Body 101 & Puberty

As you read through the case example, consider the following questions.

How did you react to the example? Why do you think you reacted that way?
If this was your client, what would be the most important discussion points?
What additional information do you need to respond to the case example?

Why does it all have to be so hard? I have enough on my plate right now after leaving home and now problems down there! I’m just not sure that everything is growing like it should. I know I’m circumcised so I guess that may affect my size, that’s what I remember hearing. What is the right size penis anyway? I’m 16 and maybe I’m done growing, who knows? I’m going to have to talk to someone but who will even listen?

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Still no period! I know I’m not pregnant as I haven’t had sex in six months so what is going on? I’ve been getting my periods since I was 12 so you would think that they would come regularly by now. One of the girls at the shelter said that stress and even not eating well can affect your cycle, so I guess that could be the reason. But what if there’s something really wrong with me? I’m not sure if at 15 I should be through the whole puberty thing and if I’m not, I’m worried that maybe I’m not growing properly. I haven’t seen a doc in years since my mom used to take me for shots and stuff, but I wouldn’t even know where to start looking to get a check-up.

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Healthy sexuality includes an understanding of how the body works. When youth understand their sexual development they can build the confidence and motivation to enhance their health and the skills to avoid negative outcomes such as unplanned pregnancy and sexually transmitted infections (STI).

Puberty is a life stage that everyone goes through during adolescence. It is the process of a child’s body growing and maturing into an adult body. The physical, emotional and social changes associated with puberty usually start anywhere between the ages of 9 and 16. On average males usually develop about two years later than females. Each person goes through puberty at their own pace as every body is different. Puberty changes happen slowly and take several years to complete. It may be a fast process for some people and a more gradual one for others.

What happens during puberty?

Many of the physical changes experienced in puberty are the same for males and females such as growth spurts, growing hair under the arms and oily skin. However, some changes are specific to males or females. There are many myths about puberty changes especially associated with secondary sexual characteristics such as menstruation for females and penis size for males.

Physical Puberty Changes at a Glance

Adapted, with permission, from www.teachingsexualhealth.ca

What happens to males during puberty?

Puberty for males can start any time between 11 and 16 and last until around age 20. Males will grow taller and develop broader shoulders. The penis and testicles will grow larger which can lead to issues with the foreskin. If uncircumcised, some young males find that the foreskin does not pull back until after they have finished puberty. Keeping the penis clean by retracting the foreskin is important, but the foreskin should not be forced back. It is important that if a male is experiencing discomfort with his foreskin that he visit a healthcare provider to discuss the issue.

Young men in particular are often concerned about penis size. It is important to emphasize that everyone goes through puberty at different rates and some men do not finish growing until they are in their late teens. Penis length varies from male to male and is not influenced by circumcision. The average penis is 5 – 7 inches when it is erect (hard), and 3 ½ to 4 inches when flaccid (soft). Everyone is different, so a penis that is larger or smaller is still normal. It is important to note that penis size does not affect a male’s ability to give or receive sexual pleasure or to get a female pregnant. Using pills or creams to enlarge the penis is not recommended as these products do not have medical research to support that they are safe.

During puberty, sex hormones are released that lead to the production of sperm which can be ejaculated from the penis in the form of semen. Semen is a sticky, whitish fluid that is ejaculated from the penis. It is made up of water, mucous, sugar, acids and bases and carries sperm cells. A typical quantity of semen in an ejaculation is about 3 to 5 millimeters (a teaspoon). Most males can ejaculate semen by the time they are 15. Sometimes this will happen at night in what is commonly known as a ‘wet dream,’ where small amounts of semen are released during sleep.

To learn more about puberty for boys, see
http://kidshealth.org/kid/grow/index.html

Male Sexual Health

Questions about sexual and reproductive health can be difficult to ask because of embarrassment or fear about the answers. For ideas and suggestions on how to talk to your healthcare provider about your sexual health, see
How to Talk to About Sexual Health with Healthcare (.PDF)

For a description of male anatomy, including diagrams and how the body works, see
http://www.cfsh.ca/Your_Sexual_Health/Anatomy/Male_Reproductive_Anatomy.aspx

Maintaining Good Sexual Health

To maintain good sexual health it is important to recognize changes and talk to a healthcare provider if there are concerns.

Whether or not the penis is circumcised, any symptoms such as unusual discharge, sores, lumps, or painful urination should be reported to a healthcare provider. It is important to:

Check the penis and testicles regularly for lumps, sores, rashes or any unusual discharge, which may be a sign of a sexually transmitted infection (STI) or other infection.
Wash the penis and testicles daily and after intercourse with mild soap and water. In uncircumcised men, the foreskin of the penis needs to be pulled back gently so that the skin underneath can be washed. This helps to lessen the chance of skin irritation and possible infection.

Testicular Health

Testicular cancer can affect men at any age; however it occurs most often in men aged 15-35. Although it is rare, it is the most common cancer found in young men. Testicular self-exam (TSE) will help males learn what feels normal so that a change can be found early and treated. There may or may not be swelling or pain. If testicular cancer is found early, there is a greater chance that it can be cured.

To learn more about Testicular Self-Exam, see the The Canadian Testicular Cancer Association

What happens to females during puberty?

Puberty for females can start anywhere between 9 and 15. During puberty females also experience fast growth and body shape changes. Females develop a curvier figure as their hips begin to widen. Some young females experience breast tenderness as their breasts grow, which is normal. It is common for one breast to be larger or a different shape than the other.

For many females the most important physical change during puberty is when a female gets her first period or menstrual bleeding. This is a sign that her body’s reproductive system is maturing and releasing eggs. The body is now capable of conceiving a pregnancy. This process is called the menstrual cycle.

A menstrual cycle is the length of time it takes the body to go through the process of:

Maturing and releasing an egg (ovulation).
Thickening the lining of the uterus preparing for a fertilized egg.
Shedding the thickened lining (period or menstrual/bleeding) when there has not been a fertilized egg implanted to create a pregnancy.

To learn more about the menstrual cycle, see
http://www.teachingsexualhealth.ca/media/lessons/5_AnatomyPhysiologyO_MenstralCycle.pdf

The average age a female goes through her first menstrual cycle and gets a period is about age 12. However, some females get their first period as early as 9 or as late as 16 years old.

The length of a cycle is counted from the first day of bleeding in one month to the first day of bleeding in the next month. When a female first starts getting her cycles, they probably will not be regular. This is normal.

A menstrual cycle is approximately 28 days, but normal cycles can vary from as short as 23 days to as long as 36 days. The number of days that a female will bleed also varies. It is normal to bleed for approximately 2-7 days. Typically, when a female first get her periods, they may be light and short. As her cycles become regular, often the bleeding may become heavier and longer.

Practice note: Many females have myths about having their first period and what a period should be like. Stress, diet, weight loss or gain, birth control and pregnancy can all affect the menstrual cycle. It is important to encourage a client to talk with a healthcare provider if she is concerned about her menstrual cycle.

Reasons to speak with a healthcare provider:

Having the first period before age 9 or not having a period by age 16.
Having a lot of pain or cramping with periods.
Bleeding that often lasts for more than 7 days.
Bleeding that is really heavy (e.g., changing a pad or tampon every 1 or 2 hours or passing lots of clots).
Bleeding between periods.
Missing a period (if participating in sexual activity) or missing several periods (only if the female has NEVER been sexually active).

To learn more about puberty for girls, see
http://kidshealth.org/kid/grow/index.html

Female Sexual Health

Questions about sexual and reproductive health can be difficult to ask because of embarrassment or fear about the answers. For ideas and suggestions on how to talk to your healthcare provider about your sexual health, see
How to Talk to About Sexual Health with Healthcare Providers (.PDF).

Maintaining Good Sexual Health

To maintain good sexual health it is important to recognize changes and talk to a healthcare provider if there are concerns.

Practice note: It is recommended that females have a complete health check-up at least once a year. This may not be possible for some of your clients who may not have access to healthcare or may not feel comfortable talking to a healthcare provider. How can you support youth to feel more comfortable using healthcare services?

Breast Health

All breasts have a certain amount of ‘lumpiness’ so females should know what feels normal for them and if something does not feel right, talk to a healthcare provider. A clinical breast exam performed by a healthcare provider can help detect changes early.

For more information on breast cancer, see
www.screeningforlife.ca

Cervical Health

Healthcare providers may perform a pelvic exam to examine a female’s reproductive organs.

To learn more about having your first pelvic exam, see
http://www.calgaryhealthregion.ca/pem/PublicSearch?direct=displayPdf&number=607441

A Pap test checks for changes in the cells of the cervix. If any cell changes are found, they should be followed closely. If needed, they can be treated so that cancer does not develop. This is why it is important to have Pap tests done regularly. It can be done by your doctor or at a Sexual and Reproductive Health Clinic and only takes a few minutes. Pap tests are FREE through Alberta Health Care.

Practice note: A Pap test is recommended for females who are 21 years of age if they have ever been sexually active. Being sexually active means any intimate sexual contact in the genital area. This includes touching, oral sexual activity or intercourse with a partner of either sex.

A Pap test does not test for infections and is not an STI test. A female should talk to a healthcare provider if she would like to be treated for STI.

For more information about cervical screening, see
www.screeningforlife.ca

Changes in the cells of the cervix are caused by certain types of Human Papillomavirus (HPV). This virus is spread through sexual contact. HPV is a common sexually transmitted infection that affects males and females. Over 70% of people will get HPV in their lifetime. There are HPV vaccines available to both males and females that can be obtained from family doctors, public health clinics and sexual and reproductive health clinics.

For more information about HPV, see
http://www.calgaryhealthregion.ca/pem/PublicSearch?direct=displayPdf&number=605632

Vaginal Health

Vaginal secretions and discharge are normal. The colour and amount will vary during a female’s monthly cycle, and at different times during the life cycle. Vaginal discharge is normally clear or whitish in color. It is important to tell a healthcare provider about changes in vaginal discharge amount, colour, smell, bleeding and/or any pain.

For more information about vaginitis, caused by common infections (e.g., yeast and bacteria) of the vagina, see http://www.calgaryhealthregion.ca/pem/PublicSearch?direct=displayPdf&number=605628

Sexually Transmitted Infections (STI) Testing

Sexually Transmitted Infections (STI) are types of infections that are spread through sexual contact. STI are sometimes called sexually transmitted diseases or STD. Often STIs have no symptoms or problems. You can not tell if someone has STI just by looking at them.

Regular testing for STI can prevent the spread of infection between partners. There are many types of STI, some are easily cured with medication prescribed by a healthcare provider, but some have no cure. Some types of STI are passed through oral, vaginal or anal intercourse, while others can be passed through skin to skin contact.

For more information about STI see:
Sexuality Topics/STI and BBP

Healthy and Happy Sexuality

The expression and experience of sexual pleasure is unique to each individual.

To learn more about sexual response and pleasure, see
http://www.cfsh.ca/Your_Sexual_Health/Sexual-Pleasure

References:

Alberta Health Services www.teachingsexualhealth.ca