Information for Adolescent Girls

Puberty, Abstinence, Sex, Breast Self-Exam, Gynecology Exam, and Emotions

As part of growing up, you will go through puberty. Puberty is the time in your life when your body changes from that of a child to that of an adult. Chemicals in your body called hormones cause these changes. Because there are so many changes that happen during puberty, you may feel like your body is out of control. In time, your hormones will balance out and your body will catch up.

Not only does your body change, but your emotions change too. How you think and feel about yourself, your family and friends, and your whole world, may seem different. As you go through puberty, you will begin to make important decisions for yourself, take on more responsibilities, and become more independent.

If you are already going through some of these changes, you may be asking yourself, "Am I normal?" or "Do other people my age feel the way I do?" Don't worry. Lots of changes happen during puberty and, although it can be a confusing time of life, it can be exciting.

Puberty is the time in a girl's life when her body changes from that of a young girl to that of a woman. It is also the time when a girl becomes physically able to have babies. Although there is no "right" time for puberty to begin, it generally starts earlier for a girl than it does for a boy - usually between 9 and 13 years of age. This is why many girls are taller and may act more mature than boys for a few years until the boys catch up.

How Will My Body Change?

Following are some of the changes your body will go through during puberty:

Breasts: In most girls, puberty starts with breast growth. When your breasts start to develop, you may notice small, tender lumps under one or both nipples that will get bigger over the next few years. When breasts first begin to develop, it is not unusual for one breast to be larger than the other. However, as they develop, they will most likely even out before they reach their final size and shape.

As your breasts develop, you may need a bra. Some girls feel that wearing a bra for the first time is exciting - it is the first step toward becoming a woman! However, some girls feel embarrassed, especially if they are among the first of their friends to need a bra. If the people around you make a bigger deal of your first bra than you would like, try to remember that they do not mean to embarrass you, they are just proud of how much you have grown.

Hair: Soft hair will start to grow in the pubic area (the area between your legs). This hair will eventually become thick and very curly. You may also notice hair under your arms and on your legs. Many women shave this hair. There is no medical reason to shave, it is simply a personal choice. If you decide to shave, be sure to use a lot of soap and water and a clean razor made for women. It is a good idea to use your own personal razor or electric shaver and not to share one with your family or friends.

Body shape: Hips get wider and your waist will get smaller. Your body will also begin to build up fat in the stomach, buttocks, and legs. This is normal and gives your body the curvier shape of a woman.

Body size: Arms, legs, hands, and feet may grow faster than the rest of your body. Until the rest of your body catches up, you may feel a little clumsier than usual.

Skin: Skin may get more oily and you may notice you sweat more. This is because your glands are growing too. It is important to wash every day to keep your skin clean and to use a deodorant or antiperspirant to keep odor and wetness under control. Despite your best efforts to keep your face clean, you still may get pimples. This is called acne and is normal during this time when your hormone levels are high. Almost all teenagers get acne at one time or another. Whether your case is mild or severe, there are things you can do to keep it under control. For more information on treating acne, ask us for our handout on acne.

Menstruation: Your menstrual cycle, or "period," begins. Most girls get their periods between 9 and 16 years of age.

What Happens During My Period?

During puberty, your ovaries begin to release eggs. If an egg is fertilized by sperm from a man's penis, it will grow inside your uterus and develop into a baby. To prepare for this, a thick layer of tissue and blood cells builds up in your uterus. If the egg does not meet with a sperm, these tissues and cells are not needed by the body. They turn into a blood-like fluid and flow out of the vagina. The menstrual period is the monthly discharge of this fluid out of the body. When a girl first begins to have her periods, she is able to get pregnant.

During your period, you will need to wear some kind of sanitary pad and/or tampon to absorb this fluid and keep it from getting on your clothes. Pads have adhesive strips and are worn inside the panties. Tampons are placed inside the vagina.

The decision to use pads or tampons is your choice. Some girls prefer tampons because they do not like the feeling of wetness or the odor that may accompany pads. Some girls prefer pads because they are not comfortable inserting tampons into their vaginas.

When using a tampon for the first time, take your time, relax, and insert the tampon slowly into your vagina. This will allow the muscles in your vagina to relax and the tampon to go in easily. Make sure the string remains on the outside of your vagina so that you can remove the tampon. To avoid infection, change tampons often and do not wear them overnight.

Pads are often called "maxi" pads or "mini" pads and can be thick or thin. These are good for when the flow of your period is heaviest. Panty liners, which are very thin, can be used for the end of your period when there is usually very little discharge. Tampons come in different levels of thickness for when your period is heavy or light. Try out different brands and find the ones you like the best.

Most periods last 3 to 7 days. After your period, you may have a day or two of light bleeding, called spotting. This is normal. If you start bleeding regularly between periods, see your pediatrician.

Having your period does not mean you have to avoid any of your normal activities like swimming, horseback riding, or gym class. Exercise can even help get rid of cramps and other discomforts that you may feel during your period.

Beginning with their first period, many girls expect their menstrual cycles to occur exactly on schedule. But that rarely happens. During the first year (and sometimes longer) some girls have periods that seem to have no schedule. Cycles can be as short as 3 weeks; others as long as 6 weeks - or sometimes even longer. It may take a while for your periods to become regular (every 3 to 5 weeks). Even after they do become regular, it is not unusual for a girl to miss a period if she is sick, under a lot of stress, exercising heavily, has a poor diet, or is nervous about something. Of course, more than any other reason, pregnancy can cause a girl's period to stop.

Some girls bleed heavier than others during their periods. You have about 5 quarts of blood in your body and you only lose I to 3 ounces of it during your whole period. However, if your period is really heavy (you soak more than 6 to 8 pads or tampons in a single day), talk to your pediatrician.

You may feel some discomfort before, during, or after your period. Common symptoms include:

· cramps

· bloating

· soreness or swelling in your breasts

· headaches

· sudden mood changes such as sadness or irritability

· depression

If you feel your symptoms are severe, talk to your pediatrician. Most of the time, cramping and other symptoms are mild and easy to control. Ibuprofen (Motrin /Advil) over the counter contains 200mg per pill. You can take 2-4 pills (400-800mg) every 6-8 hours to lessen cramping. If you know when your period is due, you can begin the Ibuprofen 1 day before and this may further lessen cramps. Remember, Ibuprofen can upset your stomach. Take with food and if you do experience stomach pain, decrease the dose until better

There are other menstrual problems that require a visit to your pediatrician. If you have any of the following symptoms, contact your pediatrician:

• a sudden change in your period that does not have an obvious cause (like an illness)
• very heavy menstrual bleeding that lasts more than 7 to 10 days
• bleeding between periods
• severe abdominal pain that lasts for more than 2 days and is not early in your period
• you think you might be pregnant
• any other concern you may have that something is wrong with your menstrual cycle

If your pediatrician feels you may have a vaginal infection, a problem with your menstrual cycle, or is recommending a pelvic exam, he or she will refer you to an OB/GYN (obstetrician/gynecologist). This type of doctor specializes in women's reproductive health issues.

Why Do I Need A Pelvic Exam?

A pelvic exam is the best way for your doctor to examine your reproductive system, which includes the vagina, cervix, ovaries, fallopian tubes, and uterus (see illustration). This visit is also a great time to talk to your doctor about important health issues such as:· your growth and development· breast health· menstruation ("periods")· sexuality· pregnancy and birth control· infection risk· or to simply get advice about your health.

The exam also includes lab tests for common problems that can be easily treated if found early.

Your First Visit To The Gynecologist

Before the pelvic exam, your doctor will ask you a number of questions to find out whether you are having problems or are at risk for problems. For example, your doctor may ask about your menstrual periods. Questions about your periods may include:

• When did you have your first period? When did your last period start?
• Do you have your periods regularly?
• How often?
• How long do your periods last?
• Do you have any discomfort (pain, cramping, headaches, mood swings) with your periods?
• Do you use tampons, pads, or both?
• Have you ever had vaginal itching, discharge, or problems urinating?

Your answers to these questions tell your doctor if your periods are normal. He or she may give advice about menstrual discomfort, tampon use, and other issues.

Your doctor may also ask you about your sexual experiences. This is so your doctor can get to know you and help you to protect your health, so giving honest answers is important.

The information you give to your doctor is confidential and will not be discussed with anyone else without your permission (unless it is something life threatening). The questions may include:

• Have you ever had sexual intercourse?
• How old were you the first time you had sex? How many sexual partners have you had?
• What do you use to prevent pregnancy and infection?

Your answers to these questions will help your doctor decide what services you will need. He or she can give you advice on decision-making, abstinence, and prevention of pregnancy and infection.

The Exam

Before performing a pelvic exam, your OB/GYN will tell you what he or she is going to do at each step of the exam. If you have any questions or feel uncomfortable, just let your doctor know. If you have a male doctor, a female nurse or chaperone will normally be present during the exam. You may request that your mother, older sister, or friend join you if it makes you more at ease. You may also request that no one, other than the doctor, be in the room during the exam.

Before the exam, your height, weight, blood pressure, lungs, heart, and neck may be checked. You may be asked to give a small sample of urine and to empty your bladder to make the exam more comfortable.

You will then be left alone to completely undress and put on a gown. A sheet will be given for extra coverage. When your OB/GYN comes into the room, he or she will ask you to lie down on the examining table for the breast examination. He or she will feel each breast for lumps, sores, or swelling. Be sure to tell your doctor if your breasts are sore in any way or if you have had any fluid leaking from your breasts.

Your OB/GYN and pediatrician will teach you "breast self-exam," an important part of keeping yourself healthy. You should do a breast self-exam each month. This will alert you to any changes or problems in your breasts and help you to be more familiar with your body. Practicing breast self-exam as a young woman prepares you for later on, when breast cancer is more common and regular breast self-exams are so important.

Usually after the breast examination, your OB/GYN will check your abdomen and then do the pelvic exam. The entire pelvic exam only takes about 5 minutes. It can be done even if you have never had sexual intercourse, because the opening that allows your period blood out is large enough to allow examination. Some young women who have not had intercourse worry that having a pelvic exam will mean they are no longer virgins. You should not worry about this; the pelvic exam does not change whether or not you are a virgin. Also, the pelvic exam is not a "test" to see if you are a virgin.

The pelvic examination has three parts. In the first part, the doctor will use a light to look at the outside of your vagina and surrounding areas to make sure everything looks normal.

During the second part, the OB/GYN will look inside your vagina. Your doctor will use an instrument called a speculum to see inside. It will be made of disposable plastic or sterilized metal. The speculum will be gently inserted into your vagina. You will feel some pressure, but it should not hurt. Taking deep breaths and trying not to tense up will help relax your vagina muscles and make this part of the exam easier. While the speculum is in place, your pediatrician will take a sample of cells from the cervix. This is called a Pap smear. The Pap smear is a test for infections or abnormalities of the cervix, and you should not even feel it. The speculum will then be removed.

In the third part of the pelvic exam, the OB/GYN feels your uterus and ovaries to check their size and see if they are tender. This is done by the doctor gently inserting one or two gloved fingers into your vagina and pressing on the outside of your abdomen with the other hand.

That's it! Most patients are surprised when their first pelvic exam is over, it really is quick.

How To Do A Breast Self-Exam

(Ask us for our handout showing how to perform a breast self-exam)

Once a month, right after your period, you should examine your breasts. Although breast cancer is rare in young people, it usually can be cured if found early, and a breast self-exam is the best way to find it.

1. Stand in front of your mirror with your arms at your sides and see if there are any changes in the size or shape of your breasts. Look for any puckers or dimples, and press each nipple to see if any fluid comes out. Raise your arm above your head and look for changes in your breasts from this position as well.
2. Lie down and place your left hand under your head. Hold your right hand flat and feel your left breast with little, pressing circles. Think of each breast as a pie divided into four pieces. Feel each piece and then feel the center of the "pie" (the nipple area).
3. Now put your left arm down at your side, and do the same thing on the outside of the breast, starting under the armpit.
4. Repeat steps 2 and 3 for the other side.

Most women have some lumpiness or texture to their breasts; breasts are not just soft tissue. Get to know your breasts - then be alert for any lumps or other changes if they should ever appear. Remember, most lumps and changes are not cancer. However, if you think you have found a lump or notice any other changes, don't press or squeeze it; see your pediatrician.

Take Care Of Yourself

Your first pelvic exam is one of the many steps you will take as part of taking care of yourself as a young adult. It is easiest to do this when you are well, before any problems occur. If you are having sex, you should have a pelvic exam at least once a year.

Along with eating right, getting enough exercise, not smoking, and wearing seat belts, regular visits to your pediatrician for checkups are important. Your pediatrician cares about your health. Even as you get older, seeing your pediatrician regularly will help you learn the best ways to take care of yourself.

Emotional Changes During Puberty

In addition to the many physical changes you will go through during puberty, there are many emotional changes as well. You may start to care more about what other people think about you. You will want to be accepted and liked. At this time in your life, your relationships with others may begin to change. Some become more important and some less so. You start to separate more from your parents and identify with others your age. You may begin to make decisions that could affect the rest of your life.

Many people your age feel self-conscious about their changing bodies - too tall, too short, too fat, too skinny. Because puberty causes so many changes, it is hard not to compare what is going on with your body with what is happening to your friends' bodies. Try to keep in mind that everyone goes through puberty differently. Eventually, everyone catches up.

Sex And Growing Up

During this time, you also become more aware of your sexuality. A look, touch, or just thinking about someone may make your heart beat faster and produce a warm, tingling feeling all over. This is completely normal. You may be asking yourself the following questions:

• "Is it okay to masturbate (touch your genitals for sexual pleasure)?"
• "When should I start dating?’
• "When is it okay to kiss?"
• "How far is too far?"
• "When will I be ready to have sexual intercourse?"
• "Will having sex help my relationship?"

Masturbation is normal and will not harm you. Many boys and girls masturbate, many do not.

Deciding to become sexually active can be very confusing. On one hand, you hear so many warnings and dangers about having sex. On the other hand, movies, TV, magazines, even billboards seem to be telling you that having sex is okay. The fact is, sex is a part of life and, like many parts of life, it can be good or bad. It all depends on you and the choices you make.

As you continue through puberty, you may experience pressure from many sources to have sex. Knowing where the pressures come from will make them much easier to deal with. Pressure to have sex may come from:

The media: Because there are so many images in the media about sex, it is easy to get the idea that having sex is the right thing to do. Sex in movies, TV shows, magazines, and in music is often shown as not having any risks. Do not let these messages fool you. In real life, having sex can be very risky.

Your own body: It is perfectly normal to be interested in sex. After all, growing sexually is what puberty is all about. The sexual urges you feel during puberty can be very powerful. What is most important is to stay in control of these feelings and not let them control you. Keep in mind that sex is not the only way to express how you feel about someone. Taking walks, talking, holding hands, hugging, and touching are great ways to be close to someone you have strong feelings for.

Your friends: It may seem like "everybody's doing it" or that people who have sex are "cool." Maybe you feel like you should have sex to be popular and fit in with the group. However, people like to talk about sex and some may want others to believe that they are having sex even when they are not. Someone who does not want to be your friend just because you are not having sex is probably someone who is not worth being friends with anyway. Do not let friends - or anyone - talk you into having sex. This is a decision you make when it is right for you, not for your friends.

Deciding whether or not to have sexual intercourse is one of the most important decisions you will ever make. Why not take your time and think it through? Talk with your parents about their values. Waiting to have sexual intercourse until you are older, in a serious relationship, and able to accept the responsibilities that come along with it is a great idea! You should enjoy being young without having to worry about things like pregnancy and sexually transmitted diseases (STD’s).

However, if you decide to have sex, talk with your pediatrician/Ob-Gyn about which type of birth control is best for you. When using condoms, always use latex condoms to prevent sexually transmitted diseases like gonorrhea, syphilis, chlamydia, herpes, and HIV (the AIDS virus).

Abstinence: Young People Can Wait

Not having sex (abstinence) is the only sure way to prevent pregnancy and STDs.

People who wait until marriage to have sexual intercourse usually find out that it is:

• Less risky to health
• Easier to act responsibly and take precautions to avoid infections and pregnancy
• More special
• More satisfying
• More accepted by others

Be patient. At some point, you will be ready for sexual intercourse. Move at your own pace, not someone else's. Talk with your parents about their values. Your pediatrician can explain how intercourse affects your body, and why you should wait until you are older. To avoid the risks - and to make intercourse really special in the future - why not just wait for now?

Learning To Take Care Of Yourself

As you get older, there will be many decisions that you will need to make to ensure that you stay healthy. Eating right, exercising, and getting enough rest are important during puberty because of all the changes your body is going through.

It is also important to feel good about yourself and the decisions you make. You have to learn to care for your own body, work hard and maintain good health, and to like yourself as you are.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.