The journey into womanhood
Puberty/Adolescence-girl to woman
These words are used interchangeably to describe the transitional period from childhood to adult autonomy. Puberty refers mainly to the physical changes which occur in the body, whereas adolescence refers to both physical and psychosexual development.
Puberty is transformational
In this blog, I want to talk about the physical changes which occur in puberty, usually between the ages of 8 and 14. What happens during this time is nothing short of transformational. It’s the biggest change a woman will ever go through, yes, including pregnancy, and it is important for us as caregivers to understand what is happening so that we can support our daughters on their journey.
Puberty and menopause in the same house!
I believe that puberty can be likened to menopause. At both these stages the body and mind are adapting to and coping with fluctuating levels of hormones, which cause physical and emotional changes. And both events may be playing out in the same house at the same time! Dare I suggest that adolescence is likely to be the more challenging journey and that if a girl can navigate this well, she is more likely to develop an ease with her new adult body and mind and become more able to deal with the pressures of everyday life, including the challenges presented by pregnancy should she decide to do this, and the changes menopause brings.
Big physical changes
Over the course of 4-5 years your daughter grows anything up to 7.5cm, her body shape changes, she develops breasts, body hair, genital development. Perhaps she needs to use deodorant, or products for her acne, needs to wash her hair more often and becomes concerned about vaginal discharge. And finally, she needs to learn to cope with periods!
Mixed messages
All this while receiving mixed messages from family, peers, social media, and society in general. On-line information and imagery can be undermining and frankly unreal. Your teenage daughter has a lot on her plate, and even though she may not appear to value your opinion, your input is very important as a stabilising force during this stormy time. It is natural for girls to compare with their peers. Reminding our daughters that we all develop at different stages and that our breasts and genitalia are unique to us, just as our faces and shoe size, can be reassuring.
Sequence of events
Before any obvious physical signs, there are hormonal changes occurring in the brain often from age 6-8 years, which gradually influence a cascade of changes usually occurring in a sequential manner. These include:
- Breast development
- Height spurt
- Female fat deposits
- Pubic hair development (and possibly acne)
- Genital development
- Vulvovaginal discharge
- Menarche (the first period)
Overlap of the various stages occur with a further limited increase in height after the period.
Breast development
This is the first sign of puberty in most girls. Breast buds develop which means breast tissue develops under the nipple and then as the nipple and areola develop the breast tissue extends outward as far as the armpit. This may be tender for a time and may not be symmetrical initially. It may take a year or 18 months for the breast size to become more aligned. Fine hairs can appear around the areola in some and is a normal part of breast development.
It is important to realise that breast size and shape change throughout life in response to many factors. Hormonal influences are the major players, influencing our breasts even before we are born under the influence of maternal hormones and of course during our menstrual cycle, pregnancy, breast feeding and menopause. The oral contraceptive pill and hormone replacement therapy may also influence the size and shape of the breasts.
Breast size and shape is also influenced by our parents, both mum and dad! And as a large proportion of breast tissue is made up of fat, an increase or decrease in body weight leads to similar changes in the fatty tissue within the breast and breast size changes. Exercise alone does not change breast size, but if a girl is very active it is likely that her overall body fat will be low and breasts smaller.
There are rare medical conditions which may interfere with normal breast development. One is a condition known as tubular breasts. This interferes with growth of the breasts and can affect one or both breasts. It can result in unusually shaped small drooping and uneven breasts. If you think your daughter may have this condition you should consult your GP. Referral to a breast surgeon is the usual next step as really the only way to deal with this is with surgery. I would strongly advise against any surgery until your daughter is in her later teens or early 20s as breast development continues until this time.
Height spurt
Most girls have a growth spurt up to 3 inches (7.5 cm) about 1-2 years before their period starts. Often, further growth of about 1-2 inches will occur after the period starts. Growth usually stops about age 16 but may continue at a reduced rate up to age 20.
Female Fat distribution
Body fat distribution changes during puberty. There is a general increase in body fat, and this occurs mainly at the hips and thighs, buttocks, and abdomen. Some girls can find this change distressing and become very self-conscious.
This is the time when many stop participating in sport and lose the benefit of exercise and social participation. Teenage bodies are rapidly changing and don’t work in the same way as their prepubescent bodies. It can take time to figure this out. Evidence shows that participation levels plummet to 7% of girls aged 13-14 years. A recent report from Sport Ireland identified that “the most powerful barrier is not feeling good enough to join in.” This report further identifies that “there aren’t enough opportunities for girls to take part and have carefree fun with friends while being active”.
As parents we can expand the idea of sport to any activity our daughters may enjoy with their friends and facilitate this as far as possible. It may involve us becoming taxi drivers for a time!
Pubic and body hair development
Pubic hair initially occurs along the edge of the outside lips (labia majora). Gradually the hair develops across the mons pubis to form a triangle, and in most girls and women, pubic hair eventually extends to the upper thighs. Many also develop a fine line of pubic hair which extends from the pubic area to the navel. We can reassure our girls that hair on the upper inner thighs and abdomen is normal.
Hair also develops in the armpits. This may occur sometime after the start of the pubic hair. Hair growth also increases on the legs and is entirely normal. Hair removal for women has been with us a very long time! And in the last 10 years pubic hair removal has become very popular. If you or your daughter are considering pubic hair removal it is important to do so in a safe way.
General principles include good hygiene, making sure to wash hands and the area before hair removal. Shaving, waxing and laser are all very common. Using eco-friendly products in this sensitive area is important to avoid irritation. Many who shave or wax can develop in- grown hairs, boils and infections which can, in very rare occasions, result in a generalized serious infection. If your daughter has concerns about a rash or infection it is important not to ignore this as very occasionally antibiotics may be required! My advice to people who want pubic hair removal is to consider trimming it. This reduces the likelihood of infection but, like shaving, great care should be taken to avoid cutting or nicking the genitalia.
Genital development
Often not noticed but a lot is happening! Vulval development includes growth of the mons pubis, labia majora, clitoris and labia minora (inner lips). The mons is above the pubic bone and develops a fatty pad and hair similar to the labia majora during puberty. The labia majora envelope and protect the vulva. The vulva is slightly more anteriorly placed in early puberty making the labia minora more visible. Like the breasts, growth of the labia may be asymmetrical in the first few years. This usually resolves within a few years.
The skin or mucous membrane also changes. In prepubertal girls the vulva surface is usually a bright pink or red colour. This is because the skin is very fine and delicate. After puberty, under the influence of oestrogen, this changes to a darker colour as the tissues thicken and the cells begin to release secretions which may be seen as discharge.
The hymen also changes entirely during puberty. In childhood the hymen is usually a fine membrane covering a variable part of the opening of the vagina. Usually the lower half. Post puberty the hymen becomes elastic and stretchy with a totally different ‘flower petal’ appearance.
Vulval discharge
Often begins within 6-9 months of the first period. Reflects the changing tissues in the vulval area and is a good sign that things are developing as they should. Normal discharge is light yellow, white and may have a slight odour. Some girls may have large amounts of normal discharge. This will usually settle within a few years of starting periods. And of course, during the menstrual cycle, discharge will vary from none during the first half of the cycle to an appearance like ‘uncooked egg white’ which indicates ovulation and then a creamy white yellow colour during the second half of the cycle! All normal and very reassuring.
Avoid perfumed products
Using performed products on the vulva can increase discharge by irritating the tissues. These include perfumed soaps and washes, female hygiene products, bubble baths, perfumed sanitary products, wipes, biological washing powders and fabric conditioners! The only thing to use on your vulva is water. It will also save a lot of money and is better for the environment….
Worrying discharges include change in colour to a dark yellow or green, bad odour, blood staining or an itchy discharge. Any of these findings should prompt a visit to your doctor.
Menarche
The first period. Usually starts about 2 years after the breasts start to develop. Any time between 11 and 15 years is considered normal. A period starting under 10 years or no period over 16 years should be investigated by your doctor.
Age at first period
The age of first period is mainly influenced by family history. Girls tend to start their periods at a similar age to their mothers and older sisters. Other factors influencing menarche include body weight, nutrition, race, socioeconomic group and many others.
It is not uncommon for a girl to get a period and then nothing for many months. Over the course of 2-5 years periods will usually become predictable and more manageable. We will have more content coming on the subject of periods.