- ❑ Introducing Reproductive and Sexual Health
- ❑ Reproductive and Sexual Growth
- ❑ Male and Female Reproductive System
- ❑ Menstruation
- ❑ Body Image Concerns
- ❑ Adolescent Sexuality Development
- ❑ Child Abuse—A Threat to Society
- ❑ Adolescent Sexual and Reproductive Health Needs
INTRODUCTION
The term ‘adolescence’ was popularized 100 years ago when G Stanley Hall used it to describe the second decade of life. Since then adolescence has been considered a very turbulent period. They run after excitement, thrills, stirring action and great exploits. Extremism seems to be on the air. Even the mannerisms and gestures of film stars and cricket players enthuse them.
CHARACTERISTICS
It is well recognized that childhood and adolescence are periods of intense psychological growth and development and often involve many crises, much instability, inner turbulence and behavioral deviance. These can adversely affect the development of an individual into a healthy adult (Table 1.1).
Change in Physical Stature
- Emotional changes
- Changes in thinking and behavior
- Secondary sexual changes.
Early Adolescence
- Self concern and consciousness increase and morally they may think, right and wrong, as absolute and unquestionable.
- Self-awareness centers around external characteristics, and may feel that others are staring at them.
- Self-esteem increase in boys but may decrease in girls due to assigned gender roles in society involving inequalities in power and prestige.
- Separation from family and increasing involvement with peers occur during this period.
- Changes occur in the cognitive development, from the concrete operational thinking (believing only what he/she can see, hear or touch) to formal logical operations (can understand concepts better)
- Secondary sex characters appear along with rapid physical growth.
- Ejaculation usually occurs at this time first during self-stimulation and later in sleep.
- They tend to socialize among the same sex group and role models usually are from out side home.
Middle Adolescence
- Growth spurt in girls is by 11.5 years and in boys’ 13.5 years and growth stops at 16 years for girls and 18 years for boys.
- With menarche, sexual maturation is dramatic (age of menarche is decreasing due to good nutrition and less physical activity).
- Before menarche clear vaginal discharge can occur.
- In boys spermarche occurs.
- Biologic maturation and social pressures combine to determine sexual activity in this stage.
- They gain knowledge about various aspects of sexuality like risk of pregnancy; STD's, AIDS from, peers and from newspapers, television and radio, parents and teachers.
- The peer group exerts less influence over dress activities and behavior.
- They become distant from parents, redirecting emotional and sexual concept energies towards peer relationships and the need to belong to same sex group decreases.
Late Adolescence
- In late adolescence somatic changes are modest, even though changes in breast, penis and pubic hair can occur.
- Sexual experimentation tends to decrease.
- Cognition tends to be less self-centered with increasing thoughts about concepts of justice and history.
- They are often idealistic but may be absolutists and intolerant of opposing views.
- Intimate relationships are also an important component of identity for many older adolescents. They involve love and commitment than superficial relations (Table 1.2).
Ego, Fads, Anxiety Mob Mentality, Mood Changes Hostility to parents, Idealistic/Moralistic Can't accept rejection, Interest in opposite sex Dependence on friends
ADOLESCENT GROWTH PATTERNS
Velocity of growth is different in different periods of life. It is high during the first years of life, then slows down and again reaches its peak during the adolescent years. With the onset of puberty there is adolescent growth spurt. Increase in general growth rate with growth of skeleton, muscles and viscera.
This is the most rapid period of growth with gains of 19 gm/day in boys and 16 gm/day in girls. The gain in height is about 27-29 cm in boys and 18-23 in girls and stops with epiphyseal closure. Weight gain is 25 to 30 kg in both sexes. The skeletal growth is completed in adolescence—50 percent of adult bone mass and 20 percent of the body stature is acquired during this period.
Each one cm gain in height needs 20 gm of calcium. The bone growth is mainly cortical growth.
At the cessation of growth boys are taller than girls, although in the early adolescents the girls are taller.
Body segments grow at different rates at different stages of puberty.
- Legs begin to grow earlier than the trunk
- Hands and feet grow at a faster rate
- The shoulders widen in boys
- The hips widen in girls.
Weight and Height
It is the growth hormone, which play a major role in growth spurt.
Pubertal height spurt begins at an average age of 12 years for girls and 14 years for boys
About 25 percent of adult weight is gained during this period.
Usually the more distal parts of the limbs (feet and hands) grow faster first. This accounts for the awkward appearance of adolescents;
E.g: Foot accelerates first followed by calf and thigh
E.g: Hands, forearms, followed by upper arms.
Target Height Gain of Adolescents
Mid parental height (MPH) is approximately the average final height expected in a child. It is calculated as follows. The target height of the child can be calculated roughly from the mid parental height.
There are two important processes that contribute to the physical manifestations during this period; adrenarche and gonadarche. Adrenarche normally occurs between 8-10 years of age with increased androgen secretion from the hypothalamus and pituitary glands. Gonadarche is initiated by the hypothalamus that secretes gonadotrophine releasing hormone. The exact age of adrenarche and gonodarche depends on factors such as heredity and nutrition and whether the baby is a boy or girl.
ADOLESCENT GROWTH FAILURE
Never noted in time because after early childhood nobody bothers to monitor growth.
Causes for Growth Failure
Normal variation—need only reassurance Pathologic—due to genetic, chronic illness, nutritional problems and endocrine problems need to be detected early and given proper management. Growth failure resulting from reduced nutritional intake is also a major community health problem.
The adolescence is the second and perhaps the last chance for nutritional rehabilitation and prevention of future risks like growth failure, psychological problems, birth of low birth weight babies and so on.