NOT YOUR MOTHER'SGYNECOLOGIST
You're a New Kind of Girl—You Deserve a New Kind of Medicine
Casey,1 fifteen, a slender redhead with a sprinkle of freckles on her nose,was sitting next to my desk, twisting a strand of long, straight hair when Iwalked into my office. I could tell she was nervous.
"Hi, I'm Dr. Ashton," I said, sitting down at my desk. Since this wasCasey's first visit, we were meeting in my cheerful office, not in an examroom. (After all, do you want to meet your doctor for the very first time in an exam room withyour clothes off? I wouldn't either. So my patients meet me in their clothes, at my desk.)Casey looked startled when I introduced myself. "Really? No way," she burst out. Thenshe blushed. "Sorry, it's just…; you don't look like a doctor."I laughed. I hear this all the time. Is it my blond hair? My leopard-print skirt and ToryBurch boots? Lucky for me, I didn't have to check my fashion sense at the door when theywere handing out degrees at Columbia Med School. Or my sense of humor, either.
And it's a good thing, too. Without a sincere appreciation for a witty comment or thelatest color in Uggs, my job wouldn't be nearly so much fun. I love the humor, the sass, thestreet sense, and the totally exhilarating energy of my teenage patients. Although I do treatadult women, too (often the mothers of my teen patients), I spend most of my time everyday talking with, laughing with, and treating girls from their early teens to early twenties.That's what Casey and I did—talk and laugh. After a good chuckle overher confusion, we found ourselves talking about pretty much everything—why she'd come (bad cramps), her overall health (pretty good), and her lifein general (crazy busy, with dance team practice, SAT prep courses, collegevisits, and a long-time boyfriend). The more we talked about her incrediblyfull life, the more Casey reminded me of something—the single most importantthing I've learned from my patients. It's this:
It is much, much harder to be a teenage girl now than ever before.
Yeah, I know, the lonely-zitty-anxious-harassed teen years have neverexactly been an all-expense-paid vacation to Hawaii. But it's tougher todaythan ever. Even tougher than when I was a teen (and that wasn't so longago—really!). And also tougher, at least in some ways, than when your parentswere teens. Sure, you've got your iPod, your cell phone, your computer.You can text your best friend about tomorrow's math test and checkyour new crush's Facebook page at the same time with one hand tied behindyour back. You're smarter, more sophisticated, and way more connectedthan your parents were (or are). But you're also under phenomenalpressure—academic, social, physical, and sexual.
"You're supposed to get perfect grades, but even straight A's aren'tenough to get you into a good college," Casey told me. "You're supposedto volunteer, play sports, and be a genius at something, like violin or math."Don't forget being pretty, popular, and fun. And talk about social pressure—who knows what your so-called friends might be texting about you at anygiven moment? Sure, social pressure's been around forever. But today it'snonstop, always-on, 24-7.
I asked Casey if she was sexually active. "No," she said. "But at schoolthere's definitely pressure to dress sexy and act like you're having sex."Where does all this extra sexual pressure come from? Everywhere. Onestudy showed that teens today may be exposed to twice as much sexualcontent on TV as they were even ten years ago. Another shows that themore sexy shows a teen watches, the more likely she is at risk of gettingpregnant. Then there's music, movies, videos, and social networking sites—not to mention the fact that it just takes one click of the mouse for someoneto e-mail a naked picture of you to a thousand of your closest friends.
On top of all that social pressure, there's this physical fact of life. Notonly are girls dressing older and acting older but their bodies actually areolder, in some ways, than they used to be. Just a decade or so ago doctorswouldn't have expected your breasts to start developing until age ten. Nowwe know that your breasts might start budding as early as age seven oreight.2 Meanwhile, if you're white, you're likely to get your first periodabout three months earlier than girls did forty years ago, and if you'reblack, it will come a good five to six months earlier than it did in the late1960s. And two centuries ago girls hit puberty a good four or more yearslater than they do now.
We don't really understand all the reasons for the shift, but we do knowthat better nutrition and general health play a big role.
So with all this added pressure on you, are you getting lots of new informationand new resources to help you deal with it all? Or a new levelof respect for handling stress that previous generations just didn't face?
Yeah, right. In your dreams.
That's why I wrote the book. A new kind of teen—that's you—needs anew kind of doctor. That's me.
The way health, sex, and physical information is handled by schools,teachers, doctors, and even some parents, you'd think today's girls wereliving in a time warp. Sex ed is still taught exactly the way it was thirtyyears ago (often it's all-abstinence-all-the-time). Most parents still have atough time talking with their daughters about their bodies: Many parentsdon't even know the right words for the female anatomy. (Not that I blamethem—their parents never talked to them about their bodies.) Even doctorsdon't seem to want to talk straight with girls. Old-school doctors alwaysseem to fall into two groups: the "Just-Say-No" group (as in "Can we talkabout safe sex?" "No.") and the "Free Love" group ("Whatever you do isbeautiful. Just use condoms.").
Come on, people! This is the information age!
If you ask me, both these approaches are disrespectful to girls. I believein giving you all the information you need, at the right age, so you canmake smart choices for your body and your emotional health. That doesn't mean I'd tell you it's OK to have sex at a young age: In fact, I'll tell you allthe medical reasons why that's not a good idea. But I'll also expect you touse your own best judgment and I'll treat you accordingly, with respect forthe choices you make.
To make those choices, you need the very latest research and informationpresented in a straight-up way. That's why I wrote this book. I'm notgoing to take sides or preach one school of thought over another. You'resmart. You know how to get information and you know how to think. I'mgoing to give you the right information at the right time and let you makethe choices that are right for you.
LESSONS FROM THE RUNWAY
If there's one thing Project Runway has taught us, it's that one size or styledoes not fit all. I trust you. And I know you can make the decisions that fityou—your physical and emotional development.
To help you do that, I'm giving you all the facts, in a straight-as-an-arrowway, about pretty much everything your body will encounter through yourteens and early twenties. In Section One you'll read about what to expectfrom your body in puberty—how to deal with period problems, infections,injuries, and hormonal issues. You'll also learn how to care for your breastsand bones for the rest of your life. In Section Two I'll give you the latestresearch and thinking on sex—what it means medically for your body,brain, and emotional health when you decide to hook up or have sex atearly and later ages. I'll also explain the very strong medical evidence suggestingyou should wait until at least eighteen for sex. Meanwhile, I'll tellyou exactly how to protect and take care of yourself whenever you domake your decision about becoming sexually active. Finally, in SectionThree, I'll tell you how to build a body that will last for the rest of yourlife—through healthy eating, risk control, exercise, and learning to handlemood problems.
To sum it all up, I'm basically offering you a free virtual visit to my office.I can't meet you and show you around like my actual patients. But I do want to welcome you to your new body and teach you everything you needto know to take care of it, love it, and enjoy it. I want you to own your body,because only you can care for it.
WANT A LATTE?
"Care for a chai? Some herbal tea? A latte?" my receptionist asks newpatients when they arrive. They find her sitting at her glass desk in frontof a curved wooden wall in the reception area of my office.
The beverage menu and the reception area are usually a surprise fornew patients like Casey. "It looks like a spa," Casey told me. There's no bigwhite counter or glass window to check in at. No ugly institutional graycarpet. Everything's done in cream, chocolate, and pale blue, with splashyred end tables and softly glowing wall sconces instead of the usual harshoffice lights.
If you were a new patient, my receptionist would serve you your beverageof choice and snap a digital photo for your record—I like to "see" my patientswhen I'm reviewing their records or talking to them on the phone. Then,beverage in hand, you and, if you wanted, your parents would be escortedto my office, where you'd find fresh flowers on my desk. Later, if you neededan exam, you could slip into a comfy spa robe (not one of those flimsy paperor polyester gowns) in the exam room and watch TV on a plasma screen,check your e-mail on a Mac, or make calls while waiting for me.And by the way, did I mention that everything's eco-friendly? I want torespect the planet, too.
The robes and the TV may all sound a bit much. It's not that I'm allNew-Agey or that I'm trying to be some kind of Beverly Hills doctor to thestars. The truth is, it was just really fun dreaming up an office my patientswould like. I mean, nobody rolls out the red carpet for teen girls, treatingthem like young women who deserve to be pampered and cared for. Onlylater, after we'd designed the new office and opened for business, did Irealize just how much all the little details would mean to my patients. Thedetails practically shout "I care about you. I want you to have a nice experience here. I want everything you see, hear, and touch while you're hereto be respectful, soothing, caring."After all, you have enough stress in your life. I should be helping easeit, not making it worse.
DOCTORS ARE A GIRL'S BEST FRIEND
OK, so not every doctor's office is going to offer you a latte. I'm not tellingyou to pick your doctor based on her taste in end tables. But I do want youto find a doctor who makes you feel respected, well cared for, and, yes,maybe even a little pampered.
That's especially important these days, now that girls are seeing gynecologistsat a younger age. The American College of Obstetricians andGynecologists—the huge national association that looks at data and makesrecommendations for doctors like me—says that you should start seeing agynecologist in your early teens, specifically between ages thirteen andfifteen. That's a surprise to most parents—especially moms, who probablydidn't see a gynecologist until their senior year of high school or later.
If you're between thirteen and fifteen and haven't seen a gynecologist,you should (see the box on pages 13–15 on how to talk your parents into it).At the very least you need to see a gynecologist before you start having sex,so you understand all the medical consequences of your choices. For a lotof medical reasons I'll explain later, I think it's a really good idea for you towait until you're at least eighteen to have sex. But if you decide to becomeactive before that, it's my job to help you handle it in a smart way.
PRIVATES PRACTICE: MORETHAN JUST VAGINAS
Before they meet me, most of my patients think they're coming to see a"vagina doctor." But actually, "gynecologist" means the study of women—inmy case, young women in particular. It's my job to be familiar with every health issue that might affect you as a member of the female sex. Sure, I cantell you if that funny bump or itch down there is something to worry about.(And, by the way, I don't want you ever to be embarrassed to bring stuff likethat up. I have the same parts as you, and I do this all day long. To me examininga vagina is like examining an ear or nose—no big deal.) But I can alsohelp you learn how to take care of your breasts, your bones, your weight,and your mental state—not to mention treating period problems and hormonalimbalances. My job as a gynecologist specializing in young women isto take care of the whole package and help you understand this new bodyyou got when you reached puberty. Isn't that cool? I love my job.
It makes me sad that many girls never get to see a gynecologist untilthey're leaving for college—that's like studying for the SATs after you'vetaken the test. It's so much better to learn everything you need to know inyour early teens, before you start running into the challenges you'll face later. Plus, a gynecologist like me probably will be the one doctor you seemore of than any other medical profession later in life. The sooner you findsomeone you trust and can confide in, the better.
DR. ASHTON'S PLAYLISTS
Over the years I've found myself repeating the same thingsOver…; and over…; and over…; to all my patients. These arethings I really want them to remember, so I say them again andagain. Sort of my personal playlist of advice. I've gathered upthese lists and put them in boxes throughout the book, stressingthe things I really want you to remember. Forgive me if I repeatinformation you've already heard, but these really are my greatesthits. Here are a few I share with my new patients:
TRUE OR FALSE?
You should go see a gynecologist for the first time whenyou're between ages thirteen and fifteen.
You need both a pediatrician and a gynecologist whenyou're in junior high and high school.
You always need a pelvic exam when you go to the gynecologist.
FALSE. You don't usually need a pelvic exam unless you're sexually active.
HOW TO TALK TO YOUR DOCTOR
Jessica and her mother first came to see me about a year ago. Jessica wasthirteen, a flute player with a friendly face and short, glossy dark hair.Later I learned she had a radiant smile, too…; but she definitely wasn'tsmiling when I walked into my office. She and her mother were sittingrigidly in front of my desk, waiting to talk to me about Jessica's painfulcramps. They both looked like they'd rather be having their teeth drilledby a student dentist with a jackhammer.
I didn't take it personally. I'm used to being the only person in the roomwho isn't nervous on a first visit. Typically new patients like Jessica worrythey'll have to put their feet up in the stirrups for a pelvic exam. Theirparents worry that they're giving their daughter a green light for sex justby mentioning the word "gynecologist"—let alone taking her for a visit."So what's going on?" I asked.
I listened to Jessica describe her cramps, with her mom adding a fewdetails now and then.
"OK," I said. "I think I can help. And don't worry—I don't need to do apelvic exam."
"Really?" asked Jessica. I could almost see her white knuckles unclench.
"You don't have to use that metal thing?" She meant the speculum, theinstrument used in pelvic exams to gently open the vagina.
"Nope," I said. "We won't need that until you're twenty-one, or untilyou're sexually active—which I hope won't be until you're at least eighteen."I explained that very strong medical evidence suggests that it's muchhealthier to postpone sex as long as possible. From the corner of my eye Icould see her mother relax. A few minutes later we were all laughing andchatting. BFFs!
Not bad, I thought. Five minutes into the visit, they both feel better.And we haven't even stepped in the exam room yet!
I just love my job.
Here are a few more things I tell all my new patients to help them feela little better about the process. Understanding what to expect from yourfirst visit can make your job and your gynecologist's job a lot easier.
1. You shouldn't be embarrassed.
All I do, every day, is take care of girls and women. We've all got the sameparts. I've given birth, I've delivered babies, and I look at female anatomyall day long. To me looking at a vagina is so not a big deal. In fact, I'd ratherlook at a vagina than a foot (sometimes vaginas are much cleaner thanfeet!). If you take away just one thing from this book, remember this: Pleasedon't ever feel embarrassed or ashamed of your body. Go ahead. Ask your doctor anything. She (or he) wants to help you but can't unless you say what's on your mind.
2. Anything you tell me is confidential.
By law I'm not allowed to tell your parents if you're sexually active or not.They can pound on my door and beg and plead, stalk me with phone callsor spam me online, and I'm still not going to tell them whether or not you'rehaving sex.
There are only two conditions where I do have to break patient confidentiality:
If I feel
3. I trust you—but I'm not a psychic.
I expect that you'll be honest with me about what you're doing or not doingso I can treat you appropriately. If you tell me you're a virgin, I'm going tobelieve you . . . and I won't give you the same treatment as a girl who'ssexually active. And if you don't tell me about problems you're having—itching, burning, discharge, whatever—I won't be able to help you.Bottom line: If you're not honest with me, you won't receive the rightmedical treatment, and I won't be able to help you stay healthy. So don'tbe shy: Tell me what you're up to.
4. I don't need to do Pap smears or pelvicexams until you're sexually active.
That's a huge relief for most of my patients. But once you've had vaginalintercourse, you need to let me know—then it's time for what my patientJessica called "that metal thing" (the speculum). As long as you're a virgin,I probably won't need you to put your feet in the stirrups. Most of my patientsfind this another very good reason to hang on to their virginity aslong as possible.
5. Exams won't hurt.
One last thing to keep in mind. When you do finally need the stirrups andthe speculum during your exam, please trust me that if the exam is donecorrectly, it really shouldn't hurt.
AN M.D. OF YOUR OWN
Many parents and girls don't realize that teens need both a pediatricianand a gynecologist. The pediatrician helps with healthissues affecting kids of both genders. The gynecologist advises onissues specific to girls' growing bodies. Of course, good pediatriciansknow all about girls' issues, too, and can even perform pelvicexams. But—and of course I'm biased!—I think gynecologistslike me, with specialized experience, offer girls special expertiseand knowledge that only come from seeing patients like you allday, every day.
Unfortunately, many parents don't take their daughters to thegynecologist until the girls are about to leave for college. By thentheir daughters have missed the chance to learn about their bodiesfrom an early age and to get important information and advice when they need it—like what you can do in your early teens toprotect your breasts and bones for the rest of your life and howto make great decisions about sex. I don't blame parents: Manyjust don't want to think about the fact that your body is maturing,so it doesn't occur to them that you now also need a doctor whotreats grown-ups, not just a pediatrician.
If you don't have a gynecologist of your own by the time you'rein your mid-teens, talk to your parents about finding one. Thismight be a little awkward, especially if you think they'll thinkyou're asking because you're sexually active (BTW, if you are, it'seven more important to find a gynecologist soon). Here are threestrategies to persuade your mother or father to help you find agreat gynecologist when you're in your mid-teens…; and hopefullylong before you need one.
STRATEGY 1. Show your parents this book. Say "Mom (or Dad), thedoctor who wrote this thinks it's a great idea to wait as long aspossible for sex." (Your parents will really like that.) Then add,"I'd love to see a doctor like her. Can we find one?" You might alsomention that adolescent gynos are not just "vagina" docs: We'rethe physicians who know the most about breast problems, bonehealth, period problems, and hormonal issues. What more couldyour parents ask for?
STRATEGY 2. Blame the cramps. If you have menstrual cramps,this is a great—and not too embarrassing—reason for seeing a gynecologist.This is the twenty-first century, after all, and sufferingis out. Say "Mom (or Dad), these cramps are really bad and myfriend So-and-So saw a gynecologist for hers, and it really helped.Can I do that?"