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Breast growth is usually the first sign of sexual development. The tiny budding breasts look like small round bulges behind the nipple; the gland tissue and fat cells start to develop in this one place. The areola swells too, and the effect looks slightly odd: cone-shaped hillocks which cause the nipple bud to be raised up. The breasts do not always develop at the same time. In 10 percent of girls, there is a time lag of a few months before the second one develops. Parents who notice this one-sided growth may fear cancer and take a daughter to the physician to check that it is not an abnormal growth.

  • Breasts take, on average, 4 years to develop. This can vary from 1 1/2 years to 6 years.

  • Pubic hair appears some 9 months after the breasts; underarm (axillary) hair can be a year later. Body hair takes 2 or 3 years to fully develop. This can vary between 1 and 4 years.

  • The inner and outer folds of the labia enlarge. By menarche they meet and cover the inner organs.

  • The vagina grows rapidly in length, and the walls become robust. It is about 11 cm long at menarche.

  • The inner vulva and vagina become paler in colour, changing from red or shiny pink, to a duller and thicker pink.

  • The cervix becomes more clearly defined, and the cervical glands start to produce mucus.

  • The uterus grows from pea-size in a child, weighing 2 grams, to the strong muscular organ weighing about 80 grams in a woman.

  • The ovaries develop from nubs of inactive tissue to ripe, round structures the size and shape of almonds.

  • The oviducts lengthen and the fringed fimbria spread. Inside the tubes, the cilia commence their rhythmic beat.

Apart from body hair, all these female organs are estrogen-dependent for growth. They cannot develop without estrogen from the ovaries. In fact, the first (unseen) pre-puberty change occurs in the ovaries, which begin developing at about. 8 years and increase in size by about 4 times in the next 4 years.

During childhood, the production of female hormones is low. A low volume of androgens (male hormones) is secreted by the adrenals. As puberty nears, androgens promote the growth of pubic and underarm hair, and are involved in rapid bone growth. The sebaceous glands are also stimulated by androgens. Some girls at prepuberty break out in facial spots. It is now thought, though not proven, that these spots could be one of the earliest signs of puberty.

The Whites

From 3 to 12 months before menarche, a girl may notice cream in her underwear. It is a thick, clear, greyish-white fluid which lacks odour. The distinctive sea aroma of a mature vagina does not begin until after menarche. In some girls, the "whites" are profuse. This is perfectly normal. Underwear should be of cotton to absorb the fluid, and keep the area dry.

If the "whites" cause pain, soreness or itching, there could be a vulva infection. A worm infestation from the anus could also be the cause; lax hygiene habits when using school toilets can cause outbreaks of such infestations. More rarely, foreign matter or dirt get into the vagina and cause inflammation. Usually, however, a vulva infection is due to lax habits. Now is the time to instruct a daughter in genital hygiene.

Little girls are rarely concerned with cleansing routines. At the approach of menarche, they benefit from a fairly serious chat on feminine hygiene. The "whites" should be removed daily to avoid risk of infection. Towels and body cloths should be kept separate and really clean. (Wash cloths tend to hold germs; clean hands are effective.) Cotton panties should be changed frequently; panty liners are useful to mop up discharge if it is profuse. Worm infestation is transmitted by hand from lax toilet habits before handling food. Hand-washing before meals, and after using the toilet, reduces this risk.

Menarche

The first period, menarche, occurs about 18 months after the phase of rapid growth. In America, the average age is 12.3 years. In Britain, it is 13.3 years. Girls who eat less stay thinner and often have a later menarche than those who eat well. There is a big possible range of 18 months or more either way. Some 10 percent of girls menstruate before age 11, and 10 percent after age 14. A smaller height increase of 2 1/4 inches (5.8 cm) remains after menarche, within an inch or so more or less.

On average, menarche starts 2 1/2 years after the first signs of puberty; breast development is well advanced. This interval can be only 6 months or up to 5 1/2 years. The first periods are non-ovulatory; no egg is sprung from the follicle. As the ovaries produce more estrogen, LH is released from the pituitary with FSH, and the two hormones trigger the rupture of the follicle. Ovulation begins 3 to 12 months after menarche, yet occurs in only half of all periods. It takes about 2 years to be regular and consistent. By this time, the uterus has reached full adult proportions and sexual maturity is attained.

The first periods are naturally irregular. They can come for a few months, then stop, or be unevenly spaced. This irregularity takes a while to settle down. On average, a 16-year-old knows when to expect her flow, knows it will last 4 to 5 days, knows it will be heavy at first, and then slow to mild spotting on the last day. Even painful periods tend to be regular (though she may perceive them as always coming early if dread of pain clouds her time-keeping).

A young girl can imagine that she is losing a great deal of blood. This is because blood looks very dramatic and stains very vividly. Average blood loss is between 3 and 9 tablespoons (50 to 175 cc). Reassure a girl who considers her flow to be abnormal. Give her a diary to record the dates, duration, and type of flow. Check her diet for sufficient iron to avoid anaemia. Sleep, and more sleep, is of great benefit. If appropriate, a visit to the physician will bring her peace of mind.

Not Too Early...

Precocious puberty is very early sexual maturity. Puberty is considered precocious if development begins at age 8. In most cases, early developers are healthy and normal. For some unknown reason, the hypothalamus, pituitary, and ovaries simply switch on before the norm. Check for early menarche on both sides of the family. The phenomenon of precocious puberty accounts for those sensational tabloid tales of 5-year-old girls giving birth. It can happen!

A girl who matures much earlier than her age mates can feel isolated from them. If her breasts grow large, they cannot be entirely hidden. Hair on the arms or legs, and underarm hair with its special odour, make her feel different, not one of the gang. Carrying napkins to school, having nowhere to deposit used ones, being fearful her flow will start at an inappropriate time, all these factors increase her feelings of being odd.

Problems of mental adjustment can arise because the girl looks more mature than she actually is. Adults can easily forget her social and emotional skills have not kept pace with physical precocity. The girl may be given responsibilities or tasks she is too young to cope with. Other children, especially siblings, often tease cruelly about her height, spots, gangly movements, extravagant breasts.

Individuals who experience precocious puberty can (and often do) become mothers at very early ages. This statement by a woman gynaecologist is not carved in stone! In fact, the shock of early development causes some girls to withdraw into themselves. Others find their new state a challenge. They flaunt their breasts, and flash their charms in a manner which makes adults cringe. If not handled with great tact, and reassured that they are loved, they look for something to put in isolation's place. Unfortunately, that something is all too often the male organ. A girl who is desperately seeking recognition will take on any man who appears to offer love.

Counsel your little "grown" girl. She is still a baby, after all. Explain to her exactly what is happening, but without too much detail. Encourage a withdrawn daughter to feel better about her emerging charms (she cannot be proud of them yet). Explain to a "jail bait" daughter that this phrase is a sneering joke among certain men who know how to exploit her and despise her at the same time. If the parent/child relationship is not close, seek professional help and counselling.

Precocious puberty can be due to hormone or brain disorders. There are usually signs of other things seriously amiss. In most cases, no reason is found for precocious puberty; the girl is perfectly healthy. A physician's all clear sets everyone's mind at rest.

Not Too Late...

The medical indicators for delayed puberty are no breast development by age 13, and no menarche by age 14 or 15. Until then, the girl is considered a late developer. Like precocious puberty, it is an inherited tendency, and there is no cause for alarm. If the girl is plump and neither sign has appeared by age 13, a visit to the physician is advisable. Thinner girls tend to menstruate late and there are some benefits to this.

Boys show a fairly standard correlation between their state of maturity and physical performance. Girls who mature late are usually superior to their age mates in terms of strength, speed, and agility. Thinness can be a great advantage in many sports. Late maturers who are thin often excel in physical activities. This success fuels their interest for a longer time, which allows for more improvement of a skill which, in turn, increases their motivation to remain interested in sports.

Primary amenorrhea occurs when menarche does not start within the average time range after breast and pubic hair development. It could be due to a genetic disorder. One in 5,000 girls is born without a uterus. In very rare cases, the hymen is imperforate. The tendency to go on crash or fad diets should be considered. A certain level of fat cells is necessary to support estrogen production. However, in most cases, late developers are perfectly healthy. If there are no signs of puberty by age 14, visit the physician for a check-up.

Breast Reduction Surgery

The condition of oversized breasts in young girls is virginal hypertrophy. For some unknown reason, breast growth does not switch off at the usual time. If breast reduction is an option, keep in mind that the larger the breasts, the greater the risk of problems with surgery. The nerves to the nipples can be damaged during their transposition, with total loss of sensation. Grafting the nipples back rather than transposing them adds to this risk. After breast reduction, even with minimal nerve damage, sensation is reduced in both the nipples and the breasts.

Breast reduction reduces the chance of breast-feeding. One option is to wait until child-bearing is over, but a young girl then has to endure years of misery and pain.

Keep in mind that any type of cosmetic surgery does not always provide the expected outcome. This is particularly so with breast tissue.

In about 4 percent of cases, reduction surgery damages the blood supply to the areola-nipple complex. If this occurs, they die; tissue cannot live without blood. Artificial nipples are then constructed from genital tissue, and attached to the breasts. Obviously, there is no sensation left. To date, there are no reports that breast reduction carries a cancer risk. Women over age 35 should have a mammogram first.

A girl whose breasts remain small after puberty may plead for breast augmentation. This is not generally advisable until she is older. There is now considerable controversy over the health risks of silicon gel implants.

Self Esteem

"I like the way I look."
"I feel happy the way I am."
"I like most things about myself."
"I wish I were somebody else."

By the time they reached high school, less than one-third felt that way. The others had also suffered a drop in self-esteem. Mothers know this, often from past personal experience. The benefits of self-esteem are now better understood, and most parents do their best to boost a daughter's confidence through puberty.

The study found that boys also suffered a drop in self-esteem. Perhaps this drop is a reasonable part of growing up. The child loses what remains of egocentricity; she stops believing that the world revolves around her. For example, a 4-year-old thinks that the stars come out at night solely for her delight. A 14-year-old accepts that they do not, and has a diminishing sense of her own stature by comparison. Peer pressure is at its highest, and teens measure themselves against harsher critics than those at home.

Such events do not necessarily lower self-esteem. Yet puberty is a friable time; anything can alter anything for a while.

Body Image

Though a drop in self-esteem might be considered normal after puberty, the boys ended up with far more self-assurance than the girls. The question "How often do I feel happy the way I am?"

One curious finding from the study concerned racial factors. Far more black girls, than white and Hispanic girls, remained self-confident in high school. White girls lost self-esteem earlier than His panic girls. The survey raises questions about the effects of culture on self-concept. It also raises queries about the role of schools, both in the drop in self-confidence and in the role of intervention. One of the great disappointments for a boy at puberty occurs if he does not grow tall.

A girl can worry over her entire body image; she must also learn to cope with the monthly flow. It has become acceptable at menarche to tell a girl that her periods are a wonderful phenomenon to celebrate. She is now part of Mother Earth, at one with the moon, her glorious womanhood has arrived, and she should rejoice. This is a very grown-up response to menstruation, and one which only an adult mind can accept. Many girls dislike their periods; they feel diminished by the monthly flow. If they suffer cramps, the problem is compounded. They then face a quandary: either they cannot trust their mothers to tell them the truth, or they themselves are unnatural monsters to dislike their periods so.

For whatever reasons, self-esteem is put to its greatest test at puberty. Even a girl with a healthy self-concept can find it is shaken at times. A close friend suddenly turns enemy for no reason, an easy subject becomes difficult, a group she wishes to join rejects her. If her self-esteem is high, she is unlikely to blame herself for such failures or rejection. If her confidence is low, she may not bounce back easily. Studies show that the lower a girl's self-esteem when starting puberty, the more likely she will become estranged from her parents later.

Awful Adolescence?

"Who am I?"
"What am I here for?"
"Where am I going?"

The primary task in the teens is to find out who the self is. A girl struggles to assess herself realistically: to discover her strengths and weaknesses, to learn what she wants in life, to establish her own belief system. She may look for help to female teachers, women in various careers, pop stars, heroines from the past, and so on. More often, she looks to her peers; girlfriend attachments become very close.

An adolescent can be an exquisitively sensitive plant. Parents are excused if they sometimes forget this when faced with an over-critical, self-centred youth! Such unattractive behaviour is a defence mechanism to conceal flaws which the girl perceives in herself. Mood swings, often attributed to hormones, are due to fears of an unacceptable body image, and attacks of self-doubt.

Spuming parental advice and criticizing their lifestyle are all part of the search for autonomy. Denial of adult values seems an appropriate way to find her own. There is no excuse for obnoxious behaviour nor is there any need to tolerate it. Yet a girl's struggles for independence are a critical factor in the maturation process. If serious conflicts erupt, consider whether adult reins are appropriate for her age group. If so, check that they are consistently held. Reins which are too slack one day and too rigid the next can result in her taking tremendous risks--in case she has the right day. Youth is a time of risk-taking; teens regard themselves as invulnerable and life as ever-lasting.

If the early parent/child relationship was satisfactory, this stormy stage soon passes. If the relationship was unsatisfactory, consider professional help. Unconsciously, the girl is seeking revenge; she wants to return hurt now that she is old enough to do so. She also wants something of her own which nobody can take from her. Unsuitable boyfriends and pregnancy can be the answer.

Adolescents perceive issues in terms of black and white; there is rarely, if ever, an acknowledgment of grey. They lack the skills and maturity to accept that adults, particularly parents, are mixtures of frailities and strengths. Keep in mind that teens and parents both are learning new roles. They are equally capable of making mistakes. Guiding a daughter through adolescence can be the ultimate test of parenthood. Even difficult daughters stay close friends. One survey found that 87 percent of girls put down "Mom" as their best friend.

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