So, in case you are wondering, it does not mean whether someone moves a lot when they are having sex. I know, I know, marginally funny, but it’s an old joke and I couldn’t resist.
Seriously, this is a great question. Sometimes we Doctors forget that what makes sense to us as a question or some of the terminology that we use makes no sense to normal, non-medical people.
When you go to the Doctor, there are some standard categories of questions that we ask (either in person or on a questionnaire that we have patients fill out. These typically are:
The sexual history often starts with “Are you sexually active?” which translated means “Have you ever or are you having now sex of any kind? Any intimate contact with anyone? Oral sex? Anal sex? Vaginal sex? Making out? Anything? With anyone – same sex, opposite sex, both, neither? This part should include questions about sexual orientation or gender identity as well. Asking this question opens the door to anything you want to ask or talk about, but also lets us know what we might need to talk to you more about – STIs or birth control? Being subjected to bullying because you are gay? Resources to help you figure out what to do if you think you are trans? Consent?
Now, I know questions like this can be embarrassing...
....but, being honest with your doctor helps us help you stay healthy. Even though ideally full and open communication with parents would happen around all health topics, we know that might not always be possible. So we totally get it when you might fill out a paper form one way since your parent might be there watching, and then when there is private time, just you and the doctor, you might really need to say something else. I encourage all teens to make sure you get alone time with your Doctor. And, parents, take note as well! It is really important that you learn how to advocate for your own health and to learn how to be comfortable asking health questions and getting health care on your own. When you are an adult, you will be glad you practiced as a teen! For more on how to get private time with your Doctor, read THIS.
This is a great question. There are a couple of things that get covered in a gynecology visit. The one everyone things of right away is cervical cancer screening. This is what is done with a pap smear. Visiting with a gynecologist is very helpful to discuss problems with your periods, breast issues, birth control (if needed), STD screening and questions about sex. Many primary care doctors take care of many of these things as well (I know I do).
It is recommended that first visits to the gynecologist start around age 21:
This recommendation is the same whether or not you are or have been sexually active. That means if you are 21 and not having sex, or if you are in a same sex relationship, or if you are transgender but still have your cervix, you should go to the gynecologist. It also means that even if you are having sex, most young women do not need to go before the age of 21. Personally, I think it is helpful to meet a gynecologist once you are sexually active, but a lot of young women are scared to go and then start having sex without birth control or STD prevention. You can get birth control without visiting a gynecologist. Make sure you protect yourself against infections and unwanted pregnancy if you decide to have sex!
What exactly happens when you go visit the gynecologist:
She will ask you about your medical history, sexual history, medications you are taking, what concerns you have, what your period pattern is like, and similar questions. Often you will fillout a form with a lot of these questions, and then she can go over it with you.
You will be given a gown and told to undress completely underneath and then tie the gown in the front (like a robe). She will step out for you to change and then come back to examine you. You will get your weight and your blood pressure checked (perhaps by one of the nurses). Then you will sit up on the exam table. The exam table looks like this:
She will ask you to lie back and she will do a breast exam that involves looking at your breasts for abnormalities and also gently examining your breast by feeling for lumps and bumps. Then she will pull out foot rests and ask you to put your feet in them and scoot your bottom down to the edge of the table. (you will stay all covered up – don’t worry!). She will ask you to drop your knees to each side to make it easy for her to examine the outside of your vulva. She will spread the vulva (lips) with her fingers and look for abnormalities. Then she will use something called a speculum to examine inside your vagina and your cervix. A speculum looks like this:
She will use lubricant or water to make the speculum and insert it gently. When it is inside (not the whole thing, just the part on the right that looks like a closed duck bill!) she will gently open it so that she can see inside. She will do a pap smear with a small plastic tool and may take other samples for infection with cotton swabs. She then will insert one or two fingers into your vagina to examine for lumps and bumps inside your pelvis and for any pain. Depending on what your situation is, she may also insert a finger in your anus to look for similar problems.
What exactly is a pap smear?
A pap smear is a gentle scraping of the cells off your cervix to look for cancer or HPV changes. This is a picture of what the lab looks at for a pap smear:
The HPV vaccine helps prevent infection with strains of HPV that cause cervical cancer and warts. The HPV vaccine should be given before you become sexually active, which is why it is recommended starting at age 9. For more on HPV vaccine go HERE.
Well, I hope that answers your question and also sheds some light on exactly what happens when you go to the gyno.
This is a great question, and parents, I hope that you read my answer too. As a mom and as a physician, I cannot stress enough how important it is for teens to have some private time with their doctor to talk about concerns, as well as to learn the very important life skill of managing your own health and learning how to advocate for yourself regarding health issues.
Typically, my routine for teen patients (but also for adults who come with spouses) is do the initial part of the visit with everyone in the room. But then I tell the accompanying person that I need them to step outside so that we can have some additional private time. During that time, I may ask additional questions (aka: sex, drug, rock and roll questions, as I like to call them) or probe issues that I might be worried about (abuse, mental health, etc) that the patient may not reveal with an audience. Then, I pull the parent or other person back into the room when we finish up and talk about concerns that the patient is OK with me discussing together.
Now I know that not all Doctors have the same routine, so there are a few things you can try:
Now a few notes – each state has different adolescent confidentiality laws – meaning that what you discuss is private and not shared with anyone. Your Doctor will be aware of the laws that cover this issue in your state. Most states allow for adolescents to receive mental health care and reproductive health care without requiring adult permission, but this can vary.
Separate from the laws themselves, there are a few things that your Doctor will have to reveal in order to protect your safety. If you are feeling suicidal, she may need to share that information in order to get you the care that you need. Also, if you are a victim of abuse and are a minor, most states require that to be reported as well, so that you can be safe.
Now, before I end, a note for parents who might be reading this:
Please let your teens have this alone time with their Doctor. This is an important step in young people learning how to be self-sufficient adults. If your teen has questions about drugs or sex or other sensitive issues and they feel strange coming to you for information, you would definitely rather he or she get accurate answers from a Doctor than from their friends, right?
“Hi, my name is J. and I'm 17, but for over a year now, I've been having hot flashes and I'm not sure why.”
Here's a question I got through Tumblr from J. Thanks for your question!
There are a lot of reasons teen girls can get hot flashes or flushing, but it is important to have this discussion with your doctor so that she can examine you and think about your symptoms knowing your entire medical story. In the meantime, I’ll give you an idea of how I think about hot flashes in a female teen.
The first thing I would want to know is what’s going on with her periods. Did she have them and now they have stopped or they are lighter and she misses a lot of periods? That would make me think about problems that cause the ovary to stop working properly – like premature ovarian failure (fancy medical speak for the ovaries stopping functioning before menopause, when this usually occurs). One common reason for decreased ovarian function is an eating disorder like anorexia. Even extreme exercise and weight loss below what is a normal healthy weight for an individual can lower hormone levels that affect fertility and periods, cause hot flashes, and also cause thinning of the bones. Some girls in certain sports are more at risk for this – such as in track or other sports where making weight is an issue.
In young females with normal periods, anxiety disorders are common cause of hot flashes. Anxiety and anxiety -related disorders are one of the most common mental health issues that teens face. Almost 1 in 10 teens suffer from anxiety. Panic attacks are a specific type of anxiety disorder that causes hot flashes along with a pounding and racing heart, a feeling of dread or terror, and intense anxiety or nervousness.
You don’t have to have an anxiety disorder to experience hot flashes though - emotional flushing, more often known as blushing, causes hot flashes too – it usually occurs when a teen is nervous or embarrassed and has no health problems associated with it.
Did you know that alcohol can cause hot flashes too? This is especially true when combined with certain medications leading to a specific chemical interaction (such as metronidazole which is used for trichomonas and other infections).
Speaking of medications, some medications by themselves can cause hot flashes as a side effect – some of these are blood pressure medications and certain types of anti-depressants. Female teens that have been treated for cancer with chemo drugs may have premature ovarian failure (or early menopause) from the chemo drugs that had to be used to treat her cancer.
Here’s one to consider too: teens who smoke a lot of weed or consume a lot of cannabis on a regular basis can have hot flashes when they stop. This may occur with other symptoms in what is considered a withdrawal syndrome. On the other hand, some teens have hot flashes when they use weed, as opposed to when they stop.
If hot flashes happen along with having a really hard time breathing plus abdominal pain and hives, that could be a severe form of allergic reaction called anaphylaxis. This needs medical attention right away.
There are other medical conditions that can cause hot flashes as well, such as having an overactive thyroid. Too much thyroid hormone also causes jitteriness, rapid heart-beat, weight loss and other symptoms.
So, J., you can see there are a bunch of reasons that teens can have hot flashes. I didn’t even cover them all here – but your doctor can sit down with you and think through what you are experiencing and then make some recommendations for you.
So, you’re packing to go off to college. Feeling good. One thing you are probably not thinking about is when you don’t feel so well – like with a headache or stomach upset or an annoying cold. When you feel like not getting out of bed, you will be glad to have certain over the counter things with you in your dorm.
Now everyone is different, and most of you will have a few other things you need to bring for your medical needs, but this is a good place to start. I made a short list for you of common ailments that you probably will have at one point or another along with over the counter medications you might want to use for them. Now that you will be in charge of your health, you need to know how to use these medications safely and also a few things to watch out for that might mean you should go stop in to student health. To help you with your list when you get done reading this, I highlighted everything in GREEN that you should bring with you.
Before we start here’s the usual reminder – this post (and nothing on this website) is a substitute for medical care and the advice of a Doc or Nurse who knows you and your medical history well. But that said, here’s a list of what to bring and how most people should take them:
Headaches are really common, and there are a few different types of headaches that you might get. For a regular, run of the mill headache, most people try either acetaminophen or ibuprofen.
Acetaminophen is the active ingredient in Tylenol®. Key things to remember, pay close attention to the dose on the bottle. You probably will be taking 325 mg of a regular pill, or if it is extra strength, you will be taking 500 mg. The maximum amount most people should take at once is 1000 mg (3 regular strength, 2 extra strength pills) and a total amount over 24 hours of no more than 2000 mg or 2 grams. For example, don’t take more than 2 extra strength acetaminophen every 12 hours. And this is not a good thing to have (take my word for it).
Ibuprofen, which is what Motrin® is made of, is in the NSAID family. These medicines are good for pain and inflammation. They can irritate your stomach, so if you take these, take them with some food in your stomach, or with an antacid or acid blocker. These medications also have a maximum dose so look at that bottle. Generally, I recommend no more than 600 mg every 6 hours for a maximum of 2400 mg a day. Usually ibuprofen pills are 200 mg, so that means no more than 3 pills every 6 hours. Most people get good relief with a lot less (like only 1 pill every 6 hours), but I don’t want teens to take too much since these too can hurt your kidneys and liver at high doses over a long time.
A few things to watch out for:
Problem: Upset Stomach / Acid stomach
An upset stomach can be caused by a bunch of things – stress, stomach irritation, alcohol, or just because. For mild cases you can take antacids like Tums® (calcium carbonate). These work right away by having a chemical reaction with the acid in your stomach and neutralizing it. Some people think they can take acid blockers like Pepcid® or Zantac® as needed (right when they feel the upset stomach). These don’t work as quickly since they need to be absorbed into the bloodstream and then go back to decrease acid production in your stomach. This takes hours.
Diarrhea is pretty common in places where a lot of people live close together. Most often it is caused by a virus and will run its course over a few days. The biggest thing to worry about is making sure you don’t get dehydrated. If you have no fever and just some really bad runs, you can try a diarrhea medicine like Immodium® or Pepto Bismol®. I always tell patients to avoid dairy, high fiber, or hard to digest food until things settle down. Lots of fluids. Simple foods like broth, jello, rice, bananas. Add dairy back in last since diarrhea strips the good bacteria out of your intestines that break down lactose – making you temporarily lactose intolerant and prolonging the unpleasant situation.
What to watch out for:
Fever? Bloody diarrhea? Feeling really ill? Dizzy? Time to go to student health.
Problem: Cold / Runny Nose?
Colds stink. They just don’t seem worth the hassle and they always last longer than it seems they should. What to do for relief? Well, steam, rest and fluids! Sometimes (OK, usually!) that isn’t enough. There are a lot of multi-symptom cold medicines out there, but usually they have things in there you don’t really need. (Like if you have no fever and no achiness, you really don’t need the acetaminophen that comes in them.)
So, the best thing is is to take medicines to treat the ssymptoms you have and only those:
Problem: Athlete’s foot
This one is pretty common – it’s a fungal infection that is especially easy to get from dorm / gym showers. You can use an antifungal cream like clotrimazole, miconazole or ketoconazole.
This is why you should wear those flip flops to the shower! And keep your feet clean and dry.
Problem: Cut looking infected
Again this one is pretty easy to deal with – you can use a topical antibiotic like Neosporin® and cover with a bandaid. Most importantly keep the cut clean and dry!
What to watch out for:
If there is redness that is spreading away from the cut, or you see streaks of red going away from the area, or if it is really painful, and you have a fever, get to student health!
So, college food! Yum! No nagging from mom about whole wheat bread, fruits and veggies, brown rice. Finally you are FREE TO MAKE YOUR OWN FOOD CHOICES! Every day! But, well, somehow things have gotten sluggish. In fact it’s been days. And it doesn’t feel good.
This happens. Have a gentle stool (aka poop) softener on hand like docusate (Colace®). This is a better way to go than using a laxative. Your intestines can get dependent on laxatives and “forget” how to poop on their own. A stool softener just helps soften poop up to make the normal contractions of your intestines have an easier job. You can take a few pills a day to get things moving, then back off, and then stop when you are back to normal. Dosing is on the bottle. Prevention? Water, fiber and exercise.
Problem: Seasonal Allergies
If you suffer with seasonal allergies, bring along something to help! There are pills such as loratidine or Claritin®, for instance. Those you can take as needed, though they do take a few hours to kick in. If you know a certain time of the year is bad for you, just start taking them every day. If you have eye and nose symptoms, they are useful Another option which actually works better for a lot of teens are nasal steroids. These are best if you only have nose symptoms (achoo and runny). Common sprays are fluticasone or Nasonex®. They do NOT work if only taken as needed. You take these every day through your allergy season. Dose and directions on package.
Problem: Itchy rash
Common again. Often we aren’t sure why, but common causes are new soaps, lotions, detergents.
A gentle steroid cream (like hydrocortisone) can give you a lot of relief.
What to watch out for:
Shifting gears - how NOT to have a problem
Okay, not everyone is going to have sex in college, but it is always better to be prepared than to be swept away in a moment of passion. So a few things to bring along with you to prevent problems:
And a few final tips:
This is really important - remember to bring your regular prescriptions if you have any.
One final thing – when you get to campus, figure out where you go for medical help- where is student health, or if you need to see a specialist when you get there for a chronic medical condition, figure out who that might be. Never a good idea to wait until you have an emergency, or even just an urgency to figure out where to go. Remember to bring a copy of your insurance card too if your home medical insurance is covering you.
That’s it! Good luck, Freshmen! And, upper classmen – anything I forgot that you wish YOU had in your dorm room when you got to College?
Today I am really excited to share our first guest Vlog! Grace, one of this summer's teen guest Vlogger / Bloggers has put together a great video for us where she shares what she tries to do to live a healthier life! I personally like all her ideas and do many of them myself! You might see something that you want to try!
So, what did you think? What are you going to try? Do you have other ideas that you want to add? Use the comments below!
Shots are uncomfortable. Trust me, I know. It took nine years before I was finally able to sit down for a shot without making a desperate attempt to escape the doctor’s office. Despite this and the recently developed stigma behind vaccination, vaccines are a necessity to keeping us safe from disease.
Let’s talk about some of the many questions surrounding vaccines.
Why do vaccines work?
When we’re infected with a virus, our bodies produce white blood cells to fight off the intruder. In the process, we become very sick. Once the virus is gone, antibodies remain to remind our bodies how to fight the virus if it comes back, making us immune to that strain. Luckily, vaccines let us develop those antibodies without becoming sick. A vaccine is filled with weakened lab-grown versions of a virus. When injected into the body through a shot or other means, the immune system is easily able to beat the vaccine.
Do vaccines cause autism?
Short answer: Nope. The supposed link between the MMR vaccine (for measles, mumps and rubella) and autism originated from a falsified study in 1998 by Dr. Andrew Wakefield. Despite the study being discredited, celebrities such as Jenny McCarthy, Jim Carrey, and Donald Trump have gripped the misconception with fear-filled hands. Don’t let them mislead you, though. There’s no scientific link between vaccinations and autism.
Why do I need to be vaccinated if everyone around me is?
Unfortunately, choosing not to vaccinate doesn’t just affect you. It also affects those around you. Not everyone is medically able to take vaccines, forcing them to rely on a system called herd immunity. When most of the population is immunized, the spread of the disease is contained so that unvaccinated people have an extremely small chance of being sick. However, when only some of the population is immunized, the disease can spread quickly and through those who were previously protected.
What are some of the vaccines I may get?
Dr. O adds:
Julia, thanks for your post! I couldn't have said it better myself! There are a bunch of vaccines that teens need that did not exist when your parents were teens, so it may not occur to them to see if you need new shots. So, make sure to ask your doctor if you are due for anything!
And, just to reiterate:
You’re all set with College for next year. Here’s the stuff you need to make sure is in order before you get there.
First things first, those of you who are moving onto college next year: CONGRATULATIONS! Senior year is stressful and adding the challenge of figuring out what might be the best fit for you to continue your studies only make matters worse. Some of you got into your first choice; many of you didn’t. Some of you are thinking about taking a gap year; others are going straight to freshman year after the summer. Some of you know exactly what you want to study; most of you don’t.
Regardless, you need to know this:
Getting into college is not the finish line! It is a big step on this long and windy path called life. What you do when you get there is what really matters. College provides opportunity to learn more and learn deeper, as well as to develop independence and learning how to care for yourself. Too many people think once they get into their first choice or the college of their dreams, the rest of life just falls into place after that. A lot of parents (we mean well, we really do) slip into that thinking too. The reality is, you can go to community college for a few years to save money and to take time to figure out what to do and ROCK your classes there and move on to become a huge success (whatever that looks like to you – it’s not always fame and money; but it should be making the world a better place!). Or you can show up to Harvard or Stanford or another elite school and not really engage with what’s there and spin your wheels when you get done. If you get done.
I have a few things I think every rising college freshman need to think about and get in order before you take that leap. This post could also be titled: Getting Your S&^% Together for College.
1: What is your relationship with substances? Do you overuse them? Are you dependent on them? Have you tried to quit or think you should or do friends and family worry about your use of them? Substances in this discussion mean things like: Alcohol. Prescription pain medications. Marijuana. Heroin. Fentanyl. Oxycontin. Xanax. Anything like this that you feel like you cannot live without. A lot of people (and I see a lot of parents think this way) think once you land at your new location with new friends and a new environment, this problem will go away. While it is true that changing some of the external cues can help you resist, the reality is, soon you will be exposed to a new stressor or feel uncomfortable in a new place or something will drive you back to that substance, often worse that before. You are going to be in a place where you usual support system, although still there, will be much further away. Those triggers may be impossible to ignore. The bottom line is this: before you pack up and move to college, address this problem. Take a gap year. Get some medical help. Do not make the mistake of getting there and wasting a year of your life and a whole lot of money holed up in a dorm room using since you didn’t address this problem now. Parents who are reading this, if your teen comes to you and wants to put things on hold to address this, hug them and congratulate them on making a very adult decision. Then support them. Even if your teen isn’t ready to come to you, but you see your teen is some of these words, you can help them get to treatment they need. Please do not fall into the common misbelief that everything will be fine once they get off to school.
2: How is your mental health? I mean, really, how is it? Many, many teens experience depression, anxiety, bipolar disorder and don’t take the time to address it as they go through high school. Either they are embarrassed by it or for other reasons they don’t get to a doctor or counselor or another professional who can help them. Perhaps you struggle with an eating disorder. Get a plan in place so that you can keep it under control when you get there. Take the time now. Go get a treatment regimen put together so that you can get used to it before you head off to college. Again, you will be in an exciting new environment and you can show up with whatever “you” you want to bring along. But new classes and expectations and a new environment and new friends, with a dose of home sickness all cause stress. And increases in stress can worsen mental health symptoms. Prepare yourself now! This is a great opportunity!
3: Think about what works for you for stress management. Really think about it. Make sure when you head on out, that you have what you need to help you with that. Look up where you can get exercise on campus if that is how you like to take the edge off (one of my favorite ways!). Make sure you have music that helps you too. Figure out good places to get outside. You get the idea. You can make a mental arsenal of stress-busting tools to have on hand for when you need them!
4: Lastly, practice making good food and exercise choices now. You know how annoying it is when your parents or other adults try to make you eat those darn vegetables, or nag you about eating too much sugar. Or when we Loudly Encourage (aka: yell at) you to get some exercise and put those screens down? (I know – I see it in my kids’ eyes most days!). Well, think about this – in a few short months you will be on your own with all those decisions! Yes, you will now have to nag yourself! Maybe each week make a personal goal – like have more water and less sugary beverages, or get out for some exercise every day, or learn to cook an easy healthy meal. Practice now so that when you get there, some of these things will be second nature.
Maybe you aren’t ready just yet to tackle college.
Listen to me: THAT IS OK! Take a gap year.
Get a job. Figure out what direction you want the future to go. I didn’t take a gap year before college, but I did before starting med school. I was a secretary for a year (actually I got fired from the first job and had to move onto another). It was the best thing I ever did. I knew no matter how hard the path got, that in the end, I could get a job and earn money to pay rent and feed myself. No, I didn’t live in a mansion or a modern condo – I split a small 1 bedroom with a roommate – one of us got the bedroom, the other converted the living room into sleeping quarters. It was in a walk up in NYC. There was a really tiny kitchen and no real dining room. But it was awesome! And giving myself that breathing room allowed me to tackle med school rested and with enthusiasm.
Finally, does something here speak to you and you are nervous about going to your parents about it? Listen here – you need to advocate for yourself. This is one of the most important things you need to learn how to do as you mature into adulthood. You can tell your parents that you read an article that a Doctor (me!) wrote about addiction / mental health / gap year / etc and you think you need to address something before you go onto college. Show them this article if you want! Point out that paragraph above where I talk right to parents - (it is in the same color font)! Parents really do want you to be happy and healthy, and we so often hope beyond rational thinking that something will be just fine if you get to the next place. But when our kids need help and ask us for it, we want to do just that.
OK I think that’s enough to think about for today. And these are just a few things to think about as you wind down this year and look to the future.