ADOLESCENT HEALTH

Most young girls seek medical help only when they have irregular or heavy or painful periods and seldom approach a doctor for information and guidance about sexual well being. For this, they resort to ill-informed peers or pornographic material (books or web sites) or simply presume most things! The dangers of such behavior cannot be quantified because it impacts hugely on the mental make-up, social behavior, academic performance and finally the kind of an adult that one turns into in later life. Many a family is shaken; many girls lose their confidence, self-esteem, resort to dangerous behavior and may also become reproductively crippled for the rest of their lives only because they were not aware that the solution to the adolescent problems was only a discussion away! This article is dedicated to all those unhappy girls who may have suffered or might be suffering because they are alarmed at what is happening in their lives and are at a loss to cope up with the adolescent stress.

What is Adolescence?

The World Health Organization defines Adolescence as the period between the ages of eleven and nineteen. The teens are adolescents.

Adolescence can further be categorized as:

Early Adolescence (10 to 14 years) when children need concrete straightforward information applicable to actual life situations;
Middle Adolescence (14 to 17 years) when they are testing new adult behavior and are not easy to influence.
Later period between 17 and 20 years when they are capable of abstract thoughts and are able to undertake preventive safety measures which may have been difficult earlier.

Why is Adolescence the focus of so much discussion and concern?

Adolescence is a milestone period in a person’s life. It is associated with physical changes, psychological changes, sex & sexuality confusion (including fears and facts about sex abuse), relationship dilemmas and career planning. It is hence obvious that it this is a period of maximum stress from all spheres.

What are the physical changes associated with Adolescence?

Adolescence includes a very important phase in human development and that is puberty. Puberty is the period during which physical growth and sexual maturation occurs. In girls, it usually begins with breast development (thelarche) followed by appearance of axillary (underarms) and pubic hair (adrenarche). Menarche or the appearance of first menstrual period is the last in the sequence of puberty in girls. Girls have a sudden growth spurt between breast development and the first period.

What is the pattern of normal breast development?

Appearance of breast buds is often the first sign of puberty and occurs between 8-10 years usually. It presents as a small firm protuberance beneath the nipples and is often painful. However, the pain does not last long and also, it is normal to have one breast bud develop first. Mild breast asymmetry is not a matter of alarm. Breast development is under the control of the female hormone, estrogen.

What is the normal pattern of axillary and pubic hair development?

Pubic hair appears about six months after the breast buds and axillary hair about 1-2 years later. Unlike for the breasts, the hair development does not depend on estrogens, but on the proper functioning of adrenal glands. Therefore, girls without ovaries can also have normal axillary and pubic hair development.

When does the growth spurt occur?

Growth spurt occurs about two years earlier in girls than in boys. This is around 11-12 years and the growth peak is reached two years after breast budding. Girls attain menarche about a year after their growth peak. Also because of the effect of estrogen, the body begins to acquire the female contour with narrow waist and broad hips.

Is there a variation in the age of puberty?

Yes. Children closer to equator, at lower altitudes and in urban areas start puberty earlier. Obese girls and those with a family history also experience early puberty. Earlier the onset, longer is the duration of puberty. However morbidly obese girls (more than 30% over weight), diabetics and intense exercisers may have delayed menarche. Blind girls experience earlier menarche.

What should we do to ensure that the girls accept their physical changes positively?

It is natural and normal for girls to feel overwhelmed by the changes that begin to occur in her body. As development of breasts is the change most obvious externally, girls become conscious of this. Most feel shy and some may even want to hide the changes by wearing loose fitting garments or even avoid company. Some on the other hand may become overly expressive and this may lead to dangerous behavior. In order to ensure that the child accepts her bodily changes with the right attitude:
Keep her knowledgeable about the changes she may expect in her body during this period.
Select the right kind of clothes that neither accentuate nor hide her. She must develop confidence without becoming vain.
Shopping for undergarments could be embarrassing to the child. The mother must do this shopping until the girl feels up to it.

How should the girl be prepared for her first menstrual period?

The onset of menstruation may be expected about two years after the onset of breast development and a year after the growth peak. Girls who know what to expect are not overly shocked at the sight of blood. As many girls do, it is advisable to always carry a sanitary napkin. Some girls may not get their monthly cycles regularly for a year or two after its onset. This is because of hormonal changes and the gradually maturing reproductive organs. However if the irregularity continues or if the bleeding occurs over a prolonged period or is heavy, the gynaecologist must be consulted. Many girls may experience pain during periods. The pain usually starts a few hours before the onset of periods and disappears after a few hours or after the onset of bleeding. The response to this pain varies between girls. Some may accept the pain and bear it while for others it may become unbearable and may even mean absenteeism. It is wise to consult your doctor if the pain seems abnormal.

What are the common psychological dilemmas encountered in Adolescence?

As if the rapidly developing physical changes are not enough, adolescents go through a tumultuous psychological phase as well. The abnormal behavior is also a cause of intense parental anxiety and may lead to disharmony at home.
The adolescent behavioral dilemmas may be:

Developing and consolidating relationships: Making friends of the same or opposite sex may be exciting, adventurous and even taxing to the adolescent. Peer pressure, loyalty and an intense desire to be accepted play a major role in adolescent behavior.
Establishing the right relationship and rapport with elders at home or teachers in schools and colleges.
Interest in and getting attracted to the opposite sex.
Getting introduced to dangerous behavior: Smoking, alcohol consumption, drug abuse and indulging in sexual activities may begin out of curiosity and may develop into serious consequences.
Unacceptable behavior: Lying, stealing and class absenteeism are some of the negative behaviors observed amongst adolescents.
Threatened or attempted self-injury-slitting wrists, drug over dosage may be observed in some.
As Adolescence is a transitional period, major psychiatric disorders like Maniac-Depressive psychosis and Schizophrenia may manifest for the first time during this period.
Impaired body image and faulty dietary habits: Some girls may develop a pathological aversion to being obese and begin to fast, almost to death.(Anorexia nervosa) At the other end of spectrum are the depressed girls who begin to over eat and become obese. Also underlying diseases as hypothyroidism or polycystic ovaries may also contribute to obesity. Food faddism and junk food gorging are common behavioral abnormalities of adolescent girls.

What is the right approach to deal with the adolescent behavioral problems?

Even the best of parental-off-spring relationship might be put to test as the child passes through Adolescence. This is a passing phase and can be passed off as such without far-reaching negative consequences only with a lot of effort from the older generation. It is not unusual or wrong to seek the help of professional counselors for both the child and parents to overcome this tumultuous phase successfully. It is the duty of the parents to help young people form a strong moral identity in their early adolescent years & to empower them to contribute to the well-being of their communities.

Adolescent health-Part II

What are the Medical Problems of the Adolescents?

The medical problems may be:

Sex related-lack of sexual awareness, Sexual abuse, early sexual relationships and attended complications.
Emotional : These arise because of the changes that occur with the transition from childhood to adulthood, being attracted to the opposite sex, fantasies, mood changes (irresponsible, stubborn) and a search for identity and sexual development that creates a sense of crisis
General medical problems :Mainly dietary mal-adjustments resulting in anaemia, obesity, food-faddism and anorexia nervosa (Extreme cases of impaired body-image)

What is sexual awareness? How does one become sexually aware?

Sexual awareness is no way obscene or a no-no to adolescents. Sexual awareness simply means understanding the physiology of the human body with special reference to the reproductive organs. Understanding your bodily functions not only gives you a sense of being in control but also helps explain the various changes that occur in your body and which may be baffling to the un-initiated. It is desirable that the adolescents know about the medical aspects of how human life is conceived. For this, a basic understanding of the reproductive organs-namely, the production of egg from the ovary; the production and functions of the sperms and the consequences of fertilization must be understood. Nowadays this information is being imparted in schools as a part of the curriculum. However, if not, the adolescents must approach any elder in the family with whom they feel free or the counselors at school and request them to clear the doubts and mis-conceptions. This approach is far healthier and informative than resorting to pornographic web sites or reading material or even an ill-informed peer.

What is incorrect ‘sexual awareness?’

Information from the pornographic sites is most often incorrect, far from reality and given with an aim not to be informative but provocative. If anything, they cause more confusion than awareness! Pornographic books: Same as for the internet information. There are however a few reliable and authentic books which may be of help. Ill-informed friends- may turn out to equally dangerous, as they are poorly aware themselves! Finally, experimenting and sexual escapades are certainly not the ways for adolescents to become sexually aware! What are the actual problems related to sex in the adolescents?

Most stem from ignorance and irresponsibility.

Early sexual involvement with its attended complications of an unwanted pregnancy. This naturally leads to resorting to abortion, not to mention the attended psychological trauma.
Reproductive tract infections: Infection of the reproductive organs which may cause pain, white discharge and even infertility (inability to conceive) in future.
Sexually transmitted diseases: HIV, Syphilis, Gonorrhoea, Chlamydia, Hepatitis-B are some of the long-standing infections that can be contracted due to unprotected sex.
Mal-adjustments to normal bodily functions: The classic example is the fear and mis-conceptions about menstrual pain.
Sexual abuse

What is the main way to avoid complications arising from sex?

The best and the only way to avoid pregnancy, infections and psychological scarring is to keep away from sex! It is important to understand that Adolescence is a period to consolidate the overall personality of an individual and sex must not be a priority issue. However, if you have been sexually initiated, the next best advice is to maintain a monogamous relationship and remember to use protection always! Barrier contraception protects from pregnancies as well as infections and sexually transmitted diseases. It is always advisable if you could consult a gynaecologist who will help you out with more contraceptive advice.

What must be done in the unfortunate scenario of an accidental pregancy?

If unfortunately, pregnancy is suspected or even happens, a gynaecologist must be contacted immediately. And also remember-it is best to confide in your parents, however unpleasant and embarrassing it may be for you. DO NOT GO AT IT ON YOUR OWN. It could cost your life!

What are STDs (Sexually Transmitted Diseases)?

In India, STDs affect 30 lakh teenagers every year! STDs are dangerous and occur only after sexual contact with infected partner. So it is obvious that your partner is not monogamous and has in fact, contracted it from someone else! An infected person may not have visible signs and definite illness cannot be predicted. It can lead to serious consequences like pelvis infection, infection in fallopian tubes and problems in having a pregnancy in future. Curable STDs include Trichomoniasis, Chlamydia, Gonorrhoea, Syphilis whereas the least Curable / Incurable are HIV / AIDS, HPV, Hepatitis B, Herpes Common symptoms of STDs are discharge, redness, itching, ulcers, over genitals and burning while passing urine. The partner may also have similar symptoms.

What are the safety tips to avoid STDs? Remember prevention is better than cure. Learn to Say ‘NO’. Follow your mind more than your heart. Never say YES when you actually want to say NO .Learn to politely refuse and even give a reason!

What constitutes sexual abuse?

Sexual abuse is most often under-reported for obvious reasons.

The following constitute abuse:

Whenever a person’s sexual privacy is not respected.
Forcing sexual intercourse.
Rape.
Unwanted touching, fondling, watching, talking, or being forced to look at sex organs
"Peeping" secretly at another individual (boy/girl) in bathroom / bedroom

What must be done to protect one-self?

Most often, a known person is the culprit. It could be a distant relative, a married person, a family friend or a neighbor. Whoever it is, it is important to understand that sexual abuse is a crime and must be addressed seriously. Here is what you could do:

Tell a trusted adult about abuse
If you have been sexually assaulted you may feel ashamed, guilty, depressed, angry,
voiceless. This is natural, but silence is not a solution or even an option.
Counseling & healing are important to help tend your bruised shaken self & to move on.
Choose not to remain silent because harassment will not go away if you ignore it. What are the medical problems that may be associated with adolescents?

Faulty dietary habits are common among teen-agers and it may cause anaemia, Obesity and even malnutrition (As in anorexia nervosa) Also Thyroid disorders, PCOS (poly cystic ovarian syndrome) which cause irregularity of periods, acne and certain psychiatric disorders may manifest for the first time during Adolescence and may need to be addressed. What’s the last word? Adolescence is indeed a roller-coaster ride. It has happened to all others before you and you can sail through it too-with a little awareness, some support from family and a lot of determination and positive attitude from you!