Components of a Well Woman Visit for a 17-Year-Old Female
A well woman visit for a 17-year-old female should include a comprehensive health history, targeted physical examination, appropriate laboratory screening, confidential discussions about sexuality and reproductive health, and preventive counseling, all delivered in a youth-friendly manner that respects confidentiality while encouraging parental involvement when appropriate.
Medical History Components
- Comprehensive review of medical history, including chronic medical conditions, medications, allergies, and family history 1
- Menstrual history including age at menarche, regularity of cycles, and any menstrual problems 1
- Psychosocial assessment screening for depression, anxiety, domestic violence, and major psychosocial stressors 1
- Discussion of the adolescent's reproductive life plan, including questions about whether she intends to have children and her timeline 1
- Assessment of risk behaviors including substance use, tobacco, and alcohol 1
Physical Examination
- Measurement of height, weight, BMI, and blood pressure 1
- Focused physical examination including thyroid, heart, breast examination 1
- Pelvic examination is not routinely recommended for asymptomatic adolescents and should only be performed when indicated by medical history or symptoms 1, 2, 3
- The American College of Physicians found no data supporting the use of pelvic examination in asymptomatic, average-risk women for conditions other than cervical cancer 1, 2
- About one-third of women report fear, embarrassment, anxiety, pain, or discomfort during pelvic examinations, with younger women more likely to experience these negative effects 2
Laboratory Testing and Screening
- Cervical cancer screening (Pap test) is not recommended for women younger than 21 years regardless of sexual activity or other risk factors 1, 2
- Screening for sexually transmitted infections (STIs) can be reliably performed using tests on self-collected vulvovaginal swabs or urine samples without requiring a pelvic examination 1
- When indicated based on sexual activity, screening should include tests for chlamydia, gonorrhea, and other STIs 1
- Other laboratory tests may include complete blood count, urinalysis, and other tests as indicated by history 1
Confidential Discussions and Counseling
- Discussions about sexuality, sexual orientation, and gender identity should be conducted in a nonjudgmental manner 1
- Information about contraception, including emergency contraception, should be provided regardless of reported sexual activity 1
- Adolescents should be informed about the availability and access to confidential sexual and reproductive health services 1
- Discussions should address the influence of media on sexuality, including social media and sexting 1
Preventive Counseling
- Counseling on healthy behaviors including nutrition, physical activity, and sleep 1
- Discussion about avoiding tobacco, alcohol, and other drugs 1
- Immunization review and administration of recommended vaccines 1
- Folic acid supplementation counseling for all women of reproductive age 1
Special Considerations
- Services should be provided in a "youth-friendly" manner that is accessible, equitable, acceptable, appropriate, comprehensive, effective, and efficient 1
- Confidentiality is crucial, though adolescents should be encouraged to involve parents/guardians in their healthcare decisions 1
- Providers should be aware that some adolescents may have experienced sexual assault or coercion, with screening for sexual violence being an important component of care 1
Practical Implementation
- Use pre-visit questionnaires to address sensitive topics that may be difficult to discuss face-to-face 1
- Schedule adequate time for the visit to allow for comprehensive discussion 1
- Provide educational materials appropriate for adolescents 1
- Consider the visit as an opportunity to establish a trusting relationship that will encourage the adolescent to seek future care 1, 4