Episode Transcript
There are a lot of times when I have female patients on my schedule for "girl part concerns." So much so that the running commentary is that I'm actually the pediatric gynecologist at the office.
Limitations of Pediatricians in Managing Gynecological Conditions
Well, first, let me say that I absolutely am not a gynecologist. No pediatricians really are. In fact, we had very little training with gynecology issues during our residency. But parents think that since we are doctors, we can address all concerns in all body areas. Truth is, we are generalists. We know how to treat common conditions in all body areas, but sometimes issues are beyond our expertise.
In fact, pediatric gynecologists are actually gynecologists with extra training in pediatric age conditions, not the other way around.
I will often have parents wanting me to evaluate their daughters for things like endometriosis or fibroids. Pediatricians can't do that.
Birth Control
We can do things like birth control for significantly irregular periods. But most girls have irregular periods until around the age of 15 to 16, so we don't treat them unless it's medically necessary.
Irregular Periods
We can manage very heavy periods with birth control, but mainly the pill or the Depo shot. Other forms of birth control, like Nexplanon implants or IUDs, are usually done by family practice providers, internal medicine providers, and gynecologists.
Those of us who just see kids usually defer to those who do these procedures more often because they see adult patients and are better trained.
Polycystic Ovarian Syndrome
We can evaluate for polycystic ovarian syndrome with blood work, but then we refer to gynecology if further management is needed.
Pregnancy
We can do urine tests for sexually transmitted infections and treat if they are positive. We can do pregnancy tests, but if a girl is pregnant, they are followed by an OBGYN. Pediatricians do not take care of pregnant teenagers.
Pap Smears
I have moms ask all the time if once a girl starts getting her period, does she need a Pap smear? The current guidelines are that Pap smears are not needed until age 21 or three years after a girl starts having sex. Moms are often shocked by the fact that we don't do them at 16.
Also, pediatricians don't do Pap smears at all usually. Some adolescent pediatricians who only see adolescents and have additional training in adolescent medicine sometimes will, but most general pediatricians do not.
Pelvic Exams and Postpartum Care
We do not do pelvic exams. We do not do postpartum exams either. Yes, I have been asked to do them on teen moms who are patients of mine whose babies I also see.
If a girl continues to have gynecology issues such as frequent pelvic pain or frequent infections, we will do whatever workup we can and treat what we can, but then we will refer to a gynecologist.
Many gynecologists actually will see girls ages 16 and up. For those under 16, most of us know a gynecologist who has done additional training in pediatrics and they will usually see kids as young as 9. If a patient is younger than age 9, it's usually something very uncommon and often general surgeons will get involved. That's pretty rare though.
Seeking Specialized Care from Obstetrics and Gynecology
So the bottom line is your daughter's pediatrician can do basic care when it comes to lady part issues, but often these concerns are out of our area. Like I tell my patients, a gynecologist wouldn't be able to manage your daughter's asthma as well as a pediatrician. Same thing. Your daughter's pediatrician very well may not be able to manage your daughter's gynecology needs.
If it is more than we can handle, please understand that we will do all we can to help get your daughter to the right provider to address those gynecology needs.