PUBERTY AND CHANGES IT BRINGS

Puberty is the period when a child begins to mature sexually. It is accompanied by various changes in the body of the teenager. Puberty kicks off at ages 11-12 for girls and sometimes earlier and ages 11-14 for boys. This stage is fundamental in the life of a young person and determines how they relate with others. Parents should therefore help their children cope with the changes that come with puberty.

Hormonal changes during puberty Image

When children reach puberty, their bodies produce some hormones which are responsible for the physical changes in this stage. Some of these changes entail an increase in height and weight, growth of hair in pubic parts, pimples and even body odor.  These changes are as a result of hormones produced by the body including progesterone and estrogen. However, due to the varying levels of these two hormones in boys and girls i.e. more estrogen in girls and more testosterone in boys, boys and girls undergo varying physical changes. These changes will therefore be analyzed separately.

Changes in Boys during Puberty

At puberty boys become men which starts when their testes and penis enlarges. They become more masculine. They experience regular erections that may be followed by an ejaculation. They experience what is popularly known as ‘wet dreaming’ where semen flows through the penis. Sometimes erections come during the day for no apparent reason and the boy may feel embarrassed thinking that the people around him have noticed, while the truth is no body is aware unless one draws attention. During puberty, boys experience the following physical changes:

  • Hair growth under the armpits, around the penis, on the face, legs and chest areas
  • Increase in height, weight and muscles and broadening of the shoulders
  • Skin becomes oilier and may develop acne, an increase in perspiration may cause body odor
  • The testes and penis enlarge and lengthen, erections and ejaculations occur often
  • Breaking of voice
  • Breast appear as if they are developing a bit, which vanishes by the end of puberty

Changes in Girls

During puberty, a girl becomes a woman. She starts ovulation where an egg or ova leaves one of the ovaries every month and goes down the fallopian tube. If the egg meets a sperm before it reaches the uterus, fertilization may occur causing the girl to become pregnant. If it doesn’t get fertilized, it breaks and leaves the body together with shed uterus lining as blood. This is what is called menstrual period. Generally girls exhibit the following physical changes;

  • Girls gain weight and increase in height
  • Body becomes curvy and the hip bone broadens
  • Breasts begin to develop; they start as a small swelling under the nipple and later develop into bigger breasts.
  • Onset of menstrual cycle and a girl may get some whitish jelly from their vagina before or during periods which is a natural way of the body cleaning process.

Issues that Teenagers have to deal with at puberty

Both girls and boys have to deal with the changes that occur during this stage. They include

  • Changes in body shape
  • People reacting differently towards you, for instance if you are tall for your age, some people may expect you to behave like an adult or if you are still small for your Age, they may treat you like a small child. Some people may talk to the teenager in an embarrassing manner or touch them when they don’t want to be touched.
  • Teenagers experience mixed up feelings and moods during this stage. This is related to hormonal changes in the body of the child and it is difficult for them and their parents to deal with these changes unless there is understanding.
  • Also teenagers experience changes in the way they think. They are no longer children and are transitioning into adulthood which brings about a lot of crises with themselves and with parents and teachers.

Ultimately, puberty is a rather trying and an exciting time for teenagers. It’s the time they discover themselves and evolve into adults. At this stage, parental understanding and support is necessary to deal with the challenges that this stage brings about. Children also need guidance as this is the period when they become sexually active and can fall pregnant or contract STIs. These changes also affect children performance in school if they do not cope well with it.  

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Teenage Acne

Acne occurs when skin pores become clogged with oil and dead skin cells. Whereas acne can affect anyone, teenagers are at the greatest risk of infection due to increase in oil production during puberty as a result of hormone effects. Blockage occurs when more oil is produced than it can be removed through the skin. It usually occurs on the face, neck, back, chest and shoulders, as they are areas with highest number of functional oil glands. Acne wounds heal slowly, and when one begins to resolve others appear. Acne can be emotionally distressing in teenagers as it leads to skin scarring. It makes the teenager to have low self esteem and can avoid interacting with others in school or at home. Fortunately, there are available treatments for the condition. The earlier the treatment is started, the lower the risk of longer lasting physical and emotional harms.  

Causes Image

Acne can be exhibited by non-inflammatory or inflammatory lesions depending on the intensity or form of blockage, either deep or on the surface. There are three factors that cause acne i.e irregular shedding of dead skin cells which leads to agitation of the hair follicles of the skin, overproduction of oil in the skin and bacterial build up.

Triggers

There are various factors that are known to worsen the acne condition.

  • The effects of androgen hormones in boys and girls which increase at puberty cause the sebaceous glands to enlarge and make more sebum (skin oil).
  • Birth control pills and fluctuating hormonal levels resulting from menstrual cycle can also contribute to development of acne in teenage girls.
  • Use of topical steroids, lotion, cream or cosmetics during an acne attack can irritate the skin.
  • Wearing tight clothes as they facilitate oil trapping in the skin, worsening the condition.
  • Some drugs containing androgens, corticosteroids are known to cause acne.
  • Some foods may also aggravate existing acne including dairy products and carbohydrate rich foods such as chips, bread.
  • Stress can worsen acne, but does not cause acne.

Common Myths

The following factors have been commonly associated with acne. However, the fact is they have little or no effect on acne.

Dirty skin: acne does not result from dirt. The truth is, scrubbing the skin too hard or washing the skin with harsh chemicals or soaps agitates the skin and can worsen acne. Simple cleaning of the skin to get rid of dead skin and excess oil is what is needed.

Greasy foods and chocolate: these have nothing to do with acne.

Treatment

Acne treatment works by minimizing the production of oil, enhancing skin cell turnover, fighting bacterial infection or reducing inflammation or doing all the four functions. Most treatments for acne do not bring instant results and one might wait for four to eight weeks and your skin may deteriorate before improvement is realized. Your dermatologist or doctor may recommend a prescription medication to be applied on your skin or oral medication. Types of acne treatment include:

Over the counter topical treatments; acne lotions help dry up the skin oil, kill bacteria and enhance shedding of dead skin cells. These lotions are usually mild and are used for mild acne. They may have side effects including irritation, dryness and flaking of the skin which mostly improve after a month of treatment.

When acne refuses to resolve with OTC medication, it is good to see a dermatologist for further treatment. The dermatologist may prescribe stronger lotion oand topical antibiotics to deal with the acne.   

It is of importance for a teenager or a woman to disclose if they are pregnant as oral prescription must not be used during pregnancy especially during the first trimester.

Antibiotics may be prescribed for both mild and severe acne to reduce infection of bacteria and reduce inflammation. Due to acne developing resistance to antibiotics, one should stop taking them once improvements are realized or if no change occurs.

Isotretinoin; this is treatment used for deep cysts. Isotretinoin is a powerful medication for scarring cysts acne or acne that has not responded to other treatments.

Oral contraceptives may be suggested for women with acne although it has various side effects.

Laser and light therapy; these therapies reach the inside of the skin without harming the skin. Laser damages oil glands causing them to produce minimum oil while light therapy destroys bacteria that cause acne inflammation.

In addition, scars left by acne can be treated through various procedures including chemical peels, soft tissue fillers, dermabrasion, microdermabrasion, laser light source and radiofrequency treatments, or skin surgery.

Lifestyle and Home Remedies

Teenagers can avoid or manage acne by practicing basic skin care such as washing the affected skin with a gentle cleanser, avoid irritants including cosmetics, using over the counter acne lotion which helps dry excess oil and enhance peeling, avoid picking or squeezing blemishes and general care of the skin such as avoiding contact with telephone receivers, tight clothes among other things that may enhance acne problem.

Prevention

Acne can be prevented through various ways including washing acne prone areas only twice a day, use of over the counter lotions that helps dry excess oil, avoiding heavy foundation makeup, removing makeup before going to bed, having a hot bath or a shower after exercising or hard work and wearing loose fitting clothes.

Myths vs Facts Related to Menstruation

Myths associated with menstruation have been in existence for as long as women have existed. Every community, culture, race or religious belief has their own myths about menstrual cycle. Some of the myths are very common in most people, but as the name suggests, they are just myths and not facts, hence one should not be concerned. Here are some of the myths and facts about menstruation.Image

It is unhealthy to have sex during periods

Whereas some women and men feel uncomfortable on having sex during menstruation, it is perfectly okay, and may also help lessen menstrual cramps. Sex during menstruation has been associated with reduced endometriosis (tissues lining inside of the uterus grow outside the uterus instead) and other health benefits including preventing breast cancer, regulating the menstrual cycle, managing pain, reduced heart disease, and improved quality of life. Though the health benefits associated with sexual intercourse have not been fully explored, there is no valid reason why you should not have sex during menstruation, so if you want to have sex during this time, go ahead!

You can’t get pregnant if you have sex when on periods

Don’t count on it for safety! Unless you are on pills, an internal device or any other form of contraceptive such as a condom, there are no guaranteed safe days. Sometimes you can menstruate without ovulation and ovulation can occur without a period. It is possible for you to release an egg during your menstruation which can make you pregnant if you have unprotected intercourse.  

You should not exercise of do strenuous jobs during your periods

Menstruation is a normal process in a woman’s body. Periods is not a form of disability and should not prevent anyone from carrying on with their routine activities. There was a time that it was treated as an ‘ailment’ and menstruating women stayed home resting and did not even socialize. With the help of sophisticated tampons and pads, a woman can live a normal life throughout their periods.

One cannot go swimming while menstruating

Maybe this myth came to be in the days when there were no internal devices such as the tampons or it could be due to fear of developing cramps while swimming or that one could contaminate the swimming pool with menstrual blood. Regardless of the basis of this myth, there is no reason why one should not swim during periods as long as they have their tampons well fitted. Besides, swimming is a good form of exercise that help ease cramps and low morale that comes with menstruation in some women.

Skipping a period means one is unhealthy

Healthy women usually miss a month or two of their periods. This is because hormones do not fluctuate much in some women. However, premenopausal women are recommended to have at least a period in three months to ensure that the uterus is shedding its lining. Some contraceptives also stop menstruation and that is nothing to worry about.

A normal Menstrual Cycle is 28 days

Actually normal menstrual cycle occurs between 21-35 days in healthy women adults and 21-45 in young teens.

If one is still having their periods, they are not menopausal

Normally a woman will have her periods during premenopausal period (onset of menopause) which can last to seven or ten years and often starts when a woman is in her mid 40’s. Bleeding is just a symptom of hormonal changes and one may experience other menopausal symptoms such as vaginal dryness, hot flashes but still have their periods.

Irregular periods are a sign of infertility

Some women believe that having irregular periods shorter ones or longer ones is a sign of infertility. As noted earlier, periods range from 21-35 days for adult women and 21-45 for young teens. Hence any irregularity in periods does not imply infertility.

For sure, there are numerous myths surrounding menstrual cycle. Menstruation is a normal process in the woman’s body and may be affected by various factors including contraceptives, health problems and even age, as in menopause. The myths discussed here and many others that have not been mentioned are baseless and it is good for a woman with doubts to consult a gynecologist or a reproductive health care expert for advice.

Does She Have To Skip School On Those Days?

Dear Doctor

My 16 year old daughter has been complaining of painful periods, to the extent where she ends up skipping school on those days. She has been taking pain killers on occasion but refuses to visit a doctor saying that this is normal, even among her peers. Is this the case? As a single father I feel very helpless when it comes to dealing with this particular issue. What should I expect and when should I insist that she visits a doctor?Image

Single Dad.

Dear Single Dad,

Thank you for your question. This can be a very difficult topic for fathers to discuss with their daughters especially in the beginning, but it gets easier once you have the knowledge and can confidently answer the questions that she may have.

Your daughter is right, painful periods are a very common especially for young girls at the early years of their periods. Painful periods, also known as dysmenorrhea, usually cause pain in the lower abdomen, but may also be associated with other symptoms such as pain in the lower back, nausea, vomiting, diarrhea and headache. These symptoms vary in severity form one individual to another, as well as from one period to another. The severity of the symptoms is what should dictate whether medical attention is warranted. In mild cases, women are able to control the pain by using home remedies such as hot baths or hot packs and rest. Others will require some pain relievers and other medications used to treat dysmenorrhea.

Some women feel that since periods are just part of being female, then it really isn’t a disease that requires medical attention. This is not true. There are cases when it is advisable to visit a doctor, such as if pain is not relieved by mild pain killers or if it is getting worse with time and if it is keeping her away from school as is the case with your daughter currently. In the same sitting, the doctor is able to assess whether there could be any other cause of the painful periods. There are some pelvic conditions that are known to worsen dysmenorrhea, and an accurate diagnosis is required for appropriate treatment. Therefore, talk to your daughter and explain the necessity for a doctors’ evaluation, which will go a long way in helping her control the pain so that it does not interrupt her school or social life. It will also help reassure you that everything is ok with her, and will promote the communication between the two of you where reproductive health is concerned.

 

Dear Doctor,

I am 19 years old and I have been suffering from very painful periods since my first period 4 years ago. I have been taking pain killers which have helped relieve the pain. The only problem is that the pain seems to have been getting worse this last year, so I have been taking more and more pain killers. Is this normal?

Mary.

 

Dear Mary,

Thank you for your question.

Painful periods, also known as dysmenorrhea, is one of the most common reproductive conditions affecting young women not only in Nairobi but worldwide. As in your case, the pain usually begins when the periods first start and may persist in varying severity. However, in many cases, the pain reduces rather than increases with age. In this case where pain is worsening with time, then it is advisable to visit a doctor to ensure that there is no other cause of the dysmenorrhea. The doctor will take a full history, conduct an examination and order some tests to check for conditions such as fibroids, pelvic inflammatory disease, adenomysosis, and endometriosis among others, which can worsen dysmenorrhea. Treatment of any such condition will result in a reduction in the severity of pain you experience during your periods.

If the doctor does not find any condition that worsens dysmenorrhea, then he/she will be able to prescribe more effective treatment for the pain. This may include changing the pain killers you have been taking, or combining this with other drugs used to treat dysmenorrhea. In addition, you will get advice on some of the non-medicinal approaches that are helpful in controlling the pain during your periods. Therefore, please arrange to visit your doctor as soon as possible for the appropriate attention.

Asthma in Children

Asthma is one of the leading respiratory conditions affecting children. In most of the developing world, most people, and very few medical specialists know how to properly manage asthma. When not properly managed, asthma results in a lot of difficulties for growing children and occasionally results to severe illness and death.

Victoria is a 4-year-old living with asthma and her mother Muthoni would like to better understand what she can do to help.

 

Muthoni: What exactly is Asthma?

Doctor: Asthma is a medical condition, mostly genetic, that results in one having an exaggerated response in their breathing system to common every day environment. In the environment there are small particles that we take in as we breathe. They are too small to be seen and are commonly called antigens. These then enter the upper and lower airway, and engage with special cells in the airway- call them receptors. The reaction in asthmatic persons is that their breathing pipes tighten and they produce excessive mucus in the airway. This makes it difficult to breath.

 

Muthoni: Why does this happen?

Doctor: It is an allergic reaction. We know there is a genetic component, but there are many other factors that influence the severity and varying presentations.

 

Muthoni: Does this reaction last forever?

Doctor: No. In many circumstances, it will resolve on its own. However this could take quite some time. Medication is given to make it resolve faster.

 

Muthoni: How come then that some children have died from asthma?

Doctor: In some children, the disease can be severe (even in adults). They can have this reaction and develop complete blockage of the breathing system. They can suffocate. Why this happens depends on many factors such as how severe the illness is on one person, how severe a reaction the antigen triggers, other illnesses that the child might be having on that particular day, such as flu and how fast they can access treatment.

 

Muthoni: Therefore what can be done to intervene?

Doctor: When the child is having an attack, they need to be treated with a medication called a bronchodilator which relaxes the breathing pipe. It works very fast, and is best given as an inhaler. The tablet and syrup options are not for use during an active attack. This medicine works in seconds to minutes, and in about 15 minutes, the body has cleared most of it out of the system. For this reason, repeated administration might be required, and this is what is done for a severe asthmatic attack treated in hospital.

Those who have moderate to severe asthma are given other medicines that change the way their body works. Long-term medicines reduce the “locks” in the persons breathing system. This then results in the child having less frequent and less severe attacks. These medicines are called steroids. When used for asthma they must strictly be guided by a qualified medical doctor and given only via inhalation route (not as tablets or syrups).

 

Muthoni: Are you therefore suggesting that an asthmatic child should have both immediate and long term treatment options?

Doctor: Yes. The acute medication, such as ventolin inhaler should be kept ready and handy. This inhaler if used on time would prevent many of the severe cases and deaths from an acute asthmatic attack. Then the long term treatment with steroid inhaler is required for those with moderate to severe asthma.

 

Muthoni: Should my daughter stop playing sports?

Doctor: This is a common misconception. What most people see is that in poorly managed asthma, the children develop bouts of coughing in doing physical exercise or playing. Therefore the impulse is to avoid the activities. This is the wrong approach. In fact, it is medically proven that regular challenging exercise strengthens the breathing system of asthmatic. However, one must be careful because the asthma must be well managed first, otherwise the exercise could trigger a severe asthmatic attack. When well-managed, almost all asthmatics, even those with severe asthma, can engage in active sports. Many Olympians are actually asthmatic.

 

Muthoni: What can I do to reduce the incidence of asthmatic attacks?

Doctor: Frankly not much, because you cannot control the air your child is breathing. If there is an identified antigen, such as a specific food that triggers an attack, this can be avoided. If it is pollen, you might want to avoid having fresh flowers in the house every week. General cleanliness of beddings is necessary, to remove house dust mites.

 

Muthoni: What are the complications of asthma?

Doctor: There are the common complications due to a destructive cough or difficulty in breathing. The child might not be able to sleep well, or eat properly. This might lead to general dullness, sleepiness in class, and consequently poor performance, or poor growth and development. Poorly managed asthma will also be complicated by repeated upper and lower airway infections.

 

Muthoni: Will my child outgrow asthma?

Doctor: Yes, this is possible. Many asthmatics present only in specific times in their lives, either early childhood, or after the age of 65 years. There are also many children who are not asthmatic, but tend to show symptoms similar to those of asthma at certain times, such as when they have flu. Many asthmatics will also have changes in severity of symptoms through their years of growth. You will have to wait and see how your daughter progresses as she gets older.