"I couldn't believe what I was reading. It said, 'I think your daughter needs to see a gynecologist.' A gynecologist! She was 9 years old! I won't even tell you the horrible thoughts that went running through my mind," says Mary, a 42-year-old divorced, single mom who asked that she and her daughter not be further identified.
As it turns out, Mary's daughter had been suffering with a vaginal itch caused by an irritation from a new bath gel, and she was too embarrassed to share the details with her mother. When the itch became unbearable, the girl confided in the school nurse, who sent the note home.
"You just don't think of a 9-year-old needing a gynecologist -- it just doesn't enter your mind," Mary says.
Indeed, most parents -- particularly mothers -- associate the need for gynecological care strictly with an active sex life. However, in reality, there are a variety of reasons why young girls may need this kind of medical attention.
"If a female of any age is experiencing any problems that are breast- or vaginal-related, such as irritation, infection, bleeding, discharge or pain, or if she experiences pelvic pain that does not appear to be related to any other cause, then she should be examined by a gynecologist, regardless of her age," says Dr. Boris Petrikovsky, chairman of the obstetrics and gynecology department at Nassau University Medical Center.
Reasons behind the problems, he says, can include something as simple as a new toilet tissue or bath gel to more serious issues such as a hormonal imbalance or, more rarely, a tumor.
"Any problem that can affect a woman has the potential to also affect a young girl, which is why gynecological care must be considered," Petrikovsky says.
If you're not quite ready to have your daughter go from the playground to the gynecologist's office, you're not alone. Fortunately, it's not your only option.
An increasingly popular alternative is a medical specialty called "adolescent medicine." Here, doctors who are schooled as pediatricians also receive training in adolescent gynecology. They are prepared to deal with any number of problems that befall young girls.
"We believe we play an important role in the lives of girls and young women by recognizing the need and providing care for a number of gynecological problems, but doing it with a decidedly pediatric slant," says Dr. Karen Soren, director of the Adolescent Medical Center of Children's Hospital of New York Presbyterian.
"We are more than a pediatrician, but not quite as much a gynecologist, and I think we bridge an important gap in a young woman's health care," Soren adds.
Among the most common gynecological problems Soren sees are menstrual and puberty-related issues -- cropping up as early as age 10 or 12 or as late as age 19 or 20.
"Some girls are plagued with very severe cramping, dysfunctional bleeding -- either too heavy or very light, highly irregular periods, or no periods at all," she explains.
Among the most prevalent gynecological problems being diagnosed in young women today, she says, is polycystic ovaries, a hormone-related condition that, if not treated early, can cause problems such as infertility.
Whether you choose a gynecologist or adolescent medicine specialist for your daughter, experts say it's important the doctor have both the physical training and medical equipment to properly examine and treat a young woman -- such as a small speculum and more slender instruments of all kinds.
Equally important, both Petrikovsky and Soren say, is that the doctor has the proper "bedside manner" to reduce trauma and make the experience a positive one for the girl and her family.
"In many instances the girl would like her mother in the examining room, and if that is what she wants I think the doctor should make every effort to accommodate her," Petrikovsky says.
Likewise, Soren says, if the doctor senses the young woman is embarrassed or intimidated by her mother's presence, the physician should try to speak to the patient privately.
"It's important that both the parents and daughter feel the doctor is someone they can trust and feel safe and comfortable with," Soren says.
As for the right time for a young woman to have her first gynecological exam, doctors say there are no rules regarding age. However, both Soren and Petrikovsky say that once a young woman becomes sexually active, it is important she receive a checkup at least once a year.
What To Do
For some terrific information for girls and their parents about that first gynecological visit, check out GYN 101.
To learn more about adolescent gynecology options, check out the North American Society for Pediatric and Adolescent Gynecology or the Washington University in St. Louis Department of Pediatric and Adolescent Gynecology.