The American Academy of Pediatrics (AAP) recommends that all young people aged eleven to twenty-one be seen annually by their pediatrician; the evaluation includes a history of what is going on in the teen’s life. When necessary, there will be a physical examination, screening for vision and hearing and laboratory tests (such as blood work or a urinalysis). The pediatrician decides what needs to be done at each annual visit depending on what has been happening in your teen’s life and what tests have been done in the past.
The Physical Exam
After your pediatrician has reviewed your teenager’s medical history, she begins the full-screening physical examination, which will most likely include the following:
- Height and weight measured.
- Blood pressure and pulse taken.
- Discussion of important health and safety issues such as sexuality and the prevention of sexually transmitted diseases, the dangers of experimenting with alcohol and other drugs, dietary and exercise habits, driving safety and so on.
- Vision is tested and if your pediatrician detects any sign of injury or disease, or suspects that your teen might need glasses, you’ll be referred to an eye care specialist.
- The doctor uses her fingers to feel the neck for swollen lymph nodes or an enlarged thyroid gland. She also touches and presses on the abdomen to feel for any problems with the spleen, liver and kidneys.
- Placing a stethoscope to your youngster’s chest and back, the pediatrician assesses respiration and listens for any abnormal sounds from the heart.
- Posture is checked. Any apparent abnormality of the spine may warrant X rays, because adolescents are prime candidates for developing progressive curvature of the spine, such as scoliosis.
- The pediatrician tests joint flexibility and muscle strength.
- Both girls and boys have their breasts felt, or palpated, for lumps. At this age, a mass in a girl’s breast is almost certainly benign. As for boys, early in puberty, many will develop excess breast tissue. This condition, gynecomastia, is usually temporary and more distressing than it is serious.
- The pediatrician may conduct a full-body skin inspection, checking for acne and suspicious looking moles.
- Pediatricians often inspect the genitals last, knowing that this is the part of the exam that many teenagers, self-conscious about their bodies, dread the most.
Immunizations and Laboratory Screening Tests
Vaccinations? Still? With his last inoculation several years behind him, your teenager may have assumed he was all through with having to get shots. One in five adolescents and young adults are not adequately immunized against preventable diseases such as measles and mumps. If you don’t have a pediatrician, call your local health department. Public health clinics may provide immunizations at reduced cost.
The Gynecologic Exam
A young woman should have a full gynecologic exam that includes a pelvic exam and a Pap smear as soon as she becomes sexually active, or at the first sign of a possible gynecologic disorder. It is normal for a girl to be nervous beforehand. A parent’s taking the time to patiently describe the procedure should help relieve her anxiety. This is what she can most likely expect.
The Interview
First a doctor or nurse will ask the young woman questions about her reproductive health, such as, “When did your last period start? How regular are your periods? How long do they last?” She may also inquire about the patient’s sexual history and discuss methods of protection against sexually transmitted diseases and unintended pregnancies. Then the patient is escorted to the exam room, where she’s asked to take off her clothes and put on a gown.
The Breast Exam
In examining the breast, the pediatrician looks for lumps and other abnormalities, such as signs of infection. The pediatrician may use this opportunity to instruct the patient how to examine her own breasts. Periodic breast selfexam (BSE) is often recommended for young women.
The Pelvic Exam and Pap Smear
For the pelvic exam, the young woman lies down on the table with her knees apart and her feet placed in a pair of metal stirrups. A sheet is draped over her legs and stomach for added modesty. Throughout the procedure, the pediatrician will describe and explain what she is doing, which greatly helps to put patients at ease.
The examination has three parts. First the pediatrician uses a light to inspect the anatomy of the outer vagina and surrounding areas. Next an instrument called a speculum is gently inserted into the vagina. Made of plastic or metal, it widens the vaginal opening just enough so that the physician can view the vaginal canal and the cervix. Most patients say they feel pressure, but not pain. If your daughter feels nervous or uncomfortable, she should take several slow, deep breaths, to relax the vaginal muscles.
Some girls who have never had sexual intercourse worry that the procedure will tear the hymen and rob them of their biological virginity, or that the doctor won’t be able to place the speculum. There is no cause for concern; the vaginal opening is large enough to accommodate the device. Also, the teen should always feel that she has a right to discontinue the exam once it has begun.
A pelvic exam includes a Pap smear, one of the most effective screening tests in medical history. First the doctor takes a long-handled brush and gently obtains a small sampling of cells from the outer and inner linings of the cervix. The cells are placed on a slide and sent to a laboratory, which will test for cancer and other diseases.
In the third part of the exam, the pediatrician removes the speculum and inserts one or two fingers in the vagina. She feels the uterus and the ovaries, checking for size and cysts, while pressing on the abdomen with her other hand. Usually, a pelvic exam for an adolescent does not require a rectal exam. With that, the exam is over, and the young woman can get dressed. The internal exam is a limited part of the gynecologic exam. “For a girl’s first visit,” says Dr. Marianne Felice of the University of Massachusetts Medical Center in Worcester, “we spend a lot more time with her, getting her ready
for the initial exam.
The Testicular Exam
As part of a teenage boy’s annual physical, he will be asked to lower his pants and underwear so that the pediatrician can examine the testicles for cancer and for hernia. In a hernia, part of the intestine protrudes downward until eventually it descends into the scrotum. Some hernias cause a bulge that the doctor can feel. The condition is corrected with surgery.
As the physician palpates each testicle for possible tumors, he’s also explaining to his patient the importance of practicing testicular self-examination (TSE) at home on a monthly basis. Testicular cancer, while rare in teenagers (approximately thirty cases a year), is the leading malignancy among young males aged fifteen to thirty-nine. It is also one of the most curable of all cancers.
“While I’m examining a boy, I’ll describe what I’m doing and what I’m looking for,” says Dr. Mark Scott Smith, chief of adolescent services at the Children’s Hospital in Seattle. “It’s a good idea for boys to learn how to check themselves, just so they know what’s normal and what’s abnormal.”
Memo to Mom and Dad: Mention to your son ahead of time that it is not uncommon for an adolescent to reflexively develop an erection during a testicular exam. Assure him that this is a normal (although inconvenient) reaction.
