Who Needs a Gynecologist -- and When?

But Blank says girls may be readier, medically and emotionally, to transition to a gynecologist once they've graduated from high school. That's especially true when this doctor is already seeing other members of their family, as some of Richardson's patients can attest.

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Judy Gelfand, a school principal who lives in Newton, Mass., followed that approach with her younger daughter. "She was about to start college, and I thought it was time for her to start seeing [Richardson]" -- the same doctor who delivered her, Gelfand said.

Anne Gerberg, a 52-year-old nurse who also sees Richardson, took a middle course with her family.

"I think it depends on the kid; it doesn't always make sense to go early," she said. Her daughter Laura was 17 when irregular periods prompted a first visit to Richardson.

"I wasn't really sure what it would be like," Laura said. I didn't know of any of my friends who have had to go to the gynecologist. [But] I wasn't really nervous or anything."

A Trusted Counselor

ACOG recommends annual pelvic exams starting once women are sexually active, or else at age 18, though the cost-effectiveness of such frequency has been debated in recent years. ACOG also advises that women start getting annual Pap smears -- in which the doctor takes a swab of the cervix to check for signs of cancer -- within three years of becoming sexually active, or by the time they turn 21.

(For certain women 30 and older, the organization recently loosened the recommended Pap test intervals to every two or three years. The move has caught some women by surprise. "Trying to talk [these] women out of getting Pap smears is challenging," Richardson said.)

A drop in the average age of puberty -- a century ago, most girls had their first period at 14, compared with between 12 and 13 today -- has coincided with rising concern about teen sex.

"I'm certainly seeing younger people than I used to," said Richardson, who has been practicing for 30 years. "My mother never would have done that with me. I think this has to do with mothers coming to grips with the fact that their daughters are sexually active earlier."

In the past few years, sexual activity among teens has dipped by some estimates: In a Kaiser Family Foundation survey, 53 percent of high-school-age boys and girls reported in 1995 that they had had intercourse, compared with 47 percent in 2005. But teens remain a vulnerable demographic when it comes to sexual health, and good early care, whether it is from a specialist or a pediatrician, can make a big difference.

"From my perspective, it partly depends on how comfortable your primary care doctor is with handling reproductive/gynecologic issues," Richardson said. "Because some are really good at it, and some don't have a clue."

A girl may have questions, for example, about vaginal discharge or uneven breast size, and may be embarrassed to ask her mother.