Teen Development: What’s Normal, Anyway?

Dr. Amie Miklavcic’s first experience visiting the gynecologist as a young teenager was frightening and confusing. “I remember holding the nurse’s hand and saying, ‘Is it almost over?’” But the memory of that traumatic visit now guides her compassionate approach to adolescent care, because she wants her patients to have a better experience than she did.

“I think a lot of times that first visit is really awkward, and they’re scared to death,” Dr. Miklavcic says. Often, she tells her patients, they’re just going to talk about what’s going on and how they feel. Here are a few of the topics she covers.


“A lot of times they don’t know what normal is,” Dr. Miklavcic says of her younger patients. Some think it’s normal to miss school days because of their periods, and they don’t know that they can get help for heavy and/or painful periods. On the other side of the spectrum, some teenagers worry because they haven’t started their period yet, and it seems like everyone else has.

Dr. Miklavcic starts with the basics. Are they using pads or tampons? If they’re using pads, do they know how to use a tampon? “There’s always that hesitation if they haven’t tried one,” she says, so she demonstrates how to insert a tampon properly.

Dr. Miklavcic also explains how the menstrual cycle works. “I think very few women understand their period cycle at all,” she says. They don’t understand that a normal cycle can last between 21 and 32 days, and may be shocked that they get a period twice in one month. Young girls also don’t realize their periods will be irregular for the first year because they’re not yet ovulating and “it takes a while for their hormones to catch up.” Stress, illness and travel all can cause abnormal periods, too.


There’s no getting around the awkwardness of puberty, but knowing what to expect—and that there’s really no such thing as normal—makes it easier. Girlology has some excellent, conversational resources on puberty that cover the typical hormone-related changes:

  • Breast development
  • Vaginal discharge
  • Pubic hair
  • Acne
  • Body odor
  • Growth—both height and new curves.

Doctors can also offer help for certain physical problems that arise at this time. One young patient reported feeling really uncomfortable every time she wore a swimsuit; the reason, Dr. Miklavcic says, was a septate hymen, which could easily be corrected with minor surgery.


While a parent can be an important ally and advocate for a daughter’s health, it’s also important for young patients to retain their privacy. If a patient’s mom comes with her into the exam room, Dr. Miklavcic speaks with both of them about confidentiality. “I make sure the patient knows that anything we discuss is between her and me, and will not be shared with Mom unless she gives me permission to, or if there’s an immediate danger to her or someone else,” Dr. Miklavcic says.

“I always encourage them to share things with Mom, because she was a teenager too,” Dr. Miklavcic says. But she wants young patients to know that they can call her anytime with questions and that anything they talk about will remain confidential. She also asks moms to step out of the room during the exam, “just from a privacy standpoint,” unless a patient wants her mother to stay. Girls also can come in on their own, Dr. Miklavcic says, particularly if they’re sexually active, concerned about STDs or birth control.

Looking for caring and compassionate adolescent care in the Richmond area or the Northern Neck? Dr. Miklavcic sees teenagers—and women of all ages—at the Virginia Women’s Center’s Mechanicsville and Tappahannock locations. Make an appointment today.


Dr, Amie Y. Miklavcic believes in a patient-centered approach to care—a team approach with input from patients on their goals and options for treatment.

Dr. Miklavcic’s practice spans the full spectrum of women’s health care including routine and high-risk pregnancies, laparoscopic gynecologic surgery and ambulatory gynecologic care including the evaluation of Pap smears, helping women with Polycystic Ovarian Syndrome (PCOS), and menopause management. She has a particular interest in pediatric and adolescent gynecology. Another area of interest for Dr. Miklavcic is her recent research and presentation on over-the-counter contraceptives.