Teen Health

By James Brann, M.D.

Learn about teen health.
Teen Physical Health

First Gynecological Visit

Related: First pelvic exam at Center for Young Women's Health

When should you bring your teenage daughter in for their first gynecological exam? The answer may be sooner than you think. Determining the right time for the first gynecological visit is but one of many questions that parents of teen girls have to face as their daughters blossom into young women.

The American College of Obstetricians and Gynecologists recommends that most teens visit their gynecologist between the ages of 13 and 15. This visit may not include a pelvic exam and Pap smear. Many patients automatically assume that a Pap smear is required at all visits; however this is not necessarily the case.

So what will occur during the first gynecological visit? At the first visit, the gynecologist will discuss important health issues that are relevant to adolescence and early adulthood. The physician can also determine whether your daughter is developing normally, and can offer reassurance and information regarding irregular menses (a common occurrence in the early years of puberty).

Another important reason for early gynecological visits is education. Your daughter's physician will be able to provide you and your daughter with health information about sexually transmitted diseases and contraception options. This is perhaps the biggest benefit of early exams. Studies have confirmed that by the age of 18, as many as 60 percent of adolescents will have already attempted or had intercourse.

The more education your daughter has prior to this experience, the less likely she is to contract a sexually transmitted disease or become pregnant. Knowledge is power, and this is certainly the case for adolescence. A visit to the gynecologist between the ages of 13 and 15 can prove empowering, and can prevent adolescents from adopting the attitude that sexually transmitted diseases won't happen to them.

Teen Menstrual Cycle

Related: Menstrual Cycle at Center for Young Women's Health

Vaginal bleeding occurs in all young women as a result of hormonal changes that occur in the body. Typically your period will begin at or around the age of 12 years. Some women however will experience their first period as early as 9 years of age, whereas others may not have their first menstrual cycle until they are 16 years old. Both are normal.

Most women will have regular menstrual cycles that occur on a 28 day cycle. However just as the age of onset varies, so too does the length. Some women's cycles will be as short as 22 days, whereas others will last 36 days. During that time you may bleed from four to seven days. During adolescence, menstrual cycles are often irregular.

What exactly is a normal cycle?
Vaginal bleeding occurs in all young women as a result of hormonal changes that occur in the body. Typically your period will begin at or around the age of 12 years. Some women however will experience their first period as early as 9 years of age, whereas others may not have their first menstrual cycle until they are 16 years old. Both are normal.

Most women will have regular menstrual cycles that occur on a 28 day cycle. However just as the age of onset varies, so too does the length. Some women's cycles will be as short as 22 days, whereas others will last 36 days. During that time you may bleed from four to seven days. During adolescence, menstrual cycles are often irregular.

Why might my cycle be off?
There are many reasons you may be experience abnormal periods. Remember that early on most teens have irregular cycles.

There are some situations however that can influence the menstrual cycle and lead to abnormal periods. Missed periods may for example, be the first sign of pregnancy if you are sexually active.

Sometimes the ovary fails to release an egg regularly, which can result in an absent or missing period.

Sexually transmitted diseases can also interfere with normal menstrual cycles. How can I tell if there is a problem?
There are some sure fire signs that you should go in for an exam. These include any of the following symptoms:

  • You haven't developed your first period by the age of 16.
  • Your periods are more often than every 21 days or occur more than 45 days apart.
  • You bleed in between cycles.
  • You experience severe pain during your period that is not relieved with over the counter medications.
  • Your periods are unusually heavy, requiring that you change your pad or tampon up to once an hour for three or four hours straight.

Learn about teen health and sexual health.
Teen Sexual Health

Teen Sexuality

Related: Resource about sexuality at Center for Young Women's Health

Believe it or not, teenagers and pre-teens are just as hesitant to approach you about sexual topics as you might be to approach them. It is normal for adolescents to have questions about sex however, and you can be the primary source of information and insight about sex if you plan things in advance.

As a parent it is vital that you work with your teen to help them understand that sexual development is a vital part of health, as important as any other aspect of their well being.

A Teenager's Sexuality is not Simply Related to Their Gender
Sexuality is in fact much more complicated. It may include the following:

  • Gender - Most teens will form a gender 'identity.' This is best described as how an individual 'feels' about themselves, meaning whether they feel more masculine or feminine, sensitive or insensitive. Gender identity may be mixed, very strongly one way or the other.
  • Anatomy - This is a very simple concept. Basically, we are all anatomically either 'male' with a penis and testicles or 'female' with a vagina and ovaries. Anatomy is largely responsible for ones gender identity, sometimes influenced by hormones.

  • Sexual Orientation - Teenagers just like adults will have very powerful affinity and emotional attractions toward others. For many this orientation is heterosexual, meaning boys are attracted to girls and vice versa. However, you may find that your teenager is attracted to the same sex or both sexes. This may be transient or permanent and may depend on a number of factors including anatomy, gender identity, society and environmental factors.

Sexual Development
Sexual development actually begins during the pre-teen years. During this time your child's body produces hormones that initiate puberty. Breast development, the appearance of facial hair in boys and growth of hair under the arms and in the genital area are hallmarks of puberty.

Puberty also involves emotional changes. During the adolescent years pre-teens and teens start feeling attraction toward others. The desire to be close to others intimately is a natural part of the sexual development process.

The attractions that teens feel vary. Teens may find that they are attracted to someone of the same sex for a brief time, and then find they are attracted to members of the opposite sex, whether exclusively or not. The opposite can also occur.

These varying transitions can be confusing for both teens and parents, but it is vital to acknowledge them as part of the growth process.

A majority of teens will identify themselves as heterosexual, though some will identify with homosexuality and still others will proclaim themselves bisexual. It often takes many years for one to grow into their sexuality.

During this time, many teens feel confused over their feelings and attractions. It is vital during the period of sexual development that teens have the support and understanding as well as guidance of family members.

Most teens will seek out a trusted adult and peers so they have someone to talk to openly about their fears, concerns and feelings. It is important to let teens know that it is perfectly normal to have a desire to experiment with sexual activity during this time.

The Facts about Sexual Activity
How do you approach your teen with regard to sexuality? The best way to approach your teen is an honest one.

Let your teen know that there are many ways to express intimacy and attraction. Spending time with another person, simply holding hands and kissing are all ways to show someone you are attracted to them and to explore physical intimacy without necessarily engaging in intercourse.

As time goes on most teens will probably start wanting to express their intimacy at other levels. Most teens are actually open to discussing sex and different sexual acts, as they attempt to sort out what their sexual boundaries are, and what is and is not OK when it comes to sexual intimacy.

It is important that you discuss with your teen the difference between sexual intercourse, petting or touching and other forms of intimacy. Masturbation is also a topic that is highly sensitive and considered by many to be 'taboo' but is an important subject nonetheless.

It is vital that your teen understand that masturbation is a normal process and part of growing up. A healthy interest in such activities may prevent your teen from seeking out other more intimate encounters.

Sexually transmitted diseases and Contraception
Teens are just as likely, if not more likely to contract a sexually transmitted disease from unprotected sexual intercourse.

Your conversations with your teen should include adequate information on STD's and protection. Despite your best efforts at education, your teen will ultimately decide when they feel they are ready for intercourse. This may be at an age that is much younger than you would prefer or deem acceptable.

The best thing you can do short of educating your teen is ensure that they are adequately informed and protected, both against disease and unwanted pregnancy.

Be sure you inform your teen of the dangers of STD's, including potential complications such as infertility. Let them know that many STD's such as Herpes are incurable, and once they contract them, they will have them for a lifetime.

Also introduce your teen to methods of contraception including the use of condoms and if necessary, birth control pills. If you feel your teen may be sexually active, you might consider accompanying them to your healthcare provider's office. Sometimes your health care provider can provide better information about contraception and help your teen make smart choices, particularly if you are uncomfortable about the issue.

Teen Sexuality Over View
Teen sexuality is a complex process influenced by many factors. During the teen years your child will be battling many opposing forces. They will be attempting to establish a gender identity, their sexual orientation and attempting to manage the physical and emotional changes that are rapidly occurring in their body.

Teens will develop a sense of their own sexuality. If you approach sex and education with an open and honest mind set, you will establish a trusting and caring relationship with your teen. This will help them develop a normal, satisfying and mature sexual identity later in life.

Remember that it is normal for teens to want to begin experimenting when they are young, but also remember that most lack the maturity to understand the severe consequences of sexual behavior.

Be sure you talk with your teen honestly and help educate them about the consequences of sex, and the potential harm that can arise from unprotected sexual intercourse. By doing so you will help ensure they are provided with reliable and trustworthy information. You can also work with them to encourage them to delay serious sexual contact until they are mature enough to make save and positive decisions.

Learn about teen body image and self awareness.
Teen Mental Health

Teen Body Image

Related: Body image and self-esteem at Teens Health

If you are a young female adolescent then at some point or another you have probably wondered whether or not you are overweight. Unfortunately thanks to media portrayals of waist thin actresses and peer pressure to look your best at all times, many young women fall prey to the belief that there is no such thing as 'too skinny' when it comes to their body image and self esteem.

Healthy Weight and Body Image
What exactly is the right weight for you? That depends on a number of factors. Forget about TV ads and magazine covers for just a moment and consider your personal health and well being. Did you know that a majority of teen females are actually a normal body weight? In fact studies show that a very small proportion of teen women are actually overweight.

How can you determine your overall health and well being? One tool you can use is the Body Mass Index (BMI). This tool computes your weight and height into a formula that determines your body mass index. A healthy BMI is much more important that the actual number on the scale. Generally the following guidelines apply:

To determine your approximate BMI you can use the table provided below. Simply find your height in inches on the left of the sheet, and your corresponding body weight in the graph. The number in the table will equal your approximate BMI.

Learn about teen body image and BMI awareness.

Teen Eating Habits

Healthy eating is vital for a teen's health and well being. The nutritional needs of teens vary tremendously, but generally increase due to the rapid growth and changes in body composition that occur during puberty. Adequate nutrition is vital for ensuring a teens overall emotional and physical health. Good eating habits help prevent chronic illness in the future, including obesity, heart disease, cancer and diabetes.

Did you know that most adolescents fail to meet the recommended dietary requirements for caloric and nutrient intake? Many teens in fact receive the majority of their calories from processed and high fat foods. A low intake of essential nutrients including vitamin A, folic acid, fiber, iron and calcium is prevalent among adolescents. A low intake of iron and calcium in particular is common among female adolescents, which can impair cognitive function and physical performance.

Among the more common teen eating habits include skipping meals, routine fast food consumption, frequent snacking and dieting. By addressing each of these factors individually you can ensure that your teen is meeting the minimum nutritional requirements.

Teen Eating Disorders

An estimated 8 million people in the United States have eating disorders. Seven million of these sufferers are women. According to the Academy of Child and Adolescent Psychiatry, an estimated 10 out of 100 young women (ages 12 to 25) suffers from an eating disorder in the United States.

Though more common in teens and young adults, an increasing number of young children also suffer from eating disorders. In fact, eating disorders can start in children as young as 7 years old!

Eating disorders have the highest rates of death, compared to other mental illnesses. Sadly, only 1 in 10 people with an eating disorder will receive treatment for their illness.

Risk factors for developing teen eating disorders include:

The two most common eating disorders are anorexia nervosa and bulimia

Anorexia Nervosa
Teen girls with body image issues are at high risk of developing anorexia nervosa, a common eating disorder that is characterized by self-starvation. This disorder typically starts in early to mid-adolescence, and it is seen more in Caucasian girls who are high academic achievers (perfectionists) and who either have a goal-oriented personality or come from a goal-oriented family.

Girls who suffer from anorexia have an extreme fear of gaining weight, and they have a very distorted view of their body, believing that they are fat but in reality, they are dangerously skinny. As a result, they either restrict their food intake or they exercise excessively. Many anorexics starve themselves to lose weight.

Around 1 percent of Americans suffer from anorexia, and it is one of the most common psychiatric diagnoses in young women (under age 25). Over 90 percent of anorexics are girls and women.

Because anorexia involves self-starvation, it has devastating effects on the body. Not only is your body starved of all the nutrients that it needs for normal functioning, starvation also slows down your body's processes in order to conserve energy. This can lead to an abnormally slow heart rate and low blood pressure (which increases your risk of heart failure), osteoporosis (dry, brittle bones that break easily), muscle loss and weakness, severe dehydration that can result in kidney failure, hair loss, loss of lanugo (the downy layer of hair that keeps your body warm), and overall weakness. Girls with anorexia also can have irregular periods or they can stop menstruating (called amenorrhea).

It is estimated that up to 20 percent of anorexics will die from their condition, and the probability of death increases with the time of the disease.

It is important for teen girls who are suffering from anorexia receive treatment. The first step is to try to restore a healthy weight for the anorexic. This may require hospitalization. Next, the anorexic sufferer will require individual psychotherapy and often family therapy. Self-help groups and supportive group therapy are also important.

Bulimia Nervosa
Similar to anorexia, bulimia is a common eating disorder that affects teen and adolescent girls. These teen girls also have a fear of gaining weight, and they are extremely unhappy with their body size and shape. Like anorexics, bulimics may suffer from depression, anxiety, and substance abuse problems. However, unlike anorexics, bulimics are often a regular weight for their age and height.

Bulimia nervosa is characterized by binge eating and pursing. Bulimics often eat an unusually large amount of food, then compensate by purging (either vomiting or using laxatives), fasting, and excessive exercise. This cycle of binging-purging often repeats several times a week, and it is done in secret. Bulimics often feel disgust and shame for their behavior.

When bulimics binge eat, they often have the feeling that they can't stop or control their eating. They purge to get rid of the fear, guilt, and shame of their binge eating.

Teen bulimics often hide their disorder by spending long periods of time in the bathroom and by running the tap water to hide the sound of their vomiting.

The purging from bulimia comes with many health consequences. The acid in the vomit can wear down your teeth enamel and give you sensitive or decaying teeth. It can also enlarge the glands near your cheeks, making you look like you have swollen cheeks. Frequent vomiting can also cause damage to your stomach and possible rupture of your esophagus.

Frequent purging can cause electrolyte and chemical imbalances in your body. This can lead to irregular heartbeats, possible heart failure, and even death. For bulimics who abuse laxatives or diuretics, they can end up with intestinal distress, irritation, and kidney problems.

Between one and two percent of adolescent and young adult women suffer from teen bulimia. Treatment often involves nutritional counseling, psychotherapy, and prescribed medication.

Learn about teen depression.

Teen Depression

Related: Teen depression resource at Mayo Clinic website

Depression is a very serious issue, for teens. Nearly two thirds of teens have depression at some point or another that goes unnoticed.

What are the common signs of depression?

What are the key symptoms of depression in teens
If you have four or more of the following symptoms, it is possible that you might be suffering from depression. You should seek out help.

What can you do if you are depressed?
The first step toward recovery is treatment. It is essential that you get a diagnosis from a qualified health care professional if you think you might be suffering from depression. There are many treatment options available including medication and counseling. In some cases it might be necessary that you seek out treatment from a specialist.

In some cases depression might be severe and lead to suicide. If you are feeling very low or suicidal, you should seek out help immediately. There are many national organizations dedicated to helping teens suffering from suicide. Check out the following: USA National Suicide Hotline

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