Who Needs a Gynecologist -- and When?

For Paula Hillard, a professor of OB-GYN at Stanford University, "the telling issue is whether or not the girl has the opportunity to talk privately with her primary care physician. All adolescents deserve that confidentiality or privacy," she said, "whether or not they have issues that demand confidentiality or privacy."

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A larger issue than which practitioner to see may be whether many get any care at all, polls suggest.

Only six in 10 sexually active boys and girls ages 15 to 17 have seen any health-care provider about their sexual health, a 2002 survey by the Kaiser Family Foundation found. And less than a third reported that they had talked with a health-care provider about HIV/AIDS, other sexually transmitted diseases or birth control.

A Slip in Habits

As discussions about first times shift to conversations about firstborns, women are more likely to exercise the OB-GYN option.

Richardson recommends that women see an OB-GYN if they are even thinking about getting pregnant, because many aspects of prenatal care -- such as eating foods that contain enough folate -- are critical within weeks of conception. Prenatal care is by far the most common reason for OB-GYN visits, according to the National Center for Health Statistics.

The farther they get from their childbearing years, the more likely women are to forgo routine gynecologic exams, the Archives study shows. Although about 20 percent of those between ages 25 and 54 got an annual exam, the figure dropped to about 10 percent in women 55 to 64 and 5 percent in women 65 and older.

This may not be wise. The onset of menopause does not diminish the medical relevance of pelvic exams, and ACOG and other major clinical organizations recommend annual ones through much of the post-menopause period. In fact, researchers now find that the pelvic exam can also reveal early signs of ovarian cancer, for which the risk increases with age.

Because menopause hits most American women around age 51, many will spend up to 40 percent of their lives post-menopause. Once they experience the constellation of menopause symptoms, including hot flashes and sleeplessness, some women look for sympathetic ears.

"I do sometimes see people who say, 'When I go to my old gynecologist, her waiting room is totally full of pregnant women. She doesn't know much about menopause,' " Richardson said. "I've learned way more about menopause as I've entered that stage of life myself."

For those who continue to receive gynecologic care, many, like Gerberg and Gelfand, prefer sticking with the OB-GYN who delivered their children -- often their only regular connection to health care.

"For me, it's not just my personal relationship with [Richardson]," Gelfand said. "I have an incredible amount of trust in her because she knows what she's doing. That, to me, trumps everything." ¿

Ishani Ganguli is a second-year student at Harvard Medical School. Comments:health@washpost.com.