First of all, Puberty (Growth of secondary sexual
characteristics) menarche (onset of menstruation), marriage and child birth are
not diseases by themselves as some ignorants may conceive and dread. They are
something physiological, natural and beautiful. Hence, they should be accepted
as vital events in life without which we cannot function as a normal human
being.
Menarche and puberty usually coincide. It is
nothing but Nature’s signal to show that a female has reached physical maturity
which will render her capable of bearing children. This certainly does not mean
that she is mature mentally. Though her body is now ready for the process of
procreation, her mental development may not have kept pace with her physical
development. She therefore need not necessarily have attained the mental
balance and understanding needed to bear gracefully the consequences of
physical relationship and child bearing at this stage.
The age of puberty is usually around 12 to 16
years in a female. She is now entering the arena of womanhood, but not quite
so. Everything seems to be strange to her. The transition period when a child
becomes a woman, referred to usually as adolescence, is the most trying period
both for the teenager and the parents. This crucial period marks the peak of
belligerence and rebellion in the child. This can only be counteracted by extra
understanding and demonstration of love and affection by the parents,
especially by the mother. The responsibility of explaining the ‘facts of life’
in the simplest possible way without unduly alarming the child should be taken
up by both or either of the parents so that the child does not get misinformed,
alarmed or misled by secondary or undesirable sources. It is natural for
adolescents to feel self conscious of their physical development and new body
functions like menstruation. The mother should
explain these physical changes to the child in a rational manner so that
the growing girl is able to adapt herself suitably to her changes. She should
be convinced that all this is nothing but a part of natural “growing-up” and
should not at all feel that is a ‘curse’ Which all members of the female sex
have to bear. She should feel proud of her potentialities as a woman and not
cringe at the thought of being subject to the various roles a woman usually
plays as wife, mother etc.
What is puberty?
In Latin puberty means ‘Bursting into
adolescence’. Adolescence is the state of becoming functionally capable of
procreation. Puberty is, in fact, the first half of adolescence and is
characterised by physical, mental and sexual differentiation. At this stage,
there is a tumultuous and beautiful onset of activity.
> There is a sudden spurt in stature.
> The breasts start to develop and become
enlarged.
> There is growth of hair on the body,
initially in the public region and later in the axillary region.
> Body contours change and fill out due to the
deposition of fat.
Breast
development at different stages of life
1. New born
5. Young
Adult
2. Young child
6. Lactating
3. Early Puberty
7. After Lactation
4. Later Puberty
8. Senile
What is Menarche?
Menarche marks the onset of the first menstrual flow
which is periodic, occurring in every mature girl. Normally there is a gap of
two years between the onset of puberty and menarche. In India, the average age
of menarche is about 13 ½ years (varying between 10-16 years). This is, to a
certain extent, affected by the family environment, diet and other
socio-economic factors.
There also exists a few abnormal conditions: for
example, if a girl fails to menstruate within 2 years of puberty or even after
15years of age, then should beexamined by a gynaecologist, as she may be
suffering from a condition called cryptomenorrhoea. In this condition the girl
menstruates every month, but the menstrual fluid remains in the uterine cavity
and vagina, distending them and does not get shed outside due to a completely
closed hymen or vagina.
Another example is where a girl does not
menstruate at all due to a developmental deformity and defective genetic
chromosomal make up. Menstruation normally occurs every 28 days with two days
difference either way and the flow of blood lasts for 2 to 7 days, the average
being 3-5 days. The flow is initially pink in colour changing to bright or
deeper red on the 2nd or 3rd day of the period. The blood
may give off a faint undesirable odour due to the bacterial multiplication
taking place in it. It would be hygienic to change 2 or 3 sanitary napkins per
day; clean cotton or soft cloth may also be used. Vaginal tampons are also
hygienic and have no ill effects whatsoever on the user, and ideally suits
married women since it has to be inserted into the vagina. In virgins the
intact hymen resists tampon insertion and therfore should not be used. The
vaginal tampons should be replaced every 4-6 hours’ failure of which may lead
to severe pelvic inflammatory disease (P.I.D).
Cryptomenorrhoea
In the beginning when the adolescent girl first
begins to menstruate, the menstrual cycle is usally anovulatory, i.e. the ovum
is not produced. Due to this the cycles are irregular and painless and may even
skip 3-6 months at a time. Erratic periods during adolescense are not at all
unusual, so there is no cause for anxiety.
Some young girls have profuse periods with
respect to volume as well as duration, sometimes lasting for more than a month.
This usually happens in those who do not get their periods for 2-3 months. This
is a type of dysfunctional uteriene bleeding (causeless bleeding) and such
excessive periods should always be reported to the gynaecologists for effective
treatment. If not, the girl becomes mentally disturbed and physically weak
since she has lost enough blood to cause anaemia.
Most people are under the wrong impression that
the blood lost during the menstrual period is bad or impure the loss of which
purifies the body. It is certainly not so. It is the normal healthy blood that
goes to form the baby if the girl is opportuned to conceive.
Another
common misconception is that when the menstrual flow is scanty, the patient
feels weak and says that she has put on weight. On the contrary, it is the
heavy flow that leads to anaemia and in reality it is the mental and hormonal
disturbance which has led to a reduced flow of blood and subsequent obesity.
There is therefore a delicate balance between the higher centres such as
pituitary and hypothalamus in the brain and the uterus and ovary in the pelvis.
Even a minor psychological disturbance will upset this harmony and affect the
menstrual flow. For example, a patient who is desperate to conceive, in her
over-anxious state can even stop menstruating upto nine months. The woman
develops a ”tummy” due to distension of the intestines which results in a
typical pregnant posture. This condition is termed as pseudocyesis. She
eventually goes into false labour and it is very difficult to convince such a
patient about her true condition. Periods which occur very rarely or too
frequently should be viewed with suspicion.
A little pain and discomfort occurs in some
girls, during menstruation especially when they have been subconsciously taught
that menstruation is a “Curse of Eve”. Sometimes, the pain may be severe. This
pain is caused by the muscular contractions of the uterus and expulsion of
menstrual blood through the cervix. The pain can be controlled by exercise,
cold water bath and analgesic and antispasmodic
drugs. The pain normally subsides after delivery when the mouth of the
uterus (cervix) is stretched and becomes expanded.
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