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f you're the parent of a blossoming teenage daughter, you may be wondering at what point she will need to have her first pelvic exam.

Sure, your trendy teen may seem sophisticated, but the truth is she may be unaware that every women requires a regular pelvic exam and a Pap smear to pick up early warning signs of cervical disease, including cancer, and to ensure the continued health of her reproductive organs. On the other hand, she may be feeling embarrassed, or even afraid, about having her first pelvic exam.

For some tips on how you can help prepare your daughter for this important step in learning how to protect her own health, the Canadian Health Network spoke to Dr. Mary Anne Jamieson, director of pediatric and adolescent gynecology at Queen's University, Kingston, Ont., and Dr. Nathalie Fleming, co-chair of the pediatric and adolescent obstetrics and gynecology sub-committee of The Society of Obstetricians and Gynecologists of Canada.

1. Why does my daughter need a pelvic exam?
   • To make sure that pelvic organs (uterus, Fallopian tubes and ovaries) are of normal size and shape, and located in the normal position.
   • To detect infections that may result in vaginal discharge, pelvic pain or infertility if not treated.
   • To detect abnormalities of the cervix such as precancerous conditions which may become cancer if not treated.
     
     
2. When should my daughter have her first pelvic exam?
   • Within six months of first intercourse; or
   • If her age is 18 or older.
   • If she is experiencing abnormal or unexplained vaginal discharge, pelvic pain, unusual or unexplained vaginal bleeding, if she has missed a menstrual period, has pubertal abnormalities or concerns, is pregnant or has been sexually assaulted.
     
     
3. Who would perform my daughter's first pelvic exam - the family physician or a gynecologist?
   • Any qualified health care practitioner can provide this service, including a nurse practitioner, family physician or general practitioner, gynecologist and even a pediatrician. In some clinics or teaching hospitals, more than one health professional may be present in the room. For example, a medical intern may be present in addition to a physician or nurse.
     
     
4. Would my daughter feel more comfortable receiving her first pelvic exam from a female health care provider?
   • The exam can be a bit embarrassing the first time around, that's for sure! However, whether male or female, any experienced health care professional can provide a competent and caring exam that ensures the health and well being of your daughter.
     
     
5. Does a pelvic exam hurt?
   • No. Your daughter may feel pressure during a pelvic exam but it shouldn't hurt. If it does, she should let the examining health practitioner know right away.
     
     
6. What information will my daughter be asked to provide when she goes for a pelvic exam?
   • She will be asked about the first day of her last menstrual period, whether or not she is sexually active and if so, if she is using birth control.
   • Her blood pressure will be measured and she will be asked to provide a urine sample.
   • Your daughter should speak up about any problems she may be having with her period, vaginal discharge, pelvic pain or if she thinks she may be pregnant.
     
     
7. What happens in the examining room?
   • The doctor will review your daughter's medical and reproductive history, and may check her overall health with a physical exam of her head, neck, breasts and abdomen. If your daughter has any concerns or questions, this would be a good time to talk to the doctor about them.
   • Following this, your daughter will be asked to undress partially or completely, put on a medical examining gown and lie down on the examining table with her knees bent and spread apart. Her pelvis and thighs will be draped with a sheet. The doctor will check the outer lips of the vagina, also known as the "vulva."
   • Next, a speculum - a slender instrument made of plastic or smooth metal, which looks like a duck's bill - is inserted into the vagina so the physician can see the walls of the vagina and cervix. Cells will then be gently collected from the surface of the cervix during a Pap test.
   • The doctor may also touch a Q-tip to the cervix to check for Sexually Transmitted Infections (STIs) such as chlamydia, gonorrhea or genital warts.
   • The speculum is then removed and the doctor will insert a gloved, lubricated finger into the vagina to check the size, shape and position of pelvic organs while gently pressing on the lower abdomen. Your daughter will feel pressure but not pain.
     
     
8. If my daughter feels embarrassed or uncomfortable during the exam, what can she do?
   • It is very important that your daughter takes deep breaths and breathes in and out easily.
   • She should also try to relax her stomach muscles, as well as the muscles around the vagina, to make the exam as comfortable as possible.
   • Finally, she may wish to look around the room to see if there are any posters or pictures to look at while she is being examined.
     
     
9. Will my daughter want me to stay with her during the pelvic exam?
   • She may. However, ideally, the health care provider should have some routine private time with your daughter so that she has the opportunity to express herself confidentially.
   • On the other hand, some girls who are apprehensive about the exam may request that a parent or support person be present during the examination.
   • Either way, it should be your daughter's choice - as long as she still gets some private time with the doctor at some point during the appointment.
     
     
10. What other advice can you provide around the time of my daughter's first pelvic exam?
    • Initiate discussions about sexuality frequently so that your daughter sees that you're willing to discuss her sexuality and sexual activity if she wishes.
    • Don't make any assumptions about whether or not your daughter is having intercourse or alternative sexual activity such as oral or anal sex. She may have questions or concerns about other issues too, including feeling coerced into sexual activity or even whether or not she is heterosexual.