Recommendations and Conclusions
The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:
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The initial reproductive health visit should take place between the ages of 13 and 15 years.
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Creating an adolescent-friendly environment is important to make the patient feel comfortable and to establish a good relationship for continued care.
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Office staff should be trained to be sensitive to the needs of the adolescent regarding contact and communication, interaction with parents or guardians, and front office procedures.
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Training should include increasing comfort with issues regarding adolescent sexuality, respectfully addressing gender and sexual diversity, and being aware of other potential barriers, such as language access (access to language interpretation and also age-appropriate and youth culture-appropriate language), negotiating parent or guardian participation in the visit, and confidentiality.
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At the initial visit, adolescents should be made aware of the limitations of confidentiality including issues related to state-specific mandatory reporting and insurance billing, notifications to parents and guardians through electronic health records (EHRs) and patient portals, and legal requirements of parental notification related to specific services (eg, abortion).
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During the initial consultation with the patient and parent or guardian, the obstetrician-gynecologist should inform them that the visit usually does not require an internal pelvic examination, unless indicated by symptoms, and that cervical cancer screening begins at postadolescence.
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All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner.
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Before completing an examination, the obstetrician-gynecologist should counsel the patient about what to expect for the physical examination portion of the visit, identify if there are patient concerns, and ask about the patient’s level of comfort. In some cases, a physical examination might be performed at a separate visit.
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At the completion of the physical examination, the health care professional should address physical findings, diagnosis, and potential treatment options. Once a treatment plan has been mutually decided upon, the adolescent is encouraged to include the parent or guardian in the management plan.
This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care. If a gynecologist is uncomfortable providing reproductive health care and contraception to adolescents, the professional should refer the patient to a different reproductive health care professional who is comfortable working with these patients. Obstetrician-gynecologists have the duty to refer patients in a timely manner to other health care professionals if they do not feel that they can provide the standard reproductive services that their patients request 1.
