From the Guidelines
For a 15-year-old female physical exam, I recommend a comprehensive adolescent health assessment that includes both preventive screening and age-appropriate evaluation, prioritizing confidentiality and trust with the healthcare provider. The visit should begin with confidential time between the provider and patient, separate from parents, to discuss sensitive topics. Key components include:
- Vital signs (height, weight, BMI, blood pressure)
- Complete physical examination with particular attention to pubertal development using Tanner staging, scoliosis screening, skin examination, and cardiovascular assessment
- Laboratory testing should include a complete blood count to screen for anemia, urinalysis, and lipid screening if indicated by family history
- Consider screening for sexually transmitted infections if sexually active, including gonorrhea, chlamydia, and HIV testing, as recommended by the Centers for Disease Control and Prevention’s treatment guidelines for STIs 1
- Immunization status should be reviewed with administration of any needed vaccines including HPV if not completed, Tdap if due, and meningococcal vaccines
- Mental health screening using validated tools for depression and anxiety is essential, as is screening for substance use, eating disorders, and safety concerns including bullying and relationship violence
- Anticipatory guidance should address healthy eating, physical activity, sleep hygiene, internet safety, and reproductive health education
- For cancer screening, the American Cancer Society recommends that cervical cancer screening should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than age 21 years, with screening done every year with conventional Pap tests or every 2 years using liquid-based Pap tests 1 This comprehensive approach addresses the biological, psychological, and social aspects of adolescent development while establishing confidentiality and trust with the healthcare provider.
From the FDA Drug Label
The physical examination should include special reference to blood pressure, breasts, abdomen, and pelvic organs, including cervical cytology, and relevant laboratory tests The physical exam for a 15-year-old female should include:
- Blood pressure check
- Breast examination
- Abdomen examination
- Pelvic organs examination, including cervical cytology
- Relevant laboratory tests should also be ordered, although the specific tests are not specified in the label 2 Note that the label does not provide a comprehensive list of labs to order, so a conservative approach would be to follow general guidelines for adolescent well-care, but the label does not provide this information.
From the Research
Physical Exam Questions for a 15-Year-Old Female
- A thorough medical history, including menstrual history, sexual activity, and substance use, should be obtained.
- A physical exam should include vital signs, height, weight, and body mass index (BMI) calculation.
- A pelvic exam may be indicated if the patient is sexually active or has symptoms of a sexually transmitted infection (STI) or other gynecological condition.
Workup and Labs to Order
- Complete Blood Count (CBC) to evaluate for anemia, infection, or inflammation 3, 4, 5.
- Urine test for STIs, such as chlamydia and gonorrhea, if the patient is sexually active 6, 7.
- Consider testing for other STIs, such as syphilis and HIV, if the patient is at high risk.
- Pregnancy test if the patient is sexually active and has a missed period or other symptoms of pregnancy.
- Consider ordering labs to evaluate for other conditions, such as thyroid disease or diabetes, if the patient has symptoms or risk factors.
Considerations for STI Testing
- The Centers for Disease Control and Prevention (CDC) recommends routine STI screening for all sexually active females under the age of 25 7.
- Vaginal wet preparation WBC counts may be useful in predicting STIs, but have limited diagnostic utility when used alone 6.
- Comprehensive STI screening, including extragenital site testing, may be beneficial in certain populations, such as those with HIV or high-risk sexual behavior 7.