Teen Health with Andrea Harper OB/GYN

Why do you have a passion for adolescent and teen medicine?
My personal experience was that I had a few gynecological problems in my late teens, and I didn’t really know much about my own body and how things worked. I found having those problems to be really intimidating. The gynecologist that I saw was an elderly male. I didn’t feel like we connected very well, and I didn’t think he had any insight into how I felt about what was going on with me. As I began to study and learn more about working with women, I realized that that ability to communicate, especially with young women who are intimidated with what might be going on with them, is so important. It is so important for them to be able to find a practitioner who can bond with them and make them feel comfortable and who it is easy to ask those simple, yet embarrassing questions to. It’s important for you to be able to ask the questions and get real answers. Also, these days it’s so important that women be asked the hard questions because a lot of young women are sexually active very early or already have questions about that, even if they're not sexually active. Somebody needs to be talking to them about what they’re really in to, as far as sex and drugs, and where they really are. Even though some teens won’t be honest with their parents, they may be honest with their gynecologist in a safe setting; I think it is important to provide that honest communication so that somebody knows what they’re in to and can give them good advice. That’s why I really love teen health and think it is so important

What do you think is critical about adolescent/teen health?
It’s kind of intuitive but also born out by lots of studies that a lot of the decisions, morally and medically, that teenagers make are the decisions that affect them for the rest of their lives. A good example of that is contracting HPV. Studies show that the majority of the contracture of HPV happens between the ages of 17 and 22, but a lot of teens become sexually active and contract HPV even before that. A huge number of teenagers are sexually active by the age of 13. More than ever before, the teen years are just so important as teens are making decisions that really are going to affect the health for the rest of their lives. Somebody needs to be paying attention and really be really aggressive about communicating with teens in our area about what the decisions are that they're making.

What are some common health-related issues that adolescents and teens face?
The decision about being sexually active is common, and not just strict sexual activity, but physical intimacy before intercourse can propagate some STDs. A lot of teens don’t realize that skin-to-skin contact in the genitals will spread STDs. That a big issue; also, HPV is a big issue. And, meningitis is a big issue for teens. As they go into the camp setting and college dormitory setting, those places are high risk for the spreading of meningitis, and teens and parents need to be educated about that and get vaccinated

How do you feel about parents putting their daughter on birth control?
This can be a tricky question, and I think the key here is the term “birth control.” Really, what we call birth control pills is just hormone therapy, and the two female hormones, estrogen and progesterone, is what is in most birth control pills. But, we use estrogen and progesterone to treat women for all kinds of medical problems, and we use it from the teens all the way through post-menopausal years for many different conditions. I think a better question is, “How do I feel about parents putting their kids on hormone therapy?” The answer is if your daughter needs it, then you should do it. The way to approach that, I think, in a way that makes the most sense is to not think of hormone therapy as birth control, unless your daughter is using it for birth control. Otherwise, it’s just hormone therapy. That can be used to regulate periods if they’re having abnormal bleeding and to decrease their cramping, pain, and PMS symptoms during their period if they're having difficult menstruation. It can also be used to help resolve and keep down the incidence of ovarian cysts. So, there can be any number of reasons why a daughter might need to be on hormone therapy that has absolutely nothing to do with birth control. And, most young women now are very savvy and understand that, and it’s important for them to understand why they're on hormone therapy and why they're not. Additionally, I know a lot of parents have concerns that if they put their daughter on hormone therapy, she might decide that it’s okay to have sexual intercourse because the hormone therapy can act as birth control. There were some interesting studies done a few years ago that very clearly showed that, for both girls and boys, those who chose to remain abstinent did so because of their own moral beliefs, completely regardless of whether or not they were on medication or had STD education in school. There were just all these other factors that were looked at and what really made the difference to those that maintained abstinence was their own moral beliefs. So, I would say if that’s your concern, the real answer is to talk to your daughter about what her moral beliefs are about abstinence, and that’s important for any parent to know about their child.

What are Gardasil and Cervarix? Are there any differences between the two?
Gardasil and Cervarix are both vaccinations against Human papillomavirus, or HPV, which is a very common virus that affects humans. HPV causes both genital warts and cervical cancer. Just like there are different strains of the flu virus, there are different strains of HPV. We kind of divide the strains of HPV into low-risk categories and high-risk categories. The strains that are considered low-risk cause genital warts, and the strains that are considered high-risk cause cervical cancer. The difference between Gardasil and Cervarix is that Gardasil covers the four most common strains of the virus: the two most common ones that cause genital warts and the two most common ones that cause cervical cancer. You get coverage for both warts and cancer with Gardasil, and with Gardasil, your reduction for your risk for cervical cancer is about 70%. Cervarix doesn’t cover for genital warts at all but it seems to do slightly better job of covering for the strains that cause cancer; so, your coverage might be 80-85% reduction in cervical cancer risks with Cervarix. They both have their pros and cons, and we offer both at the Woman’s Clinic; it’s kind of between the provider and the patient and her family, if her parents are involved in this decision, about what’s important to them. For some people, they’re very concerned about genital warts; for them, Gardasil might be a better option. For a lot of people though, they really care more about the cancer-causing strains that are potentially fatal; so they might rather have Cervarix.

Why should teens be administered a vaccine like Gardasil or Cervarix?
Mostly because cervical dysplasia can be fatal if untreated; but also, even if you always follow up with your Pap smears and always follow your physician’s directions, once you have contracted HPV, we don’t know how to get rid of it. Women who have HPV that causes abnormal Pap smear can have problems with it for the rest of their life. So, even if you don’t get cancer, if you contract an aggressive strain of HPV, it may be something you struggle with until you are no longer walking the earth. We really want to be able to prevent those kinds of situations if we can. A lot of parents and patients feel like they live a pretty quiet lifestyle and that they’re not at high risk and don’t know anybody that’s ever had HPV, but, honestly, the studies show that your lifetime risk of developing HPV as an American woman is 80%, which is huge. Obviously, the people who have never been sexually active are in that 20%; so, for the vast majority of us who grow up and get married and have normal lives, most of us will be exposed to the virus sometime in our lifetime. To think that you won’t ever be exposed is not very realistic. The other reason that I think people should be administered one of these vaccines as a teenager is that their highest risk for contracting HPV is sometime in the next five or ten years. Also, although none of us like to think of this, another thing that this age group of women is at risk for is date rape and sexual assault. Unfortunately, the people who perpetrate those acts are super high-risk for carrying STDs, and the most common STD is HPV. I see this every once in a while, and it’s just like adding insult to injury, but when a woman is assaulted, very frequently she turns up having STDs, the most common being HPV. While a patient can control her own decisions, unfortunately, we don’t make decisions for other people, and those bad decisions that other people make sometimes affect all of us. You never want yourself or your daughter to suffer long-term consequences because of some choices that she didn’t get to make.

What would be your argument to parents who think their daughter is “too young” to begin their journey with woman’s health?
There are a couple of reasons why, I think, as soon as you're a teenager, your old enough to get to know a gynecologist. One of those is simply that most of grown women have found that first time experience at a gynecologist’s office to just be so intimidating. My preference very strongly is to meet young women when they're young enough and when they don’t have an acute problem so that I don’t have to do a pelvic exam on them when I first meet them. I will listen to their heart and lungs, but it’s nice to be able to give your daughter that security of knowing her gynecologist for a year or two before she has to have her first pelvic exam. And, you never know when she’s going to have a yeast infection or something that comes up where she needs to be examined. So, if you get her in early, between the ages of 13 and 15, it’s unlikely that she’ll have to have a pelvic exam the first time she meets her gynecologist, which is much easier on the girls if they already have a rapport with their physician and they feel comfortable in the office and feel like they're meeting friends when they come to have that first pelvic exam, rather than feel like they're meeting a total stranger and they're going to have to strip down and be subjected to this exam. So, I would much prefer to have a friendship with a young woman, prior to her first pelvic exam. That’s one reason. The other reason is kind of along the lines of what we've been talking about with HPV. Unfortunately, so many women are sexually active between the ages of 13 and 15, and, sadly, most of their parents are not aware of those behaviors they're participating in. Again I would just say, even though you may feel like you really have open communication with your daughter, sometimes she may have been exposed to either conversations or behaviors that she is too intimidated to talk to her parents about. You want somebody to be getting that information and providing her with good, healthy advice, instead of her just kind of struggling along or getting that information from her peers.

What would you say to adolescents and teens that may be wary of coming to a gynecologist?
Come see me; let’s get to know each other. It’s always intimidating at first; it’s just the nature of the beast. It’s easier if you come when you don’t have to be examined the first time and we can just talk and get to know each other a little bit. We can talk about what you will need to expect the first time for your pelvic exam, but it’s just so much easier, I think, if you already know that person. It’s just not as scary if you do your pelvic exam with somebody that you already know. There are a lot of stories out there about how uncomfortable the exam is; it’s really not as bad as you think. You’ll be fine; it’s just something that has to be done at some point. I would encourage teenagers that, if you're seeing this, to go talk to your parents about letting you go one time before you actually have to have your pelvic exam.