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Puberty – Becoming a Woman

A time of change in body and mind

Puberty is an exciting but perplexing stage of life that both girls and boys go through. In girls, it is a time of physical transition between childhood and womanhood. Rapid physical change goes hand in hand with psychological change. The girl develops a new self-image to match her growing body and mind. When the facts of puberty are explained clearly and if the girl is encouraged to be confident about herself , she is likely to emerge from this crucial stage as a well-adjusted adolescent. Parents can do much to help their child during this stage.

One of the changes girls find the most trying to cope with is the first menstrual period,which occurs at this time. This is a good time to explain to a girl the facts of life, gently but and scientifically. It is important that a girl knows that her body is now capable of conception. And it is equally important that she is encouraged to continue playing games and mixing with other children as before. The changes of puberty are usually complete by the age of 18, by which time the girl is a full-grown woman.

What triggers puberty?

A girl child starts becoming a woman between the ages of 9 and 14, when the pituitary gland and the hypothalamus in her brain send a signal to her ovaries. This signal instructs the ovaries to increase production of the female sex hormones. It is this increased hormonal production that causes the changes of puberty across a period of two to six years. Some girls experience puberty early, others experience it late – usually they enter puberty about the same age as their mother or any of their father’s close female relatives.

The outward changes of puberty

Much physical change is to be expected during puberty. Secondary sexual characteristics and other changes that develop or occur at this stage include:

  • Development of breasts
  • Growth of pubic hair
  • Changes in body shape
  • Increased height
  • Increased weight
  • Growth of the external genitalia
  • Increased sweating
  • Pimples
  • Vaginal discharge
  • The first menstrual period

Changes in body shape: The hips and thighs widen and the pelvis expands. The shape of the girl’s body becomes more curvaceous, at it prepares to carry a baby during future pregnancies.

Development of breasts: The area around the nipples grows first, followed by the actual breasts. Breast development continues until the approximate age of 18. The growing girl often worries because one breast develops faster than the other. She needs to be reassured that this happens to many other girls and the pace of development will soon even out her figure.

The growth spurt: Girls enter puberty earlier than boys, and thus enter their 'growth spurt' before boys. The growth spurt is one of the first signs of puberty. A girl may grow as much as four inches taller in a single year. After this, growth slows down considerably. Most girls completely stop growing about one to three years after the first period, while some gain an inch or so up to the age of 21. A girl’s feet grow at a fast pace, reaching their full adult size much before the rest of the body.

Body hair: Hair begins to grow in new places during puberty. Pubic hair begins to grow in a triangular patch in the pubic area, lightly at first. This is followed by hair growth under the arms. Hair on the legs and sometimes hair on the arms begins to darken. Some girls are worried by excessive hair on their limbs and upper lip and may request cosmetic attention.

Growth of external genitalia: The genitals, which are not conspicuous in a child, grow and become more evident during puberty. The female external genitals include the vulva, labia and clitoris.

The first period: Shortly after the breasts and pubic hair begin to grow, the first period occurs (menarche). Girls must be forewarned about menstrual bleeding, as the first period can otherwise come as a frightening shock. They need to be taught the use of sanitary towels and proper hygiene. Sanitary towels should be changed at least three to four times a day. This is also the right stage at which to explain the menstrual cycle to a young girl. Menstrual irregularities in puberty include a number of conditions, some of which require medical attention.

Increased activity of the sweat glands: Girls now tend to perspire more than they did as children. Body odour also develops, sometimes necessitating the use of a deodorant or anti-perspirant. Daily bathing and frequent change of clothes, particularly in hot weather, helps to reduce the unpleasant effects of excessive sweating.

Skin problems: One of the difficult changes a young girl may have to endure is the crop of pimples on her face. Puberty causes her skin to break out because the oil glands are now more active. The best way of dealing with pimples is to keep the area clean and to prevent the pores from clogging. This is particularly important in Indian cities with their high levels of pollution.

Vaginal discharge: Six months to a year before the first period, a girl usually notices a clear, white vaginal discharge. This is normal, and might turn yellow on contact with underwear. It is important to change underwear regularly.

Increased appetite and weight: A girl tends to be hungrier and have a better appetite during puberty than she had earlier. Her body needs more calories as it is growing very quickly. There is an increase in weight as well.

The invisible changes of puberty

Growth of internal sex organs: The uterus and vagina, which are the female sex organs within the body, grow during puberty. The uterus increases in size and sheds its lining in a monthly discharge called the menstrual period. The vagina grows longer and its walls stretch and become more elastic. Girls going through puberty should be taught about the working and anatomy of the female reproductive system.

When to see a doctor

Puberty does not begin at the same age for every girl. It can occur normally at any time between the ages of 9 and 14. However, a doctor should be consulted under certain circumstances, to make sure there is nothing wrong:

  • Puberty begins before the age of 9. This is called precocious puberty.
  • Pubic hair and breasts (secondary sexual characteristics) have not begun to appear by the age of 13. This is referred to as delayed puberty
  • The first period has not occurred by age 16 (primary amenorrhea), or the menstruation has stopped for a period of six months or more (secondary amenorrhea).
  • There is severe dysmenorrhea (painful periods). Although there is frequently no organic cause, the condition can be treated to ease the girl’s discomfort.

Menstrual irregularities in puberty

Menstrual irregularities in puberty and adolescence can be caused by a wide variety of factors. They range from the mild and easily treatable to the severe. Menstrual irregularities at this stage include:

Dysmenorrhea: Although there is usually no organic cause of dysmenorrhea, it could be secondary to obstructive or other anatomic causes. A doctor will help rule these out, and treat a girl with symptoms that can be extremely uncomfortable – nausea, vomiting, diarrhea and severe menstrual cramps. Treatment may include antiemetics and prostaglandin inhibitors. Girls should not be encouraged to take pain-killers without the supervision of a doctor. buse of pain-killers can damage health.

Dysfunctional uterine bleeding (DUB): For two to three years after the first period, most girls have anovulatory periods (not associated with cyclical ovulation). This is not considered abnormal unless the bleeding lasts for more than seven days and the girl is anaemic. In this case the condition is called DUB. Immature functioning of the hypothalamic-pituitary axis usually causes it. Other possible causes are psychogenic factors, juvenile hypothyroidism, and coagulation disorders (von Willebrand’s disease). DUB is usually self-limited but if the symptoms last for over four years, there is a fifty per cent chance of recurrence. The treatment is by cyclic hormonal manipulation with oestrogens and progestins.

Amenorrhea: When the first period has not happened as expected, the condition is called primary amenorrhea. When the periods start and then stop for more than six months, it is called secondary amenorrhea. Primary amenorrhea calls for investigation when it persists beyond the age of 16. Chromosomal anomalies account for as much as 40 per cent of all cases of primary amenorrhea. Other causes of amenorrhea include delayed puberty, malnutrition, systemic illness, lesions of the central nervous system, tumours, anatomic, hypothalamic and metabolic disorders and psychogenic disorders such as anorexia nervosa (link to other sections?). Sometimes, an obstructive defect in the lower genital tract causes accumulation of blood in the vagina and absence of the period. This is called cryptomenorrhea.

Delayed puberty: For most girls with delayed puberty there is no underlying physiological or anatomical cause. Nevertheless, a doctor should be consulted if no secondary sexual characteristics appear by the age of 13. The causes of amenorrhea apply to delayed puberty also. But there are some disorders which are exclusively associated with delayed puberty – Hand-Schuller-Christian disease, developmental defects of the midbrain, Prader-Willi syndrome, Lawrence-Moon-Biedl syndrome, and dwarfism. The diagnosis of delayed puberty is based on physical, neurological and pelvic examinations, measurement of the level of gonadotropin, and karyotyping, and an endocrine profile. Gonadal steroid replacement with oestrogen or progesterone is the usual treatment.

Precocious puberty: When a girl gets her first period before the age of 9, the condition is called precocious puberty. Precocious puberty can be Heterosexual or isosexual. Heterosexual precocious puberty involves the development of secondary sexual characteristics that do not match the genetic sex of the child. This may be caused by tumours, congenital adrenal hyperplasia and chronic ingestion of androgenic preparations (oral contraceptives, creams or lotions containing oestrogen). Isosexual precocious puberty is the early development of secondary sexual characteristics that are consistent with the genetic sex of the child. The majority of these cases have no obvious underlying cause. Today, progestational agents and GnRH analogues constitute effective treatment of precocious puberty.

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