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PUBERTY

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What is puberty?

  • Puberty is a period of time during which the onset of sexual maturity occurs and the reproductive organs become functional.
  • This is manifested in both sexes by the appearance of secondary sexual characteristics – growth of the breasts, pubic hair and first menstrual period (menstruation) in girls, and facial and pubic hair and deepening of the voice in boys.

How will a child's puberty affect the parents?

 A year or two before reaching puberty, the child will change physically and emotionally.

  • Their growth increases suddenly, before slowing and finally stopping around the age of 18. The accelerated growth that girls experience in puberty happens at an earlier age and an earlier stage, than for boys.
  • During puberty, the child's attitude towards his or her parents is likely to change. Often, children think their parents are hopeless, annoying and old-fashioned. In return, parents may find their child cheeky and sullen. Obviously, it can be a time of conflict.
  • During puberty, this development continues and the confrontations between teenagers and parents may continue.
  • It's perfectly natural and inevitable that tensions and controversies between parents and teenagers arise. In fact, it may be more alarming to the parents if there are no conflicts at all because it may be a sign that their child is hiding their problems.
  • If teenagers continue to suppress emotional problems, they may eventually have problems establishing a normal relationship with other people.

How do young people view themselves at puberty?

 At puberty, most children are uncomfortable with their image. They may not like the way they look. They feel clumsy, shy and insecure.

  • For boys, their voice breaks – and for both boys and girls acne and pimples makes the situation even worse.
  • Few teenagers consider consulting a doctor with these problems and a request by their parents seldom helps. However, there are excellent treatments available and spotty teenagers should seek the advice of their GP.
  • During puberty your child is developing into a sexually mature adult. Their sexual organs grow and their body changes physically. Boys and girls begin to grow hair under their arms and pubic hair between their legs. Girls develop breasts and boys grow hair on their faces.
  • During puberty young people want to be like everyone else of their age. So girls may be unhappy if they have their first period before the rest of their class or if they're the first – or last – to develop breasts.
  • For boys, the growth of pubic hair may cause similar problems.

Puberty – child or adult?

 Puberty is a time of contrast because the child shifts between feelings of being a child and becoming an adult.

  • Friendship with others of the same age may strengthen a teenager's self-confidence. Insecurity may make them want to imitate other people in their age group.
  • Puberty is a time of life when the child begins to feel liberated.
  • But support and security from parents is still of paramount importance. Parents are not only a safety net, but also the platform from which the child can jump out and eventually experience the whole world.

How Male Puberty Works

Adolescence is more than just a time in your life when you have incredibly awkward conversations with your nervous parents. It's also the time when both your body and your mind change, making you stronger, taller, hairier and able to reproduce, as well as more perceptive and philosophical. This period of transition between childhood and adulthood is called puberty, and it's the process of growth and sexual maturation that, for males, occurs generally between the ages of 9 and 18.

It is no small feat. The ability of the body to suddenly "come alive" and simultaneously advance on several different fronts is nothing short of amazing. Bones that have already been growing at a remarkable rate reveal that they've just been warming up for the real show. Glands that have been for the most part dormant now produce hormo­nes that order different parts of the body to swing into action. The mind that has for years been concerned with such things as how to catch a bullfrog or build a better kite now finds it has the capacity to probe life for meaning, to seek out and maintain romantic relationships, and to plot and plan a path in life.

Of course, change comes at a price for young men: bones hurt, faces erupt in acne, and fear and anxiety arrive with newfound sexuality and expectations. Voices change, depression may rear its head and there often seem to be more questions than answers. Some boys start puberty early, while others don't experience it until later, and it progresses at different rates for everyone. This difference in growth can cause embarrassment, anxiety and bullying, and even all three at once if you start getting an erection while being stuffed into a locker by a bigger boy.

In this article, we'll do our best to answer some of the questions about puberty and how it affects males. We'll look at its various stages; we'll learn when changes happen and how they happen, and what young men -- and their loved ones -- can expect out of this turbulent period of life.

The Onset of Male Puberty: Ready, Set, GO

While puberty begins and ends at different times for different people, puberty always begins with the appearance of a substance called gonadotropin-releasing hormone (GnRH) in the body. The release of GnRH is controlled by the hypothalamus, the same part of the brain that regulates your temperature and your sleep cycle, as well as your senses of hunger and thirst.

With that in mind, let's take a look at the different stages of puberty. While not strict guidelines, these stages provide a pretty good idea of the overall appearance and occurrence of the different changes that happen in a male's body during puberty.

Boys generally begin puberty sometime around age 10, though it isn't uncommon for it to begin as early as age 9 or as late as age 12. GnRH is released, the testicles begin to mature and an initial growth spurt may occur (with average growth being around 2 inches (5.1 centimeters) a year). Although the growth of the scrotum and testicles is one of the first outward signs of puberty, boys at this stage are still unable to reproduce. There may also be the appearance of very fine hair in the pubic area. Boys may occasionally experience erections.

The second general stage of puberty usually occurs around age 12 or 13. The testicles continue to grow, and this in turn means that more testosterone will be flowing through the body, spurring more changes. The boy will continue to grow taller rapidly, at a rate of 2 to 3 inches (5.1 to 7.6 centimeters) a year. What little pubic hair exists may begin to gain some color. Erections will become more frequent. The boy's body will begin to take on a leaner, more adult and masculine shape.

Later Male Puberty Stages, from Cracking Voices to Bulging Muscles

The third stage of male puberty occurs around age 13 or 14, but frequently as early as 11 or late as 16. Pubic hair begins to grow darker and fuller, and the penis now begins to grow in length. The testicles continue growing, erections become commonplace and the boy gains in height at a rate of over 3 inches (7.6 centimeters) a year. The voice may begin "breaking" or "cracking." This is when the boy's voice suddenly and uncontrollably changes pitch mid-word or sentence, due to the growth of the larynx and the lengthening of the vocal cords.

Stage four of male puberty commonly takes place when a boy is around 14 or 15 years old. Hair begins showing up in the armpits and on the face, and pubic hair begins to grow coarse. The boy's voice will even out and become deeper. The stage-four boy can use this deeper voice to yell forcefully at the mirror when he sees his new acne, due to his ever-more-oily skin. He begins to grow taller and even faster, at about 4 inches (10.2 centimeters) a year. The penis now grows thicker and continues to lengthen.

The final stage of male puberty occurs anywhere from age 14 to age 18. During this time, a boy will achieve most (but not necessarily all) of his height. His body shape will have evolved to that of a man's -- his shoulders will be broader, his muscles developed and fully formed, his arms and legs and chest proportioned for power and masculine appearance. This is because new muscle fibers are appearing, and all muscle fibers are getting thicker. Pubic hair will spread out to the inner thighs and lower stomach. By this stage of puberty, boys -- make that young men -- will be shaving, and their pubic hair and sex organs will look fully developed. While hair and height and body type will look adult and complete, many males will continue growing and developing into their 20s.

 Male Growth During Puberty? Like a Weed

Growth for pubescent boys establishes a pattern about as unpredictable as a teenager's time of awakening each morning. There are sudden bursts of growth followed by seeming inactivity, leading to frustration on the part of the boys who wonder if that first spike in growth was also the last. This is also a bad stretch of years for parents who must fork out money for their son's clothes one day that may seem ill-fitting the very next.

Most boys, though, will take growth any way they can get it. After all, they don't want to have girls their age towering over them for the rest of their lives. Once boys start really growing, it doesn't take too terribly long to catch up with the other gender. Between the ages of 12 and 16, boys grow in height as much as a full foot (.3 meters). Weight gain in this same period can vary from 15 to 65 pounds (6.8 to 29.5 kilograms).

The first parts of the body to really gain in size are the arms, legs, hands and feet. These extremities grow at a faster rate than the rest of the body. This explains why boys going through puberty are bumping into people, dropping things and tripping over flat pieces of pavement. Clumsiness is normal and fortunately goes away once the rest of the body catches up.

During puberty, a boy's face changes shape. The chin gets longer and the nose gets thicker. The actual muscle tissue and the bone it rests against are changing as well.

Other changes -- not all of them visible -- are taking place. Blood pressure increases during puberty. This is a good thing, because there is more real estate for blood cells to travel to as these growth spurts occur. Body odor increases as the composition of sweat changes. When the bacteria present on the skin come in contact with the ammonia and urea in the sweat, it can create a smell that attracts others about as effectively as acne and a cracking voice. A boy's pulse and metabolism also slow down, a signal that the body is making changes to prepare for the long haul.

The premature appearance of puberty in boys can lead to problems, such as higher lifetime risk of testicular cancer and problems attaining full growth due to premature closure of the bones' growth plates. If a very young boy is showing signs of puberty, a doctor should be alerted.

Male Puberty Hormones and What They Do

Although puberty can be humiliating, its actual purpose is to enable sexual reproduction. The process taking place inside a pubescent boy's body to bring about reproductive ability is quite complex. We'll learn the basics of it in this section.

At around age 9 or so, a boy's central nervous system sends out a message: "Change!" First, the hypothalamus releases GnRH. Because this hormone is present in the hypothalamus before puberty, it's believed that a protein named GPR54 helps get the GnRH out of the hypothalamus at the right time. When the GnRH reaches the pituitary gland -- a pea-sized gland located at the base of your brain -- the pituitary gland in turn produces two important hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones also exist before puberty, but once the pituitary is triggered by the hypothalamus, these hormones are created in much greater quantities.

Early on in puberty, these hormones (which, along with hormones that trigger development of the testes, are known as gonadotropins) are produced only at night. In later stages of puberty, when growth is going gangbusters, these hormones are being produced around the clock and in greater and greater quantities.

FSH, when it reaches the testes, spurs the growth of seminiferous tubules, which are the channels in the testes in which sperm is produced. Once these tubules are formed and the infrastructure is in place, the body begins producing sperm.

LH, on the other hand, has a different function. It prompts cells within the testes called Leydig cells to produce androgens. Androgens are hormones that affect the development of a male's reproductive ability. Testosterone is the main androgen, though there are many others.

Between the time FSH and LH first reach the testes and the time a pubescent boy can successfully reproduce, the changes we discussed in the puberty stages section (growth of hair, changes in penis length and width) have taken place.

 Teenage Acne in Boys

During puberty, a boy's skin on his face, neck, back and chest will eventually begin to overproduce a type of oil called sebum. Sebum is normally a good substance -- it keeps the skin waterproof and fends off harmful bacteria. But too much is definitely not a good thing. Along with excess oil, the pubescent skin is also sloughing off skin cells at a higher rate, and these skin cells -- and the extra oils -- are trying to exit the body by traveling through hair follicles and pores to the surface of the skin. When these pores and follicles get clogged up with this excess matter, there is a pileup as the skin and oil behind the blockage start building up without anywhere to escape. A form of bacteria known as Propionibacterium acnes (P. acnes for short) gets in the mix and causes the blockage to become inflamed. This pushes it outward, creating the visual sensation known as a "zit."

There are many forms of acne, but the most common one is acne vulgaris. Acne vulgaris is responsible for your garden-variety pimples, blackheads, whiteheads and the cyst-looking large bumps. There's pretty much no escaping acne vulgaris -- it afflicts practically everyone at some point, and boys get it worse than girls during puberty. (After puberty, it's a different story: Women have much more trouble with adult acne than men.)

If you're a pubescent boy dealing with acne, this is your best bet: Wash your face gently twice a day, shower immediately after working up a sweat and don't pick at your face. Don't go overboard trying to clean your face, either, because excessive scrubbing and agitating the skin can make everything worse.

Products containing benzoyl peroxide or salicylic acid can help prevent or control acne by drying out the skin; killing bacteria and helping the follicles clear themselves of dead skin cells.

Don't get too stressed out if one thing or another doesn't seem to be helping -- it often takes quite a bit of experimentation before you discover the right cure (or combination of cures). Your doctor or dermatologist will be more than happy to help you in your quest for clear skin (and you can also find out lots more about acne by checking out How Acne Works).

 Psychological Changes During Male Puberty

Puberty doesn't just cause great changes and development in a male's body -- it changes and develops the brain as well. Boys in puberty will begin to show interest in and understanding of abstract concepts and subjects such as justice, politics, philosophy and the arts. A pubescent boy will also begin planning out a life for him and establishing dreams and goals to be realized and fulfilled later in life.

With this radical new worldview and altered sense of self comes anxiety and confusion. A young man's prior understanding of himself has now been eradicated, and a new sense of identity must be built from these ruins. The ability to view the world in entirely new ways means that an adolescent must sort out not only who he really is as a mature male, but also how this new identity fits into his new perspective. It's no wonder that on most mornings, it seems much easier to just stay in bed and sleep.

By the time a boy i­s experiencing puberty, parents are no longer welcome to accompany him in public, offer advice or breathe. This new independent streak is actually a good development, because this rejection of parents' beliefs, morals and general existence means that the pubescent boy is attempting to find his own way in the world.

Along with new beliefs and new feelings, a growing boy often will form new peer groups. This will be a time of experimentation, adventure and misadventure. The important thing for parents is to provide a stable home environment, open arms should they be needed, and reasonable guidelines and behavioral expectations.

Though parents should give some extra leeway and show extra patience during these topsy-turvy years, they should also keep an eye out for some of the pitfalls of adolescence, such as depression or substance abuse. This period in life can create an overwhelming sense of being lost, and not all boys exit this stage feeling like they've found the answers they need. If parents suspect that teenage experimentation with drugs or alcohol is the beginning of a greater problem, or if problems at school or home aren't being resolved through time and attention, it might be a good idea to encourage your son to talk to a counselor, a doctor or a respected member of your religious community.

 Male Puberty Rites Around the World

When a male passes through puberty (or at least reaches the age for it), many cultures around the world have traditions, customs or ceremonies that mark this passage in the young man's life.

In Quran teachings, Islamic parents are instructed to teach their sons about responsibility and adulthood and inform them that they will be responsible for their actions from the time of the first ejaculation. After this act, sons are to pray and perform religious observations as adults do. If a boy has a wet dream, the Quran relates that the son should bathe himself immediately. If a sexual dream occurs without ejaculation, the boy doesn't have to clean himself.

In Judaism, boys become a bar mitzvah (literally "son of the commandment") on their 13th birthday. The event marks the moment when the child is responsible for observing the commandments and all Jewish teachings. Though the status is automatically conferred upon the boy's birthday, often the boy recites a blessing before the congregation or helps in leading a service. Afterward, modern practice has added a celebratory reception that most of us know as "the bar mitzvah," but it's far from a universal practice.

In some parts of the world, such as Malaysia and throughout Southern Africa, boys are often circumcised around the time they reach age 11 or 12, right around the onset of puberty. It's believed that pubescent circumcision was used by some ancient cultures to mimic the genital bleeding experienced by girls. Some Australian aboriginal tribes also incorporate penis incision or piercing into puberty rites, as well as circumcision.

Many cultures involve other forms of trials, ordeals or tests that the boy must successfully pass. Apache boys must take ice baths, while aboriginal Australians sent boys out on long foot journeys, known as walkabouts, where the boy would pick up and perfect hunting and surviving skills. Some Native American tribes also sent young men out on vision quests.

Death isn't uncommon in South African puberty rituals, when boys are separated from the village and effectively starved as part of their initiation. Though most survive this separation, some others die from infection from the circumcision ceremony that follows.

When should puberty start?

Puberty in girls usually starts at any time between 8 and 13 years of age, periods usually start about two years after the start of puberty.

What happens during puberty?

A girl grows and changes in ways that prepare her to be able to have a baby. These changes occur in certain stages.

  • First, girls can expect to develop breasts. These start from a small and often painful lump or 'bud' underneath the nipple. Breasts can take five years to reach their final size and shape. So girls, don't worry if your breasts do not currently match your imagined ideal appearance.
  • Hair starts to grow under the arm and in the pubic (genital) area.
  • The explosive growth spurt: this is greater than any other time except the first year of life.
  • The body shape becomes curvier. During this time it is normal to put on weight, especially at the hips and stomach (puppy fat as it’s rather insultingly called!) so doesn’t go on a starvation diet.
  • The body odor can change especially under the arms, and you notice increased perspiration.
  • Some people get acne on the face and back.
  • Vaginal discharge starts or changes.
  • Teenagers experience a change in their emotions and new sexual feelings.
  • Periods start.

Why do these changes occur?

  • Natural chemicals that circulate in the body, called sex hormones, cause these changes.
  • At the start of puberty, the brain releases a hormone known as gonadotrophin-releasing hormone (GnRH).
  • This causes the release of two more hormones called follicle stimulating hormone (FSH) and luteinising hormone (LH) into the bloodstream.
  • LH and FSH in turn stimulate the ovaries, which contain your eggs, to release the hormone estrogen that leads to the changes girls go through during puberty.

The menstrual cycle and periods

What is a period?

  • A period is the vaginal bleeding that women usually experience at regular intervals of about a month from puberty to menopause (the end of periods that, on average, occurs in your early 50s).
  • Periods are also called menstruation.

Why do women have periods? 

  • Periods are a part of the menstrual cycle that happens roughly every month to prepare a woman's body to have a baby.
  • Every woman has thousands of eggs in her ovaries. Once a month or so, one of these eggs matures and travels into the Fallopian tubes. These tubes propel the egg along towards the uterus (the womb), in the hope of meeting a sperm and becoming fertilized to become an embryo. If fertilized, the egg then continues its way along the tube and becomes implanted (embedded) in the uterus where it develops into a fetus. In this way, the woman becomes pregnant.
  • While the egg is on its travels, the uterus is being prepared for the implantation of the embryo. Its lining builds up to become cushion-like and engorged with blood. If the egg is not fertilized, the womb sheds this blood-filled lining, and this bleeding is what we call a period.
  • The cycle then repeats every month or so unless the woman becomes pregnant.

 What controls the menstrual cycle?

  • Again, hormones control the process. The menstrual cycle can be split into four stages.
  • Menstrual (bleeding) phase: all the hormones are at their lowest level and consequently the womb sheds its lining and the woman has her period.
  • Pre-ovulatory phase: the ovary starts to secrete estrogen, which leads to a gradual buildup of the uterus lining in preparation for ovulation.
  • Ovulation: at a critical point roughly 14 days after the start of bleeding, the level of estrogen reaches such a height that it causes the brain to release a large amount of LH, which in turn stimulates release of an egg from the ovaries.
  • Post-ovulatory phase: after the release of the egg, the ovaries produce another hormone, progesterone, which maintains the lining of the womb so a fertilized egg can implant. If the egg is not fertilized, progesterone and estrogen levels drop, the womb loses its lining, and, about 14 days after ovulation, the menstrual phase begins again.

 What is the menstrual cycle like?

The average cycle is 28 days although it can be as short as 21, and as long as 35 days.

  • Menstrual phase: day one of the menstrual cycle is the first day of bleeding, which can last anything from a couple of days to a week. The bleeding is heaviest on the first few days. Women use tampons that sit inside the vagina or sanitary towels (pads) outside the vagina to soak up the blood. Many women suffer from cramp-like abdominal pains. Occasionally, they also have back pain. The pain is caused by changes in local hormones called prostaglandins.
  • Pre-ovulatory phase: many women feel very well during this phase, probably due to the rising levels of estrogen.
  • Ovulation: your vaginal discharge can increase and become mucus-like, which is more welcoming for sperm. At ovulation, the body temperature rises. Some women may experience sharp pain on either side of the lower abdomen. Occasionally, a few spots of blood come from the womb.
  • Post-ovulatory phase: symptoms of the premenstrual syndrome occur in this phase as the hormone levels fall. When the hormones are at their lowest, just before the menstrual bleeding starts, women who are more sensitive to the changing hormone levels can experience depression, irritability, lack of concentration, tiredness, food cravings, bloating and sore, tender breasts.

What if I don't have a period by age 14?

Some girls do not get their periods until they are 16. The age of getting your period can run in the family so ask your mum and your gran when they started theirs.

If you are over 16 and still have no period, you may be perfectly healthy but you should check with your GP (family doctor).

Some things can delay your period:

  • being underweight or very overweight
  • too much exercise
  • stress
  • illness
  • pregnancy.

What causes irregular periods?

  • When you first start having periods, it is normal for them to be irregular.
  • It usually takes two years for them to become regular and for some people it is much longer.
  • This is because at the beginning the time to ovulation (pre-ovulatory phase) varies and sometimes you might not ovulate at all.

What happens if I stop having my period?

  • If you have had unprotected sex then you needs to have a pregnancy test to check whether you are pregnant. You can go to your nearest family planning clinic (FPC), sexual health clinic (also known as a sexually transmitted disease or genitourinary medicine clinic), your GP, or you can buy them over the counter at the chemist.
  • Other reasons can be losing too much weight, too much exercise, or stress. If the problem continues you should go to see your GP.

Will tampons make me lose my virginity?

  • Loss of virginity is when you first have sex. There is a thin membrane inside your vagina called a hymen, which tears and sometimes bleeds the first time you have sex.
  • The hymen is usually very elastic and tampons can be inserted without tearing the hymen. However, even if using a tampon tears the hymen, this does not count as a loss of virginity as no sex is involved.
  • Rarely, the hymen can tear when bicycle riding, horse riding or climbing fences but this does not mean you have lost your virginity.

 Can tampons get lost inside me?

  • No. Tampons lie in the vagina. The neck of the womb (cervix) lies at the top of the vagina and it is tightly closed except for a tiny hole about the size of a pinhead.
  • A tampon cannot move into the womb and has no other way out except the way it went in.
  • Sometimes a tampon can be at the top of the vagina behind the cervix and then it can be difficult to feel or pull out. If you suspect that you have left a tampon in, especially if you notice an unpleasant smelling discharge, then go to your GP or sexual health clinic to have it removed without delay.

 Can I swim or have sex during my period?

  • Yes. You should be able to have a completely normal life during your period. Remember that you can get pregnant if you have unprotected sex during your period.

Is period blood dirty?

No. It is just normal blood mixed with the lining of your uterus. If it were dirty then it would not be a suitable place for the baby to develop. Once the blood leaves the womb it can become food for bacteria so you need to change tampons and sanitary towels regularly and discard them in a suitable waste disposal place.

I feel terrible before my periods, what can I do?

Feeling emotional, irritable, tearful, tired and bloated before a period are all the symptoms of pre-menstrual syndrome (PMS or PMT). Many women have this condition and sometimes just knowing about it and predicting when it will happen is enough to help you through it. Things that help lessen symptoms include:

  • exercise
  • eating fresh food
  • avoid processed food
  • avoid too much salt, eg crisps
  • avoid caffeine (remember that chocolate and cola also contain caffeine)
  • eat regular small meals
  • pamper yourself
  • Evening primrose oil and/or vitamin B6 supplements sometimes help (note: controversy exists over whether high doses of vitamin B6 can cause nerve damage).

If PMS is very severe, go to see your doctor. Some women choose to go on the contraceptive pill (the Pill) to control the hormonal swings that prompt PMS.

 If  periods are so painful, what can I do?

  • Gentle exercise can make you feel better, (though heavy exercise can make things worse). Getting regular exercise between periods can also help.
  • Hot baths relax the muscles and can reduce the severity of the pain.
  • Over-the-counter painkillers called non-steroidal anti-inflammatory drugs, such as ibuprofen (eg Nurofen), can help reduce the pain if taken regularly in the first few days of the period.
  • If all this fails go to see your doctor. Some women go on the pills to control severe period pains and your doctor can also prescribe alternative painkillers, such as mefenamic acid (eg Ponstan).

 Pregnancy and contraception

 How do women become pregnant?

  • A woman becomes pregnant if the egg released at ovulation is fertilized by a man's sperm and then travels along the Fallopian tube to implant in the prepared womb.
  • Once released, the egg can survive for between 24 and 48 hours and will be discarded if it is not fertilized in that time.
  • During unprotected sex (without using contraception), the man deposits hundreds of thousands of sperm in his semen at the top of the vagina. The sperm are very resilient in their long swim from the vagina through the cervix, into the uterus and up the tubes. They can survive for up to seven days waiting for an egg.

 Contraception

  • If you choose to have sex, remember the risks of pregnancy and infection. Condoms can protect against pregnancy and sexually transmitted diseases, although they are not as reliable in preventing pregnancy as some other forms of contraception.
  • For further protection against pregnancy, go to your GP, FPC or sexual health clinic and get contraceptive advice. Although no form of contraception is 100 per cent effective (except abstinence!), there are plenty of safe and easy ways to protect against pregnancy. The doctors and nurses can help you find one that is suitable for you.

Good advice

Always carry a condom if you are considering having sex: you cannot rely on the other person to think about your health and wellbeing. 

What if a condom breaks?

Condoms should rarely break if they are used properly, and before their expiry date. Make sure you know how to put on a condom properly.

  • Within 72 hours: Go to your nearest family planning or sexual health clinic and get emergency contraception (usually the morning-after pill). On a weekend, many casualty departments supply emergency contraception.
  • You should also be able to obtain emergency contraception if necessary from the out-of-hours GP service. You can also buy the emergency contraceptive Levonelle one step from pharmacies if you are over 16.
  • The earlier you take emergency contraception the more effective it is.
  • Although there is a very small chance that you may become pregnant even if you take it within the first 24 hours, the risk of pregnancy increases the longer you leave it and 72 hours is the limit.
  • The morning after pill is a large dose of a progesterone-like hormone called levonorgestrel (brand name Levonelle one step or Levonelle 1500).
  • Beyond 72 hours: you can still go to a family planning clinic, as the doctor might be able to insert an intrauterine device (a coil) into the womb to prevent the fertilized egg from implanting.

Can I become pregnant from sperm left in the bath or swimming pool?

No. This is a myth.

 How do I know if I am pregnant?

  • If you have had sex without using any contraception since your last period started, and your next period does not come when it should you might be pregnant.
  • On the day that your period should have arrived and didn't, you can test if you are pregnant using a pregnancy test.
  • You can buy these at the chemist or you can get one free at a FPC or sexual health clinic or your GP.
  • The test is simple and is done on your urine sample. Do not use an out-of-date test, and follow the instructions carefully.
  • If the test is negative and your period arrives soon after, fine, but otherwise always confirm the results with a doctor.

 What can I do if I am pregnant?

  • You should contact your doctor, a sexual health clinic.
  • The staff can explain your options and help you to choose. It is advisable to involve your parents in any decisions you make.

Breasts 

At what age do breasts normally develop?

Most girls start to develop breasts between the ages of 8 and 14. For many, this is one of the first signs of becoming a woman.

Is it normal to have different sized breasts?

Yes 40 per cent of women have different sized breasts.

Do sore breasts mean breast cancer?

  • It is extremely rare to develop breast cancer during puberty and breast cancer is very rarely sore. Growing breasts can be very sore. Later on, the breasts can become sore during the fluid retention before the period. Sometimes reducing the salt and caffeine in your diet can help.
  • Pregnant women also develop sore breasts, which can be one of the first signs of pregnancy. So if you've missed a period and have sore breasts, do a pregnancy test.

Vaginal discharge

Another thing that changes during puberty is that vaginal discharge (secretions) start or change. For six months before getting their first period, girls may notice an increase in vaginal discharge.

 What is normal vaginal discharge?

  • Vaginal secretions keep the vagina moist and clean and help fight infections.
  • Once periods start, normal vaginal discharge can be thin, sticky and elastic; or thick and gooey, and the color is clear, white or off-white (yellow when dried).
  • The texture and color can change throughout the cycle. In particular, some women notice a heavier flow of thin, sticky mucus-like discharge around the time of ovulation (day 14 of the cycle).
  • Normal vaginal discharge usually has no smell, and if it has, it is not unpleasant.
  • Remember, if you are sexually excited or emotionally stressed your vaginal discharge can increase.

 What is abnormal vaginal discharge?

Keep an eye out for change, including:

  • unusual increase in amount
  • change in texture: for example curd-like or frothy and watery
  • change in color to grey, yellow, green or brown
  • Change in smell: for example fishy or yeasty.

What causes abnormal vaginal discharge?

If you have had sex, an abnormal vaginal discharge might be caused by a sexually transmitted infection, such as trichomonas, chlamydia, or gonorrhea.

Some vaginal infections are not sexually transmitted, but are caused by an imbalance in the vaginal flora ('bugs') that normally live in your vagina. These are:

  • thrush (candida): signs are a cottage cheese-like discharge with itching and soreness
  • bacterial vaginosis (BV): a grey, watery, sometimes frothy vaginal discharge that smells of fish. Mild itching can occur.

Excessive washing of the vagina, use of perfumed soaps and bubble bath, tight synthetic clothes (such as nylon knickers), lots of sex, antibiotics and stress can all lead to an imbalance in vaginal flora.

Remember, if you forget to remove a tampon or a cap you can also develop unpleasant vaginal discharge.

What should I do if my vaginal discharge changes?

You can go to see your GP or you can visit a sexual health clinic. Many clinics have dedicated times for young people that cater to their needs. It is important to seek attention early, as sometimes the discharge might be a sign that you have caught a sexually transmitted infection that needs prompt treatment.

Sexually transmitted infections

What are sexually transmitted infections?

These are infections that are passed from person to person during sex.

  • Some infect the vagina like trichomonas.
  • Some infect the neck of the womb (the cervix) like gonorrhea and chlamydia.
  • Some cause sores or ulcers like herpes and syphilis.
  • Some cause lumps like warts.
  • Some affect the liver like hepatitis B.
  • Some affect the whole body like HIV, the virus that can cause AIDS.
  • Some, like 'crabs' and scabies can be passed on just by close contact.

What are the symptoms of sexually transmitted infections?

Sometimes you do not know because you have no symptoms. Any of the following can be a sign that you have contracted a sexually transmitted infection:

  • change in vaginal discharge
  • pain or burning on urination
  • sores or ulcers in the genital area between the legs
  • wart-like lumps in the genital area
  • crampy pain in the lower abdomen
  • pain during sex
  • bleeding after sex
  • itchiness in the genital area
  • dandruff-like specks that move in the pubic hair

How do avoid sexually transmitted infections?

  • Unfortunately, nothing on the outside tells you if someone is harboring a sexual infection. Often the people do not know themselves, as they have no symptoms. The only way to be safe is to use a condom.
  • Using a condom every time you have sex is a very good way to protect against pregnancy and sexually transmitted infections.
  • You must make sure the condom is on before allowing the penis near the vagina. Remember, sexually transmitted infections can sometimes be transmitted by the penis touching the genital area surrounding the vagina (vulva).

What should I do if I think I have a sexually transmitted infection?

  • First, you should try to avoid catching them.
  • If you do suspect you have a sexually transmitted infection go to a convenient sexual health clinic. Many clinics now have special young persons' times and they will examine you, take swabs and make a diagnosis. They will also suggest you tell your sexual partners so that they seek advice and get treatment if needed.

If sexually transmitted infections are curable, why should we bother protecting against them?

  • Trichomonas, chlamydia, gonorrhea, syphilis, crabs and scabies are curable.
  • However, chlamydia and gonorrhea can spread from the neck of the womb to the Fallopian tubes leading to abdominal pain, inability to become pregnant, or pregnancies outside the womb. Unfortunately, not everyone can tell if they have chlamydia so it can hang around for a long time causing irreversible damage to the tubes.
  • If not detected, syphilis can cause severe damage to your body long term.
  • HIV, hepatitis B, herpes and warts can be controlled, but not cured, by treatment.

Can women get HIV?

  • Yes, HIV is transmitted between men having sex with women as well as men who have sex with men. Worldwide, most HIV infections are transmitted by heterosexual sex.
  • Women can catch HIV from anal sex and vaginal sex if a condom is not used, because the virus is present in semen and vaginal fluids.
  • Women can also catch HIV during the injection of drugs like heroin and crack, so don't share your needles.

How can I protect myself from HIV?

  • Always use a condom.
  • Have fewer sexual partners.
  • Delay the first time you have sex until you are 21 or older.
  • Make sure you have no other sexually transmitted diseases as they help HIV to transmit between people.
  • Never share needles.
  • Remember HIV is very common in many parts of the world - Africa, Southeast Asia, South America, Eastern Europe - so take and use condoms when you travel.

How safe is oral sex?

  • Oral sex is not 100 per cent safe from transmission of HIV, but is much safer than vaginal sex, which in turn is much safer than anal sex.
  • If you want to minimize the risk, avoid swallowing the semen, keep good oral hygiene and avoid oral sex if you have mouth ulcers, bleeding gums or during menstruation.

What about kissing?

Kissing, hugging, mutual masturbation, touching each other's genital areas, sharing cups and sharing beds are all safe.

Can you catch HIV from a swimming pool?

No.

What are the symptoms of HIV?

Many years can pass without any symptoms so many people do not know they are infected. That is why it is so difficult to know who has and who has not got HIV. By the time the disease is obvious the individual could have inadvertently infected many people.

How can I find out if I have HIV?

There is a simple blood test to detect HIV infection. But you can have to wait at least three months after the event that exposed you to HIV before the test becomes positive. Special blood tests can be used to make the diagnosis before this time so if you think you have been exposed to HIV, it is important to seek advice early.

Why would I want to find out my HIV status?

  • Good treatment is currently available that prolongs life and improves the quality of life for people with HIV.
  • By knowing your status, you can access that care. Treatment may be particularly important in the first few months of infection so if you think you have been exposed to HIV, it is important to seek advice early.
  • But remember, you don't have to take medication or experience other considerable difficulties that HIV infection brings. Instead, you can always use a condom.