Attitudes versus performance in providing gynecologic care to adolescents by pediatricians

This study ascertained current pediatric attitudes verses performance in caring for adolescent females in private practices in a suburban area. Sixty-seven randomly selected pediatricians were given a confidential questionnaire; 90% responded. Areas assessed were attitudes and practice about sexual history, breast examination, teaching self-breast examination, and vaginal examination. Comparisons were made between the different age groups and between male and female pediatricians. Ninety-two percent of pediatricians felt it was important to take a sexual history by age 16 years, while only 73% actually did. More female than male pediatricians thought it was important to take a sexual history and actually did so. Seventy-five percent stated that a breast examination should be routine, and most performed the examination. However only 60% taught self-breast examination despite the fact that 93% believed it was important. An internal vaginal examination as part of a routine physical was performed by only 7%. For specific gynecologic problems most asked to see the patient but most did not do an internal examination. The most likely indication for a pelvic examination was a vaginal discharge, but only 28% of the pediatricians would examine their patient for this complaint. Of the pediatricians who do the examination, 41% were not sure they had received the proper training. These data suggest that despite the American Academy of Pediatrics' recommendations that pediatricians continue the care of patients until age 21 years, there does not appear to be optimal care provided to female adolescent patients.