Portal de Periódicos da CAPES

Approaching an Adolescent about a Pelvic Exam

1988; Lippincott Williams & Wilkins; Volume: 88; Issue: 11 Linguagem: Inglês

10.2307/3470824

1538-7488

V L Szydlo,

Adolescent Sexual and Reproductive Health

An otherwise healthy young woman who has history of coital activity does not need a routine pelvic exam until late adolescence(1). Teenage girls come to my office for many reasons, including vaginal infections, possible pregnancy, for birth control, sometimes with an anxious parent. When to pursue the exam depends on why the teen has come to the office. If she's come on her own, she may be ready for the exam. Completing the entire history and the exam at the initial visit will relieve her anxiety and help her to feel a sense of accomplishment (It wasn't as bad as I'd thought it would be). If a reluctant teen comes in with a parent, or perhaps because of a required physical, tailor your pace to her needs. How do you proceed with the obviously uncomfortable girl who denies sexual activity, but then asks questions about STDs or pregnancy? Be straightforward and honest, but emphasize that she alone is responsible, with your help, for her own care. With this approach, you leave her in control and avoid suggesting that she's not telling you the whole truth. And if indeed her story doesn't ring true, let her back out of it gracefully without having to feel ashamed. Then emphasize the benefits of her honesty. (I know it must have been difficult for you to share that with me. I'm so glad that you did, though, because now we can take care of the problem.) Many a teen has difficulty discussing her sexual history openly. Nonverbal cues generally tell the story: Are her eyes diverted? Does she look at the floor or cover her mouth? Are her legs crossed and turned away from you? Is she twitching her foot or biting her nails? Does she cry easily, even though she's insisted she has no problem? Does she glare at you through narrowed eyes that reflect her anger? If you observe any of the above cues, approach the teen gently, with lots of time and patience. One visit is probably not enough. Give her choices about when to have the exam. I find that telling a teen that a pelvic exam is part of her right to take charge of her own body gives her the right to do just that. Keep in mind that her first pelvic exam will exert a major influence on all her future pelvic exams.