SEXUAL HEALTH………PART 3
Menstruation (a period) is a major stage of puberty in girls; it's one of the many physical signs that a girl is turning into a woman. And like a lot of the other changes associated with puberty, menstruation can be confusing. Some girls can't wait to start their periods, whereas others may feel afraid or anxious. Many girls (and guys!) don't have a complete understanding of a woman's reproductive system or what actually happens during the menstrual cycle, making the process seem even more mysterious.
Puberty and Periods
When girls begin to go through puberty (usually starting between the ages of 8 and 13), their bodies and minds change in many ways. The hormones in their bodies stimulate new physical development, such as growth and breast development. About 2 to 2½ years after a girl's breasts begin to develop, she usually gets her first menstrual period.
About 6 months or so before getting her first period, a girl might notice an increased amount of clear vaginal discharge. This discharge is common. There's no need for a girl to worry about discharge unless it has a strong odor or causes itchiness.
The start of periods is known as menarche. Menarche doesn't happen until all the parts of a girl's reproductive system have matured and are working together.
Baby girls are born with ovaries, fallopian tubes, and a uterus. The two ovaries are oval-shaped and sit on either side of the uterus (womb) in the lowest part of the abdomen called the pelvis. They contain thousands of eggs, or ova. The two fallopian tubes are long and thin. Each fallopian tube stretches from an ovary to the uterus, a pear-shaped organ that sits in the middle of the pelvis. The muscles in a female's uterus are powerful and are able to expand to allow the uterus to accommodate a growing fetus and then help push the baby out during labor.
As a girl matures and enters puberty, the pituitary gland releases hormones that stimulate the ovaries to produce other hormones called estrogen and progesterone. These hormones have many effects on a girl's body, including physical maturation, growth, and emotions.
About once a month, a tiny egg leaves one of the ovaries — a process called ovulation — and travels down one of the fallopian tubes toward the uterus. In the days before ovulation, the hormone estrogen stimulates the uterus to build up its lining with extra blood and tissue, making the walls of the uterus thick and cushioned. This happens to prepare the uterus for pregnancy: If the egg is fertilized by a sperm cell, it travels to the uterus and attaches to the cushiony wall of the uterus, where it slowly develops into a baby.
If the egg isn't fertilized, though — which is the case during most of a woman's monthly cycles — it doesn't attach to the wall of the uterus. When this happens, the uterus sheds the extra tissue lining. The blood, tissue, and unfertilized egg leave the uterus, going through the vagina on the way out of the body. This is a menstrual period. This cycle happens almost every month for several more decades (except, of course, when a female is pregnant) until a woman reaches menopause and no longer releases eggs from her ovaries.
Just as some girls begin puberty earlier or later than others, the same applies to periods. Some girls may start menstruating as early as age 10, but others may not get their first period until they are 15 years old.
The amount of time between a girl's periods is called her menstrual cycle (the cycle is counted from the start of one period to the start of the next). Some girls will find that their menstrual cycle lasts 28 days, whereas others might have a 24-day cycle, a 30-day cycle, or even longer. Following menarche, menstrual cycles last 21–45 days. After a couple of years, cycles shorten to an adult length of 21–34 days.
Irregular periods are common in girls who are just beginning to menstruate. It may take the body a while to sort out all the changes going on, so a girl may have a 28-day cycle for 2 months, then miss a month, for example. Usually, after a year or two, the menstrual cycle will become more regular. Some women continue to have irregular periods into adulthood, though.
As a girl gets older and her periods settle down — or she gets more used to her own unique cycle — she will probably find that she can predict when her period will come. In the meantime, it's a good idea to keep track of your menstrual cycle with a calendar.
The amount of time that a girl has her period also can vary. Some girls have periods that last just 2 or 3 days. Other girls may have periods that last 7 days or longer. The menstrual flow — meaning how much blood comes out of the vagina — can vary widely from girl to girl, too.
Some girls may be concerned that they're losing too much blood. It can be a shock to see all that blood, but it's unlikely that a girl will lose too much, unless she has a medical condition like von Willebrand disease. Though it may look like a lot, the average amount of blood is only about 2 tablespoons (30 milliliters) for an entire period. Most teens will change pads 3 to 6 times a day, with more frequent changes when their period is heaviest, usually at the start of the period.
Especially when menstrual periods are new, you may be worried about your blood flow or whether your period is normal in other ways. Talk to a doctor or nurse if:
your period lasts longer than a week
you have to change your pad very often (soaking more than one pad every 1–2 hours)
you go longer than 3 months between periods
you have bleeding in between periods
you have an unusual amount of pain before or during your period
your periods were regular then became irregular
Cramps, PMS, and Pimples
Some girls may notice physical or emotional changes around the time of their periods. Menstrual cramps are pretty common — in fact, more than half of all women who menstruate say they have cramps during the first few days of their periods. Doctors think that cramps are caused by prostaglandin, a chemical that causes the muscles of the uterus to contract.
Depending on the girl, menstrual cramps can be dull and achy or sharp and intense, and they can sometimes be felt in the back as well as the abdomen. These cramps often become less uncomfortable and sometimes even disappear completely as a girl gets older.
Many girls and women find that over-the-counter pain medications (like acetaminophen or ibuprofen) can relieve cramps, as can taking a warm bath or applying a warm heating pad to the lower abdomen. Exercising regularly throughout the monthly cycle may help lessen cramps, too. If these things don't help, ask your doctor for advice.
Some girls and women find that they feel sad or easily irritated during the few days or week before their periods. Others may get angry more quickly than normal or cry more than usual. Some girls crave certain foods. These types of emotional changes may be the result of premenstrual syndrome (PMS).
PMS is related to changes in the body's hormones. As hormone levels rise and fall during a woman's menstrual cycle, they can affect the way she feels, both emotionally and physically. Some girls, in addition to feeling more intense emotions than they usually do, notice physical changes along with their periods — some feel bloated or puffy because of water retention, others notice swollen and sore breasts, and some get headaches.
PMS usually goes away soon after a period begins, but it can come back month after month. Eating right, getting enough sleep, and exercising may help relieve some of the symptoms of PMS. Talk to your doctor if you are concerned about your premenstrual symptoms.
It's also not uncommon for girls to have an acne flare-up during certain times of their cycle; again, this is due to hormones. Fortunately, the pimples associated with periods tend to become less of a problem as girls get older.
Pads, Tampons, and Liners
Once you begin menstruating, you'll need to use something to absorb the blood. Most girls use a pad or a tampon. But some use menstrual cups, which a girl inserts into her vagina to catch and hold the blood (instead of absorbing it, like a tampon).
There are so many products out there that it may take some experimenting before you find the one that works best for you. Some girls use only pads (particularly when they first start menstruating), some use only tampons, and some switch around — tampons during the day and pads at night, for example.
Girls who worry about leakage from a tampon often use a pantiliner, too, and some girls use liners alone on very light days of their periods.
Periods shouldn't get in the way of exercising, having fun, and enjoying life. Girls who are very active, particularly those who enjoy swimming, often find that tampons are the best option during sports.
If you have questions about pads, tampons, or coping with periods, ask a parent, health teacher, school nurse, or older sister.
Some girls worry that if they use tampons, they will no longer be virgins. The truth is, a virgin is someone who has never had sexual intercourse. Inserting a tampon is definitely not the same as having sex!
So why do girls ask this question so often? Girls who are virgins usually have a hymen, a very thin piece of skin-like tissue that stretches partly across the opening of the vagina. A lot of people mistakenly think that a girl is still a virgin if her hymen has not been broken. Most of the time a girl's hymen breaks after having sex for the first time.
But a girl's hymen can tear in ways that have nothing to do with having sex. For example, it is possible that inserting a tampon might tear the hymen (although that usually doesn't happen). So even if a tampon does break a girl's hymen, she is still a virgin until she has had sexual intercourse.
Normal vaginal discharge has several purposes: cleaning and moistening the vagina and helping to prevent and fight infections. Although it's normal for the color, texture, and amount of vaginal fluids to vary throughout a girl's menstrual cycle, some changes in discharge may indicate a problem.
If you think you may have a problem, you should see a doctor as soon as possible. First, though, it helps to learn some of the differences between normal and abnormal vaginal discharge. This will help you to recognize changes that may occur.
Normal vaginal fluids can vary somewhat in texture and color. They can be somewhat thin, sticky, and elastic or thick and gooey. Vaginal fluids should be clear, white, or off-white in color.
It's important to keep an eye out for changes in vaginal fluids. The following changes may indicate a problem:
change in odor (especially an unpleasant odor)
change in color or texture (especially greenish, grayish, or anything looking like pus)
vaginal itching, burning, swelling, or redness
change in color that is caused by vaginal bleeding or spotting that is not a menstrual period
Vaginal infections, such as bacterial vaginosis, candidiasis (yeast infection), and trichomoniasis are common causes of abnormal vaginal discharge. Some infections are transmitted by having sex, such as gonorrhea. Other infections can occur with or without having sex, such as bacterial vaginosis or yeast infection.
Although the symptoms of these infections can be very similar, there are some differences to look for:
Yeast infections may cause your discharge to become very white and thick, resembling cottage cheese. A yeast infection usually does not cause a strong odor, but it may cause severe itching and burning.
Bacterial vaginosis (BV) may cause your discharge to be heavier than usual. The fluids may become foamy or frothy and grayish in color. BV often causes vaginal fluids to have an unpleasant, fishy odor.
Trichomoniasis, a common sexually transmitted disease (STD), may cause a musty, stale odor. Discharge may become grayish or yellow-green and may become thicker. Trichomoniasis also often causes vaginal itching and pain during urination.
It's very important to see a doctor or go to a teen clinic if you have any of the symptoms of abnormal vaginal discharge. This is really important for girls who have had sex, especially those who have had sex without using a condom. Many STDs cause changes in vaginal discharge or cause other infections that affect discharge as well.
The examination girls need:
Your mom just made an appointment for your first gynecologic exam and you're feeling:
Totally panicked. You start praying for an avalanche, four flat tires on the car, anything to avoid that appointment.
Pretty calm. You don't really mind going to the doctor that much, and if your friends can handle it, so can you.
Confused. You don't feel sick at all, and you just had some vaccinations for school and a physical for sports. Why waste time going to a doctor when you're OK?
These are just some of the feelings that girls may have before their first gynecologic (or "gyn") exam, and it's not surprising. You might be asking yourself "Why me? Why now?" The answer is that you're older and have gone through puberty, so you need to have a physical exam appropriate for a young woman. That's where breast and pelvic exams come in.
Why You Need These Exams
The American College of Obstetricians and Gynecologists recommends that a girl make her first visit to a gynecologist when she is between the ages of 13 and 15. Not all girls will need a pelvic exam during this initial visit, though. Many gynecologists will just do a regular health exam and talk to the girl about her development.
Yearly gyn visits are important for a number of reasons, including:
as a routine check. You'll want to be sure you're developing normally.
to prevent pregnancy or infection. If you have ever had sex, you are probably going to need a pelvic exam. Girls should have a pelvic exam before having sex to discuss methods of birth control and preventing sexually transmitted diseases (STDs).
to deal with a problem. There may be a number of concerns that lead to a pelvic exam. For example, if you have problems with your periods, missed periods, pain, signs of infection, and worries about development, it's a good idea to see a doctor.
If you're going to be involved in deciding who you'll see for your pelvic exam, you have a few choices. Many family doctors and pediatricians perform pelvic and breast exams and advise teens on birth control and STD prevention. So you may be able to see a doctor you already know and feel comfortable with for your first pelvic exam.
Also, a number of different kinds of doctors and nurses have special training in women's reproductive health:
Gynecologists are doctors who have been specially trained in women's health issues. Gynecologists are one of the doctors who can prescribe birth control and teach patients how to use it.
Adolescent medicine doctors have been trained in the health and management of teen issues. They are familiar with the concerns most young women have about their reproductive systems and can advise them on birth control and STD prevention.
Nurse practitioners have had advanced training that allows them to give gynecological exams and pay special attention to women's reproductive health.
Whether you want to see a male or female health care professional is up to you. Some women say that they prefer being examined by a female doctor or nurse because it puts them more at ease and they feel like they can talk more openly about women's health problems and sexuality issues. Other women feel comfortable being examined by a male doctor or nurse. If the doctor or nurse is male, he will usually have a female assistant in the room with him during all parts of the exam.
It's best to involve your parents in your health care. If you want to go to a doctor's office for your exam, you may need to involve an adult for insurance purposes (it may be expensive otherwise).
If for some reason you can't involve your parents, you can take advantage of health clinics like Planned Parenthood or your local teen clinic. These clinics have fully trained staff who often can care for you at a lower cost and respect your need for confidentiality. Each state has different guidelines on which medical issues teens can get confidential care for. Your doctor should be able to explain these issues to you.
The most important thing is that you feel comfortable with the person who is examining you. You want to be able to talk with him or her about important personal health and relationship issues, including birth control.
What Happens When You Go for Your Pelvic Exam
You don't need to do anything special before going for your exam. When you make the appointment, try to schedule the exam for a time when you won't have your period. For many young women, that can be hard to predict, though — lots of girls have irregular periods at first. Ask the doctor's office or clinic when you make the appointment what you should do if you get your period. Some doctors say it's OK to come for an exam if your period is just beginning or just ending and it's very light, but everyone has a different policy.
When you arrive for your appointment, you may be asked to fill out some forms while you wait. These forms ask questions about any illnesses or conditions you have, your health habits (like whether you drink or smoke), any family illnesses that you know of, and your history regarding sexual activity, pregnancy, and birth control. You might also be asked for the date of your last period (or a doctor or nurse will ask during your exam).
When you first go into the exam room, a nurse or medical assistant will do a few things that your doctor has probably done a million times before, such as recording your weight and taking your blood pressure. You'll then be left alone to change out of your clothes. It may feel weird taking off even your underwear because you may not have had to undress completely for a medical exam before. The nurse or medical assistant will leave you a paper sheet or gown — or maybe both — to cover you. If you're cold, most doctors and nurses won't mind if you keep your socks on.
After a few minutes, the doctor (or nurse practitioner, if that is who you choose to see) will knock on the door to make sure you're in your gown. If you're ready, he or she will come in and start the exam. The doctor may start by going over anything you wrote down on your forms, or you may talk about these things later.
If this is your first gynecologic exam, let the doctor know. That way, he or she will know to go slowly and explain everything that's going on. Now is also the time to ask about birth control or sexuality if you need to. Some doctors like to discuss these things before the exam, and some like to do it after. Your aim is to make sure you get your questions answered.
The Breast Exam
During the physical part of the gynecologic exam, you'll be asked to lie on your back on the table. You'll have the paper sheet or gown covering you, and the doctor will only uncover the parts of your body being examined.
The doctor will give you a breast exam by lightly pressing on different parts of your breasts. After finishing, he or she may show you how to examine your own breasts. This helps you become familiar with how your breasts feel so you know which lumps are normal and which may be the result of a change.
The Pelvic Exam
During the pelvic part of the exam, the doctor or nurse practitioner will ask you to move down so your behind is at the end of the table. You'll bend your knees and rest your feet in two stirrups, which are metal triangular loops that stick out from the end of the table. These might look a little scary, but they're just there to rest your feet in and keep you more comfortable. The doctor will ask you to relax your knees out to the sides as far as they will go. It might feel a little funny to be lying with your legs opened like this, but everyone feels that way at first.
The doctor will put on gloves and examine the outside of your vagina to make sure that there are no sores or swelling and that everything looks OK on the outside.
Next, the doctor will want to look at the inside of your vagina and will do so with the help of a speculum (pronounced: speh-kyuh-lum). A speculum is a thin piece of plastic or metal with a hinged piece on one end that allows it to open and close. The doctor or nurse will warm the speculum with water (some offices keep the speculum warmed in a drawer with a heating pad). The doctor or nurse will then slide the speculum into your vagina. Usually the doctor will tell you when he or she is about to place the speculum inside you so it doesn't come as a surprise.
Once the speculum is in the vagina, it can be opened to allow the doctor to see inside. Putting in and opening the speculum should not be painful, although some women say that it can cause a bit of pressure and discomfort. Naturally, if this is your first exam, you might feel a little tense. Because the vagina is surrounded by muscles that can contract or relax, the exam can be more comfortable if you try to stay calm and relax the muscles in that area.
If you feel like you're tensing up the muscles in your vagina, try breathing deeply or doing some breathing exercises to help you stay relaxed. Sometimes humming your favorite song or making small talk can distract you and allow you to feel more relaxed.
After the speculum is in place, the doctor will shine a light inside the vagina to look for anything unusual, like redness, swelling, discharge, or sores. He or she may then do a Pap smear, which involves touching the cervix to pick up cells from that area.
The cervix is the opening to the uterus, and it's located at the very top of the vagina. The Pap smear should not hurt, but it might be uncomfortable, especially if this is your first pelvic exam. The good news is this part of the exam is over quickly.
The cells that have been collected are sent to a laboratory where they are studied for any abnormal cells, which might indicate infection or warning signs of cervical cancer. (Like breast cancer, cervical cancer is very unusual in teen girls.)
If you have had sex, the doctor or nurse practitioner may test for STDs. He or she will swab the inside of the cervix with what looks like a cotton swab. The speculum is then slid out of the vagina. As with the Pap smear, the sample is sent out to a laboratory where it is tested for various STDs.
Talk to your doctor or a nurse about how you want to be contacted with results, and what they should do if they are unable to reach you. Again, doctors and nurses will do their best to maintain confidentiality, but they need to be able to reach you.
Because the ovaries and uterus are so far inside a girl's body that they can't be seen at all, even with the speculum, the doctor will need to feel them to be sure they're healthy. While your feet are still in the stirrups, and after the speculum is removed from the vagina, the doctor will put lubricant on two fingers (while still wearing the gloves) and slide them inside your vagina. Using the other hand, he or she will press on the outside of your lower abdomen (the area between your vagina and your stomach). With two hands, one on the outside and one on the inside, the doctor can make sure that the ovaries and uterus are the right size and free of cysts or other growths.
During this part of the exam, you may feel a little pressure or discomfort. Again, it's important to relax your muscles and take slow, deep breaths if you feel nervous.
At this point, the physical part of the exam is usually over. Your own doctor may do the exam in a different order, but it will probably include all these steps.
After the Exam:
Although reading this article may make it seem long, the entire pelvic exam (the parts involving your vagina, cervix, uterus, and ovaries) really only takes about 3 to 5 minutes.
Afterward, you'll be left alone to get dressed. Some women say that they bleed a tiny bit from the Pap smear after the exam, so they like to put a pantiliner in their underwear as they get dressed. If you bleed a tiny bit, it's no big deal — it's nothing like a period and it won't last.
If you haven't discussed your questions before the exam, now's the time. Don't be afraid of questions that sound stupid or silly — no question about your body is stupid, and this is the best time to get answers.
The Pap smear is almost always normal in teen girls. But if for any reason the doctor or nurse practitioner needs to see you again, the office or clinic will let you know. Unless you notice any health problems, you won't need to go for an exam for another 6 months to a year.
It's very important to go for pelvic exams on a yearly basis — even when you're feeling good — because they help detect any problems early on. If you don't want to return for another exam because you didn't like the doctor or nurse practitioner, look into finding a new doctor or clinic.
And if the physical discomfort of the exam left you not wanting another, remember that each time it gets easier and easier to relax. Naturally, no one loves getting an exam, but having a doctor or nurse practitioner you trust can really help.
Making breasts bigger:
Although many products (from special creams to exercise techniques) claim to boost breast size, you should save your money: They don't work. The truth is that the only way to permanently change breast size is cosmetic surgery.
Most doctors won't perform breast enlargement surgery until a girl reaches 18 because the body takes time to develop and some girls develop (and have changes in the size of their breasts) later than others. Even after 18 there are certain physical and psychological risks involved with breast implants.
Everyone goes through times when they don't like parts of their bodies. These feelings are part of normal development and the process of adjusting to our changing bodies. Even girls with large breasts can be unhappy about them. Some find that their backs or shoulders hurt or that the large breasts attract unwanted attention and they may wish their breasts were smaller.
If you're unhappy with the size or development of your breasts, talk to your doctor or gynecologist, who can probably reassure you that you're developing normally.
Can a girl get pregnant if she has sex during her period?
A lot of people think that if a girl has sex during her period, she can't get pregnant. But it is possible for a girl to get pregnant while she is bleeding. This can happen for a couple of reasons:
Not all vaginal bleeding is the result of a menstrual period. Sometimes a girl will have a small amount of vaginal bleeding at the time of ovulation — the time when she is most fertile. During ovulation, an egg is released from one of the ovaries and travels down a fallopian tube to the uterus. It's common for girls who are ovulating to have some vaginal bleeding that can be mistaken for a period.
Sometimes ovulation can occur before the bleeding from a girl's period has stopped, or it may occur within a few days after her period is over. Sperm can fertilize an egg for several days after ejaculation. So in both cases, having sex before the period is finished can result in pregnancy.
Having unprotected sex at any time is very risky. Along with the chance of becoming pregnant, there is also the risk of getting a sexually transmitted disease (STD), such as chlamydia, genital warts, or HIV. The only surefire way to prevent pregnancy and STDs is abstinence. If you do have sex, use a condom every time to protect against STDs. And talk to your doctor about additional forms of contraception.
