Selecting a Medical Provider

One day you're going to reach the point where you'll need to see a gynecologist. A gynecologist is a doctor who specializes in female reproductive health services. Most are also obstetricians, or doctors who specialize in pre-natal and pregnancy care, and you'll see them referred to as OB-GYNs. The first visit to any doctor can be fear-inducing, but for most women, that first trip to the gyno is more frightening than just about anything else they can imagine.

It is an important and potentially lifesaving thing to do, however, and it is critical that you select a doctor with whom you are comfortable; one you feel you can share very intimate details of your personal life. This article is intended to help you think through that process to ensure you get the best care possible.

Necessity of Reproductive Health Care

When should you seek the care of a gynecologist (gyno)? Guidelines established by the American College of Obstetricians and Gynecologists (ACOG) recommend a brief, non-pelvic exam visit with a gyno between the ages of 13 & 15 to discuss reproductive health, puberty changes, menstrual periods, etc. Once you turn 18 or become sexually active (whichever comes first), you should have an annual pelvic exam and pap smear. These exams are important because they allow the doctor to detect changes in your cervix and other structures that could portend the development of cancers and a variety of other medical conditions. With the increasing prevalence of HPV these days, these exams can be an important mechanism to detect changes in your body that might be indicative of problems down the road.

Selecting a Gynecologist

Your gynecologist will be among the most important healthcare providers you'll ever have This will be a person you'll discuss some of your most intimate secrets with, and it will be vital that you establish a close trust. Therefore, it is essential that you select someone who you can feel comfortable with and shares the same values with respect to sex, pregnancy and other aspects of your reproductive health.

Most girls will initially start out seeing the same doctor their mothers have seen, and this is an excellent way to find one, assuming your mother trusts him/her. If you are fortunate enough to have a mother you can confide in and respects your right to have your own "space" when it comes to reproductive health services, this is generally an excellent option. In some cases, however, you may wish to have a different doctor; perhaps one that you feel will maintain confidentiality and won't reveal anything you say to your parents. If you're insured (either through school, your parents, or your own policy), you'll need to verify that any doctor you select is on the list of acceptable doctors with your insurance company. Keep in mind that, if you use your parent's insurance to pay for services without telling your parents in advance, they may discover this when they receive a notice of benefits paid in the mail down the road.

Once you arrive at your appointment, you’ll fill out some paperwork and be taken back to have a cursory preliminary exam (blood pressure, pulse, etc.). Shortly thereafter, the doctor will come in and introduce himself or herself. At this point, you'll want to explain to the doctor that you have a couple of questions before s/he begins the exam – questions that you would like to ask to gauge whether or not s/he is the right doctor for you. Any reasonable doctor will be happy to entertain such questions. If s/he shows hesitation or refuses to answer your questions, this should be a red flag to you and you should politely thank him or her for his or her time and leave (checking out with the receptionist).


There are some critical questions you need to ask any doctor you are considering:

Doctor with medical file

What are your polices on confidentiality (see below) – will you keep what we discuss from my parents? If the doctor feels the need to treat you like a child and not keep your discussions private from your parents, you'll probably want to find another doctor.

What are your views on teenagers and sex? You want someone who will be non-judgmental and is more concerned with your health than imposing his/her morality on you. If the doctor says s/he doesn't prescribe birth control for teens (or even unmarried women like some do), then you should consider finding a new doctor, regardless of whether you plan on getting on BC or not. Again, you want to find someone who will be concerned about your health, not your morality.

Once I start hormonal birth control, how long must I use a backup such as a condom? If your doctor says something along the lines of “one month,” you should seek another doctor. You can stop using a condom immediately if you begin birth control on the first day of your period, and after one week if you begin taking it on any other day. Some doctors don't bother to keep up with the latest information about how BC works, and providing this kind of erroneous information is a good indicator that s/he isn't keeping up with the state of the art when it comes to BC. You don't want someone treating you who isn't keeping up with the latest information.

What are your views on abortion referrals? If you're one who considers abortion a viable option for an unwanted or problem pregnancy, you'll want to be sure that your doctor will treat this decision with respect and will honor your requests for appropriate referrals. You don't want to find out too late that your doctor doesn't believe in abortion after you've become pregnant. Again, the focus should be on your health and not his/her morality.

What are your views on pre-natal care and childbirth (assuming the doctor is also an obstetrician)? This will give you some idea of how a pregnancy will be handled if/when you become pregnant. Ask the doctor if he is going to allow you to make the decision about whether to deliver vaginally or through Caesarian, or if s/he is going to feel s/he has the right to make those decisions for you. Some doctors try to coerce women into delivering via C-section because of malpractice concerns rather than any concern for your health.

Will you provide me with a precautionary prescription for Plan B? If you're going to be sexually active and can't or don't want to be on a hormonal form of birth control, then it is critical that you get a precautionary prescription for Plan B just in case. This is true even if you aren't sexually active. If you are raped, most states do not require hospitals to even let you know Plan B exists, let alone provide you with a dose. You never know when you're going to need this, and some doctors wrongfully believe Plan B is an abortifascient (even though it is only a high dose of regular birth control) Again, you don't want an ignorant doctor or one who is concerned with his/her morality over your personal health. You should be the one who decides if you are going to get pregnant, not your doctor.

reproductive health

Planned Parenthood & Other Clinics

The Planned Parenthood Federation of America, (Planned Parenthood, or PPFA) is the pre-eminent reproductive health services provider for young people. It has clinics in every just about state in the country, and offers the entire range of reproductive health services at the vast majority of them. PPFA is a name you can trust, and you can feel comfortable seeking health services at any of their clinics anywhere in the country. If you can't find a reliable doctor near you, or just want quick access for exams, birth control or related services, PP is easily an excellent choice. You can find the nearest Planned Parenthood HERE

If you're fortunate enough to be in a high school that offers basic reproductive health services, they can often help you find a doctor that specializes in adolescent health care that would be an excellent fit for you (and frequently offer basic services on site). And, if you've waited until you've gotten to college, most colleges have on-campus health clinics that offer a wide range of reproductive health services (or can provide referrals to off-campus doctors who do). Many states also have public health clinics that provide basic reproductive health services as well, including birth control at reduced rates. Check your state health department's web site for locations and additional information.

Honesty

Once you've found a doctor you are comfortable with, it is essential that you are honest and forthright with him/her. Doctors are there to ensure your health, and if you aren't telling the doctor what you're doing with respect to your sexual health, there's no way s/he can do the job properly. If you're sexually active, let him/her know, and be prepared to explain to what extent you've had sex, and any relevant background that s/he might ask about. It might be a bit embarrassing at first, but it will get easier as you develop a trusting relationship with the doctor. In the long run, it is critical that you level with him/her to ensure that you get the best, most appropriate care.

"Crisis Pregnancy" Centers

Becoming pregnant as a teen, especially if it was unplanned can be a terrifying experience. You may be tempted to seek out help at the first place you find. Perhaps you’ll look in the yellow pages, or on an Internet directory, or you may just happen to be passing by some place that advertises "pregnancy help" - a "crisis pregnancy" center that promises to offer you "help" with your pregnancy. This seems like just the place to turn if you suddenly find yourself pregnant, and don't have a doctor you can rely on to examine your options.

The problem comes when you go in to discuss your options with these folks. Many "crisis pregnancy" centers are simply fronts for religious or "pro-life" organizations whose sole purpose is to dissuade you from having an abortion, or, in many cases, even considering abortion. If you bring up the subject of abortion, they'll show you images of mutilated fetuses (many of them PhotoShopped to enhance their effect on you). These places will often locate near high schools and colleges, and it is not uncommon for them to take over locations that used to be occupied by a Planned Parenthood or other reproductive health clinics knowing that women will come in believing that they are in a Planned Parenthood facility (and therefore expecting honest information).

These places are typically staffed by volunteers associated with a church or religious group, and they are not required to be licensed as medical providers (that alone should be a red flag). The vast majority of the employees in these places have no formal medical training whatsoever, and have only rote information that they drone out to try to persuade a woman from contemplating all of her alternatives. They promise to "be with you all the way" and they will - until your child is born. Sure, they may provide you some free diapers and formula, but once your child is born, their mission will be over and it becomes your responsibility.

The point is, if you want completely legitimate, honest and unbiased information, you want to avoid these places. Regardless of the decision you make (even if you are anti-abortion yourself), you are entitled to receive full, unbiased, medically accurate information upon which to make your decision, and you can't rely on these kinds of facilities to provide it.

Confidentiality

One thing you will want to discuss with any doctor you are considering is how they interpret confidentiality laws relating to minors and reproductive services. If you are 18 or older, this is a non-issue, since the federal Health Insurance Portability and Accountability Act (HIPAA) guarantees your confidentiality with respect to medical treatment, even with respect to your parents. With minors, however, there is a mix of state and federal regulations that affect what doctors can and cannot share with your parents. Most states have laws that guarantee a minor's access to confidential reproductive health services (for those 12 and older). This is largely the result of federal Title X legislation that provides family planning service funds to states. HIPAA also provides some protections against disclosure for medical treatment.

It would be beyond the scope of this article to explain how these laws interrelate and how they work in all 50 states, so the best course of action is for you to specifically discuss how your doctor interprets these laws and explain to him/her that you expect full confidentiality in all of your reproductive health issues unless you specifically authorize him/her to release information to your parents. S/he expects honesty from you, and it is perfectly legitimate for you to let him/her know that honesty is expected in return.

Summary

Your reproductive health is one of the most critical aspects of being a female. The choices you make about how to manage your sexuality and the health issues that are involved with it can have a significant impact on your life, and you'll want to select a medical provider who you can trust to help you make those decisions without being judged or having to worry about the doctor substituting his/her morality for what's best for your personal health. Do your research, find a doctor and ask questions that you consider important about your reproductive health. Make sure the doctor you choose is one you can trust and are comfortable with. Your very life could depend on it.