Adolescent Gynecology

Puberty usually takes place between the ages of 8 and 14 in females and may last for 2-3 years.  At puberty, hormones are produced in the body that cause the ovaries to increase hormone production of female sex hormones (estrogen).  This causes a woman’s body to mature and allows for reproduction to become possible.

During puberty there are many physical changes that occur.  These include:

1. Breast budding.  This is usually the first sign and occurs around age 11.  The breasts may grow at uneven rates and this is considered normal and the difference in size is usually undetectable by the time full maturity is reached.
2. Growth of pubic hair.  In some females this may be the first sign of puberty.
3. Growth of hair under the arms usually starts about 1 year after pubic hair appears.
4. Growth spurt.  There is usually a significant growth spurt and increase in weight during adolescence.  Some girls obtain their adult stature by age 13 and others not until age 18.
5. Widening of the hips and enlargement of uterus.
6. Sweat glands develop under the arms and in the groin.
7. Menstruation occurs on average by age 12 ½.  Girls who are overweight may menstruate earlier while menstruation may delayed in girls who are malnourished or involved in strenuous exercise or sports.  The first few menstrual periods are sporadic and may be irregular for the first two years.

Early puberty (occurring before age 8) should be evaluated by a doctor.
Delayed puberty may be considered if a girl has no signs of sexual development by age 13.  Extensive work up however is not recommended until after age 16.

Tampons or sanitary pads are acceptable for use during menstruyal periods.  A girls’ first pelvic examination should occur by age 18 or when a child becomes sexually active to ensure normal reproductive anatomy, function, STD counseling, contraception counseling and for Pap smear testing.

If an eating disorder is suspected immediate professional care should be sought.