By Desmond Lew, MD
Puberty is one of the most dramatic periods a person undergoes in his life. It is the transition from childhood to adulthood. Our bodies go through physical changes and our minds undergo an incredible transformation. Some parents dread this phase in their children because their dependent child is now becoming a young independent adult. Aside from the physical changes, the emotional changes are the most difficult. The more we understand as parents the better we are equipped to manage this challenging period and brings on greater opportunities to develop a trusting close relationship.
Boys and girls go through puberty on different times; in general girls start puberty earlier than boys. Girls start puberty between 8 and 13 years of age and boys start between 10 to 14 years of age. The main thing that pre-teens notice in elementary middle school is that girls go through a growth spurt and all of the sudden they are much taller than boys their age. Other more dramatic changes occur that are not obviously seen in the early stages of puberty.
The first sign of puberty in girls is the development of breast tissue (thelarche). These “breast buds” are firm and are sometimes mildly tender to touch. The breast buds are not completely symmetrical and this is normal. Usually after a year the breast tissues become closer to equal in size. The second sign in girls is the development of pubic hair (pubarche); about a year after that armpit hair starts to grow. About one and a half to three years after the breasts develop, the menstrual period starts (menarche). Normally the girl’s onset of period starts about the same age as her mother’s menarche. Most menstrual periods are painless but some can cause menstrual cramps, abdominal discomfort and breast tenderness that can be treated with over-the-counter pain relievers like ibuprofen or acetaminophen. Overall the body changes to a curvier shape where fat is distributed in the hips and breasts.
In addition to the physical changes, girls undergo many emotional changes and can have large emotional swings. These occur due to the changes in the hormone levels and a normal part of development. Thankfully this is a temporary phase that passes. Because of the media images of “normal” body shapes, many girls develop a distorted concept of what their body should look like. Models in magazines tend to have a thin, frail body and many actresses have curvier shapes enhanced by plastic surgery. Unfortunately their self-image can be affected if they don’t have that perfectly thin body with the enhanced breasts. It’s important for parents to have frank discussions about body image, a healthy weight and the importance of physical fitness.
Parents can approach these body changes by explaining why these changes are occurring and how these changes are preparing a girls body to become a mother when she is older. It would be helpful to use a book with pictures illustrating the different body parts and how they fit in the reproductive process. There are great books on Puberty available that I recommend. Explain the purpose of internal parts of the body such as the ovaries and uterus (womb). It would be up to each parent and child’s maturity as to how much detail to explain about the reproductive process. For a young girl undergoing puberty it may be sufficient to explain that her body has eggs that are released each month and if it is fertilized the egg grows in the womb and eventually becomes a baby. Inside the womb the lining prepares itself each month to accept a fertilized egg and provide an environment for the egg to grow. If the egg does not get fertilized, the womb lining is not used so it is released which called a menstrual period. This menstrual fluid is a mixture of unused womb lining and blood. This usually happens every three to five weeks but can be irregular during first couple of years.
The first of puberty in boys is the enlargement of their testicles at around eleven years old; this is followed by enlargement of the penis and the development of pubic hair. Later armpit hair grows and the voice starts to change and grow deeper. For some boys, there may be some breast growth that can be disturbing. This is called gynecomastia and happens more often in boys who are overweight and occasionally in boys with normal weights. In most boys the breast tissue growth is temporary and will shrink back to normal size. Throughout this period of time, there will be “growth spurts” and their final height may not be determined until the late teens or early twenties. Final height is determined by many factors such as nutrition and genetics. The increase in the hormone testosterone stimulates hair growth, changes in the voice, muscle development, and the production of sperm.
Boys undergo many emotional and behavioral changes that may seem unusual but are completely normal. They may start thinking more about sex and start having erections at various times during the day or night. Many boys will have nocturnal emissions or “wet dreams” and these are completely normal and occur during sleep when a boy has an erection at night and releases semen and sperm in a process called ejaculation. This is a normal developmental process and a sign that the body is preparing for the ability to have sex. In addition to “wet dreams” many boys discover masturbation, which can sometimes produce a great deal of stress for some parents and boys. Some religious beliefs frown upon this activity and can create guilt and shame when they masturbate. This is a completely normal activity and a part of the developmental process. With the increase in testosterone, there are changes such as increase in aggression and risk taking behavior. It’s important for parents to channel this behavior to more productive outlets such as sports or exercise.
As boys are growing physically, they will become more interested in their own body development. Boys tend to want to grow taller and develop larger muscles. It’s very important that they discuss different types of exercise with their physicians before starting exercises such as weight lifting. A developing body is susceptible to bone and joint injuries as they are still developing. An excellent reference is The Boy’s Fitness Guide. When approaching boys about their sexual development issues, it’s usually easier to use a book with anatomy pictures to describe the changes that are occurring and why they are happening. Depending on the level of maturity of the boy, a parent can explain the parts of the body, describe the changes happening and what to expect in the future. Parents can decide how much detail they want to go into the sexual reproductive process but using a book makes this process easier in an otherwise uncomfortable subject. I recommend some great references on Puberty.
The key to discussing puberty with teens is to be open to listening to their questions. Teens discuss a great deal of information and unfortunately spread a lot of misinformation to each other. Some common myths that I hear in my practice is that a girl cannot get pregnant before their first period. If there are questions that you are uncomfortable or unsure about the answers, ask your Pediatrician or Family Practice physician to help during your next physical. Your physician can be a great resource for information on topics such as puberty, sexually transmitted diseases, behavioral changes, and pregnancy prevention.