Caring for the Ladies: Adolescent Females

Being the mother of an adolescent female can be difficult. Being the physician for both can be challenging but rewarding.  I have been amazed over the years as my patients asked me to talk with their daughters about safe sex and contraception.  They gave me permission to do what as necessary knowing I could never reveal any details of the encounter.  It was a very special trust they had in me.

Often their fears were unfounded.  Many of them had been teen mothers and had to marry because of an unintended pregnancy.  The truth is all mothers want the best life for their daughters. That includes a good education and the opportunity to be independent.  However, in some cases this was not true. These encounters made my encounters difficult.

One of my teens was in a very abusive relationship.  Her mother and family were not supportive. I found myself involved in her life more than I should have been.  One unintended pregnancy was ended with my assistance but the second was not.  I had to find the best obstetrician and arranged prenatal care in the next town.  She had several ER visits due to trauma. Her pregnancy was complicated by a seizure due to Eclampsia. She had an emergency cesarean section. Being a teenager, she did not understand that the seriousness of the situation.  Thankfully, the obstetrician was an experienced provider and he and the staff acted quickly to save her life and that of her son. She was a very good student with so many strikes against her but she managed to be successful as an athlete and a mother. She achieved awards in her sport and should have gone on to a 4-year college.  With support, she did go onto first community college and then on to further success.  Her grandmother was her rock.

Sometimes, I discovered my teens were having sex only when one of them presented with a serious infection.  I admitted several for Pelvic Inflammatory Disease or severe genital herpes Infections.  This was one of those difficult times.  I could not reveal the diagnosis to the mother who was my patient.  I had to leave that to the daughter.  Most gave me permission to talk with their mothers.  As a college Health doctor, I only have to deal with the female student.   They are naïve and still not comfortable negotiating the issue of safe sex.  Still not confident enough to demand their partner use a condom.  The idea that birth control is to prevent pregnancy and condoms prevent infection is still not a concept women embrace.

In my private office back then, my encounters for contraception were made a little less complicated because I had an unlimited supply of the latest oral contraceptive samples.  I just kept my teens supplied.  I even gave them out as a morning after pill regimen.  The most enjoyable encounters were sending my teens off to college.  I performed a physical examination, discussed safe sex and gave enough birth controls refills or samples to get them through the first semester, most did very well and came back home only to visit.

Now as a college health physician, I see times have changed. I have the same opportunity now to talk to my female students about safe sex, contraception, the HPV vaccine and prescribe the new generation of Emergency Contraception. But now, my female students are from all over the world.  I don’t have the same relationship but I do have a chance to dispel myths and fears about contraception.  Many are struggling with the stress of education, family pressures, cultural expectations, and sexuality.  Not easy.  In between, diagnosing viral syndromes, managing implementation of an electronic health record; I have to be sensitive to their concerns.

I am now going to make a plug for the Affordable Care Act.  I have an easier time prescribing for my college students because they have health insurance.  They are covered by their parents, work or through our Student Health Plan.  Thankfully it covers contraception because that is part of the law.  I am starting a campaign to push emergency contraception because that is covered too.  With all the talk over what is not working, let’s take the time to be thankful for what is working.  As women and mothers, that is a lot less worry for all of us.

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