.

Thanks in advance for any input.

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I'm not knowledgeable about the situation there in England (or much of gynecology), but I'd be aggravated too. That symptom might be painful ovulation or ???
I'd probably call another gp, or a gyno's office.

I didn't try this 'symptom checker' out since I don't know the answers re the pain, but it might help:
http://www.mayoclinic.com/health/symptom-checker/DS00671/SYMPTOM=29BC7DD7-2A5D-9994-E5E4AFF0259C6908&TAB=Abdominal%2520pain

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@aidan,

Weird.

I have no idea about the cultural aspect of it. I had an exam in my early teens but that was because of abnormal periods I think. I then went on birth control pills for that reason -- to regulate my abnormal periods. I think I had annual exams from then on, for sure when I was older, annually to renew my bc pill prescription. (No exam, no renewal.)

Now I do it annually 'cause I'm over 30, or 35, or whatever the age cut-off is (I've been off the pill for a year or so).

(I'm American.)

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Chiming in with the "that's weird"

I wonder if that just for the woman's first exam, or if they don't consider a pelvic a yearly thing after that initial.

I always got one done every year. Sometime maybe a few extra months were in there due to scheduling, being busy, etc., but it got done regularly.

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@sozobe,

I'd never thought that there was a cultural difference in (Western) Europe.

During the time, I've worked a sexual pedagogic, nearly all girls (well, more than 95%) in the age-group of 14 to 16 had been to a gynaecologist.

According to what I know from friends today, I suppose that the situation hasn't changed.

Between 14 and 16, it's in the discretion of the doctor, if she/he informs the parents. From 16 onwards, these visits are strictly confidential - so often mothers just want to go with their daughter(s) ....

(In Germany, that is.)

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@aidan,

So, what's the policy in the case of a rape?

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I was around 16 years old when I had my first pelvic exam (in Germany) and once my daughter is 16, I'll take her to my (female) gynecologist too (in the U.S.)

I think it has nothing to do with socialized medicine in England, but everything with the individual physician. I definitely would change my GP if he is that nonchalant about exams and not willing to give a referral
to a specialist. Hospitals usually don't do regular gyn exams, why can't
you find a gynecologist in private practice? Surely, he wouldn't mind to
get some extra money - if you have to pay out of pocket.

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I thank you all for your input. I've spent the day reading up on the new guidelines and have talked to my daughter's father who is in the medical profession and works for the NHS here.

He has said that he notices a definite cultural difference in that they have done studies and risk assessments and have found exactly what the woman told me-that the small number of girls my daughter's age who would benefit from the findings a pelvic exam would reveal doesn't justify its routine practice among girls her age - even if they are sexually active.

This IS different than in the US. He also said that here the pelvic exam is seen as an invasive and intrusive procedure and is reserved for very cut and dry cases of obvious vaginal bleeding or amennhorea, etc. and that an internal exam is no longer required or even recommended before the prescribing of birth control pills.

Oh well...I hate to play the card of having someone who knows someone...but her dad is going to talk to someone and get her an appointment with a gynocologist he knows.

Because I'm not convinced they've ruled everything that might be wrong out. The GP has determined without any internal examination that her abdominal pain is due to costochrondritis which is inflammation of the cartilage in the ribs- though he can't tell us how or why it occurred- and her radiating pelvic pain is due to gas...he prescribed anti-inflammatory ibuprofen - that's it.
But I've watched her unable to stand up straight for two days and taken her to the doctor and the hospital and watched as two different medical professionals talked and talked but couldn't take two minutes to do a routine pelvic exam....why?
I mean, if only to rule everything out - god knows I don't want them to find anything wrong.

It's just sort of confounding to me that they won't let you pay to have peace of mind about your child. I don't get it.

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Miller - I don't know what they do in cases of rape.

Osso - that's a good point - just because her periods have been regular and uneventful and pretty much pain-free up to this point - doesn't mean that can't have changed...

Also, another thing her father reminded me of when he said they base what they do on family history as well as risk assessment and accepted practice - we adopted Olivia. I don't know what her birth mother's family history involved, or for that matter her birth-father's family history may have entailed.

Neither the GP or the student doctor at the hospital brought it up and I don't think of her as any less my child than my biological son so I didn't even think of it myself.
But it is a good point and as such, as her dad reminded me, a good reason for her to be seen and examined as we don't even have a family history to help create even a partial base line.

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The routine pelvic exam is un-necessary as your husband says, because newer methods of diagnosis are more accurate, such as ultrasound and NAAT urine screening tests. There is reluctance to perform an exam that might exacerbate an infection. PAP screening is not recommended until age 21. Still you could have received better care. New Guidelines from the American Pediatric Association for adolescent gynecological examination are available at their website.

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@steve75752,

That is American Academy of Pediatrics publication at: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;126/3/583.pdf

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Aidan, it must be frustrating to see your daughter in such pain. I'd bring her back soon if the pain doesn't go away.

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@steve75752,

Thanks for the post, Steve, that's helpful.

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I am thinking that this has to do with the fact that this is your daughter. If you wanted an unnecessary invasive procedure that you were willing to pay for then they would take your money and do it, but because you were trying to subject you daughter to what they see as in invasive unnecessary procedure money does not fix the morality problem of them doing it to someone who has not had a say in it. Let me remind you that Europeans do not generally see teens as idiots who have no rights as Americans tend to do.

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@hawkeye10,

Huh?
I wasn't trying to subject my daughter to an unnecessary invasive procedure- and she DID have a say in it- she asked me to help her Hawkeye, so even if I didn't love her and want to take care of her the best way I knew how by my own volition, I would have been remiss by not addressing all of HER concerns for her own health and body if I'd ignored her request and at least tried to help her in every way I knew how to help her.
And by the way, her father, who is an ER physician with twenty years of medical experience, thought it would be a good idea too.
But I guess you, having lived in Europe once upon a time know more about that and my daughter's health and what she needs and/or wanted than her father and I - yeah- okay.

What the hell?! I don't think teenagers are idiots. Where did that come from?

littlek - thank you for your concern. It was very hard to watch her in such pain. But she is better now. Actually the GP was correct in his diagnosis and the anti-inflammatories he gave her did the job.

Steve - I didn't see your response until just now. I'll read your link. Thank you for your time and effort with that.

Finally Hawkeye - just a little piece of the puzzle for your information. I had a friend who died of cervical cancer when she was seventeen, because her mother had taken a drug, commonly prescribed during those times, as a preventative for miscarriage. Apparently her mother had miscarried a prior pregnancy. Anyway - my friend ending up undergoing a complete hysterectomy and then dying a torturous death at seventeen.

When I was nineteen, I had my annual check-up and they found a vaginal lesion that looked similar to what these DES daughters (the ones who were subjected to this drug in the womb) had. My mother had not taken the drug, as I was the third child and she hadn't had any miscarriages - still - I had what looked to be a precancerous lesion that could have developed into something more sinister if it hadn't been found and excised.
No symptoms - no nothing....I had just gone for my yearly check-up. They found it early. They took care of it...no hysterectomy necessary for me. No cervical cancer for me - instead I got a healthy, happy pregnancy, a wonderful son, a beautiful daughter and a full life. Unlike my friend.

And again, I adopted my daughter. Her birth mother was taking medication for an issue she had during my daughter's pregnancy. I was told that there wasn't enough data to ascertain what effects it might have on the developing fetus, but it would certainly be better for her birth mother to take the medicine than not during the pregnancy - given the nature of her problem (schizophrenia).
On top of that, aside from the prescribed medication, I have NO IDEA what her birth mother took or didn't take during her pregnancy. I have NO IDEA what her birth mother's family history is in terms of disease and what this may predispose my daughter to develop...Check ups for her are more essential than for my biological son- in my mind.
Thankfully - she's just fine - and one of the loves of my life.

I have my reasons for believing in check-ups. I would do anything for my daughter - except hurt or neglect her.

Anyway - I think Calamity Jane and Walter know a little bit about what goes on in Europe too - don't you? And they both said that in their part of Europe check-ups were customary.

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@aidan,

Quote:

I wasn't trying to subject my daughter to an unnecessary invasive procedure-

I know, but this is the opinion of your GP which you know because he said so, and you have also been told that this is a common opinion in GB

Quote:

and she DID have a say in it- she asked me to help her Hawkeye

Did your GP know this? If I am right (and I may not be) things would have gone a lot better if she had done the asking and you had stayed out of it.

I am not condemning you, I would have done the same thing....you indicated that you wanted to understand why you got the response that you did and I was illustrating how your GP likely looked upon the situation that motivated him to act as he did.

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@hawkeye10,

Yes, he knew it. When we went to the office, he told my daughter that if she didn't want me there, I could wait in the waiting room - she told him she wanted me in the room with her.

When he asked her questions about her history - she deferred to me - and I'm not imagining it...she looked over at me and said, 'Mom - can you tell him?'

She's a very bright and beautiful girl, who has moderate to severe hearing loss in both ears and is supposed to wear hearing aids - she won't right now- and she realizes she doesn't hear everything she needs to be able to hear.

I treat her like the adult she is...that's why she went on her own to get her birth control pills. I asked her, 'Do you want me to go with you?' She said, 'No, I can do it.' So I didn't go with her and she did it.

Believe me - I am not a hoverer. I let her make her own decisions - about her birth control about not wearing her hearing aids...I don't like to be controlled and I don't like to control people.
That's certainly not one of my issues - I'm laughing because if anything - anyone who knows me would be like...you - controlling....one of my students said that it's a good thing I don't smoke weed, because if I did - being so relaxed to begin with - I'd probably become SO relaxed I'd fall out of the chair.

Anyway - she's had the check-up and all is well.

And it's not a question of morality for the NHS. It's a question of economics.
As her father said, for girls my daughter's age, the incidence of pathology of any sort is so low that there's not enough of a medical necessity or pay-off for them to advocate or allocate the funds for doing regular pelvic exams at this age.

I said, 'So what would have happened to me then? I would have just died - or lost my first pregnancy to miscarriage over here (it effected my cervix and I had to have a cerclage and bed rest to maintain my son's pregnancy to term).

He said, 'They'd look at you as an outlier...if you'd had that issue over here - they WOULDN'T have caught it and you WOULD have lost your first pregnancy - and maybe your fertility and reproductive ability...(the gp agreed with him when I pressed him later on the phone about it - he said they probably would have found the problem when I had a miscarriage and not before-but that wouldn't have happened to the majority of girls and that's what they look at when they set policy and allocate funds.'
And to be fair - I understand that. I don't know how this government takes care of as many people as it does as well as it does - I understand there have to be things like 20% VAT taxes, and that there's a trade-off so all people get adequate services as opposed to some people get the best money can buy while others get nothing.

But for me - it's a good thing I grew up in the US and my mother instilled the value of check-ups in me. I made the appointment on my own and had taken myself to that check-up (where they found the problem) when I was in college. My mother was 500 miles away in New Jersey- she had nothing to do with it, except that she taught me that's what I should do.

And it IS sort of ridiculous saying to someone, 'I know you don't think it's important, but I do, so I would like to pay for it,' and having someone say, 'No - I will tell you what's important-what you can spend your money on and what you can't.'

A pelvic exam is not torture. It takes two minutes and is only mildly uncomfortable (unless you're an outlier) Laughing

I think that's the new trendy medical term at the moment.

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@CalamityJane,

CalamityJane, it should be your daughter's decision when (or IF) to see a gynecologist.

Taking a healthy 16-year-old for a pelvic exam without her consent is rape.

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@femmes,

You're even more nuts than some others who have posted here.

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@CalamityJane,

How is that? I stand by my answer--a pelvic exam without consent is rape, and dragging a 16-year-old to a gynecologist just because you think "it's time" is despicable. It's her body, not yours. Furthermore, if you're pushing her in there she's not able to give meaningful consent, since authority figures (her parents, the doctor) are making her feel she has no choice in the matter. Would you make her get on the table, pry her legs apart and penetrate her? You sound like you would. How is that not rape?

Pelvic exams in asymptomatic women are not a normal part of healthcare in many parts of the world, including Great Britain. It's not that they "approach a girl's first pelvic exam" differently there: women don't routinely get pelvic exams AT ALL, and they are none the worse for it. A British woman might go her entire life without EVER getting a pelvic exam, or she might only have one during pregnancy. In most of Great Britain, women get cervical cancer screening every 3-5 years starting at age 25, and it is usually done by a nurse, not a doctor, and all they do is take the swab, so no pelvic exam. (They also don't use stirrups!) Pelvic exams and pap tests are not linked to birth control, which is how it should be: they don't have anything to do with each other!

There's no medical evidence that pelvic exams have any value in asymptomatic women. It's time the practice was abandoned.

Sources:
http://www.racgp.org.au/afp/200806/200806stewart.pdf

http://www.ncbi.nlm.nih.gov/pubmed/17475104

http://crushable.com/other-stuff/study-doctors-shouldnt-be-making-women-get-pelvic-exams-to-get-an-rx/

http://findarticles.com/p/articles/mi_m0CYD/is_20_37/ai_93531936/

http://www.nlm.nih.gov/medlineplus/news/fullstory_105865.html

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How do different nations approach a girl's first gynecological exam

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