Teen Health
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Find tips and information you can use to get healthy and stay healthy in our new guide.
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Your body is changing; your moods may be unpredictable and sometimes even unexplainable. Don't worry. These changes during your teen years are normal.
Both boys and girls go through many changes during the teenage years. And while changes in girls are different than those experienced by boys, all of these changes are a natural part of your development into an adult. These changes are called puberty.
Puberty—How Your Body Changes
Puberty lasts for several years and marks the life stage when your body is changing from a child to an adult. Hormones help trigger and guide this process. Hormones are natural chemicals in your body that produce gradual physical changes during this time and may also cause emotional changes that can sometimes seem uncontrollable. These changes are common during puberty and they happen to everyone. Although it may seem that these changes and feelings are out of your control, don't worry, you're still you, just the "growing up" version.
Girls, one of the first changes you will notice are your breasts growing, usually between the ages of eight and 12. Sometimes, one breast might grow larger than the other. Don't worry—they will most likely even out before they are finished developing. Just like your ears, they aren't always a perfect match. This is true for every young woman. Once your breasts start growing, you will most likely want to buy a bra. (See under Resources, "Checklist for choosing a bra")
Another change you will notice is hair growth. Hair will grow under your arms, on your legs and on your pubic area. Shaving your underarms and legs is a personal choice. Some women do, others don't. It's your choice. If you decide to shave, make sure you use your own razor. Don't share razors with friends. And use either shaving cream or soap and water as a lubricant for shaving. If you want to shave, you should talk about it with one of your parents first. (See Resources, "Shaving: Do's and Don'ts.")
A less noticeable change is the widening of your hips and the slimming of your waist. Your stomach, bottom and legs might change shape, too. All of these changes are making you look more like a woman than a girl, and they are all normal, expected changes.
Another sign of puberty could be all over your face. It's called acne (otherwise known as pimples, or "zits"). This aggravating condition may be mild (blackheads and whiteheads), moderate (larger inflamed-looking blemishes) or severe (large cysts or nodules). Greasy foods and dirt do not cause acne; acne is caused by a build-up of oil, microorganisms and dead skin cells in the hair follicles under the skin. When whiteheads rupture, the "acne cascade" is triggered and surrounding tissue is affected. Keeping your face clean is one way to combat acne. Also, don't squeeze pimples. This can make them much worse and increase the chance of scarring. Often the condition of your skin during puberty will be similar to what your parents experienced when they were teenagers. If your acne concerns you, talk to your parents and/or a health care professional. The condition can be treated. (See Resources, "Myths and Facts about Acne")
Your menstrual period
The most significant change during puberty for many girls is their first period. Menstruation is a turning point in your development from a child to a teenager. Among other things, it means you are capable of becoming pregnant. Your first period can be unexpected, and you might be surprised to find that you have some bleeding from your vagina. Many young women might feel frightened by the sight of this bleeding or embarrassed if it causes a stain on their underwear or clothing. It's important to remember that this is a natural process and something that makes being a woman special. You can avoid any embarrassing situations by talking to your mom or another adult (even some dads know about these things, too!) about being prepared for your period.
Your first period is likely to occur between the ages of nine and 16. It usually lasts for three to seven days and then stops until the next period begins—usually about 21 to 28 days after your period started. This timeframe—from the first day you begin to bleed until the first day of your NEXT menstrual period—is called your "menstrual cycle."
During your menstrual cycle, one of your two ovaries releases one microscopic egg, called an ovum. (Your ovaries are reproductive organs approximately one and a half inches long and located in your lower abdomen, one on each side of your uterus; ovaries also release hormones that help to control your menstrual cycle.) The egg's release from the ovary is called "ovulation," and it usually happens in the middle of your cycle—around day 12 to 14 in a 28-day cycle. Ovulation can be irregular, though, when you first start having your period.
The egg then moves through one of the two fallopian tubes (the two tubes attached to the top of the uterus that lead to the ovaries). At the same time, body tissues and blood cells are beginning to line the walls of your uterus, forming a thin layer of material that will eventually be shed as your period. The amazing thing is, you won't feel any of this happening.
Compliments of the Kimberly-Clark Corporation
If you were to have sexual intercourse at this time, and sperm from a male partner would fertilize your egg on its way to the uterus, you would become pregnant. The egg would attach itself to the lining of the uterus and a fetus would grow inside of you. However, if sperm does not fertilize the egg, your body does not need this lining to support the fertilized egg. So, hormones trigger a different process and this lining gently falls away from the walls of your uterus and is released from your body through your vagina. This is often called the menstrual flow or period.
What you'll need
To avoid staining your clothes, you will need to use sanitary pads, pantiliners or tampons during your period. Sanitary pads and pantiliners fit inside your underwear and are kept in place with an adhesive strip on the back of the pad. There are a variety of pads with various thickness, lengths and absorbencies available for your use. Don't worry, you will find one that fits your body and absorbs your menstrual flow well. Pantiliners can be used at the beginning or end of your period when your flow is lighter.
Tampons are inserted into the vagina to absorb menstrual flow. Make sure you read the manufacturer's directions for putting a tampon in your vagina correctly. Both pads and tampons should be changed every four to eight hours or more often if needed. The number of days of a period lasts and the amount of menstrual flow is different for every woman. On heavier flow days, it is not uncommon to soak more than six pads or tampons. But if you find yourself needing to change your pad or tampon more often than that, you should talk to your parent, school nurse or health care professional.
It might take a while, perhaps even a year or longer, for your periods to become regular. During the first year, you may have your period as often as every two or three weeks, or as infrequently as every few months. Your periods may be heavy or light and blood flow may change from month to month. Even after your periods become regular, exercise, stress or a change in diet may throw it off track. Don't feel discouraged—over time you will learn more about your body and your menstrual cycle and be better prepared to deal with your period. If you anticipate your period is approaching, you may want to wear a pantiliner for extra protection.
Here are some things you might want to consider keeping with you:
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Two pads, liners and/or tampons, depending on your preference, in case your period begins unexpectedly.
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A medication, such as ibuprofen, to relieve cramps and perhaps other symptoms. It's important to make sure that you don't have any allergies to ibuprofen before taking it, and you should talk with your parent and/or health care professional about how much you can take for your menstrual discomfort. Check with your school about the rules for carrying medication; you may need to leave your medication with the school nurse.
How you might feel
You may feel uncomfortable for the few days leading up to your period. Your uterus may contract, causing cramps around your pelvic area (below your belly button). You may also feel bloated or "puffy." Breast tenderness and swelling, headaches, moodiness, back and leg aches, acne breakouts and nausea are also common symptoms for many young women before their periods start. These symptoms usually stop or aren't as bad a day or two after your period starts. If any of these or other symptoms are too much for you to deal with, discuss them with a parent and/or your health care professional. Many of these symptoms can be relieved by lifestyle changes, such as changing certain eating habits, exercising and with medications.
If, however, you have any of the following symptoms or if there is a possibility that you may be pregnant, talk with a parent and/or call your health care professional immediately:
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severe pain
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heavy bleeding (for example, soaking a pad or tampon every hour)
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bleeding that lasts more than eight days
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bleeding between periods
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skipping a period for six months or longer
Premenstrual Syndrome
Premenstrual syndrome (PMS) is a term used to describe a group of symptoms you may experience seven to 10 days before your period begins. These symptoms go away when your period begins or shortly after. PMS can include emotional symptoms such as crying or crankiness, and physical symptoms such as bloating, breast tenderness or headaches. If you have PMS, you're not alone. While about 75 percent of girls and women who menstruate experience some type of menstrual-cycle discomfort, three to eight percent of them experience symptoms severe enough to disrupt their normal activities—a condition known as premenstrual dysphoric disorder.
Under Resources, see "Premenstrual Syndrome (PMS): Signs and Symptoms")
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that affects about three to eight percent of girls and women who menstruate. In severe cases, PMDD can interfere with school activities and relationships.
Symptoms include:
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Severe mood swings, depression, irritability and anxiety. Do you experience uncontrollable crying spells, anger or depression so intense you can't function? Emotional symptoms are the ones most likely to lead your health care professional to diagnose you with PMDD.
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Sleep disturbance. Do you experience insomnia (inability to sleep) or need excessive sleep just before your period?
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Difficulty concentrating. Is it impossible or nearly impossible for you to study or pay attention in class?
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Breast tenderness and bloating. Do your clothes feel too tight? Do your breasts ache?
If you think you may have PMDD, try lifestyle modifications recommended for PMS and talk to a health care professional. Many of the emotional symptoms appear to be associated with low levels of a brain chemical called serotonin. Medication can increase the amount of serotonin in the brain, thereby minimizing PMDD.
Annual checkups and pelvic exams
Before the onset of puberty, all pre-teens should have an exam, according to the Adolescent Wellness and Reproductive Education Foundation. This visit is an opportunity to discuss your questions and concerns with your health care professional. It is also a time for you to gather printed material on a variety of health issues, including your menstrual cycle, contraception and STIs. A gynecological (pelvic) examination is usually not a part of this visit. You should be tested for STIs if you have had sex, and you should be screened for chlamydia and gonorrhea infections every six to 12 months.
Women should have a pelvic exam when they become sexually active or by the age of 18 if they have never been sexually active. A woman may need to have a pelvic exam before that if she has any health problems with her vagina, uterus or ovaries. And these days, many health care professionals recommend that young women be seen before their first sexual experiences. This way, they can provide young female patients with information about abstinence, contraception and STIs before they become sexually active.
Health care professionals realize that most young women are nervous and/or embarrassed during their first pelvic exams; your health care professional will most likely talk to you about what to expect before the exam. You will probably be asked to undress. If you are asked to undress, don't worry; you will be given a disposable robe or cover-up to wear and only those parts of your body being examined will be exposed. Some young women prefer to have their mothers or another person with whom they feel comfortable accompany them on the first few visits. You can decide whether that person comes into the exam room or not.
A Pap test is part of your annual pelvic exam. It examines the cervix for the presence of any abnormal cells that could be early signs of cancer, or cancer itself. The American Cancer Society recommends you have a Pap test when you become sexually active, but no later than age 18. Until you turn 30, you should have a Pap test every year. Your health care professional may use a traditional Pap test or a liquid-based Pap test. If you're not sure, ask your health care professional what type of Pap test she uses.
If you have three normal tests in a row, you may be able to wait for about three years before having another test. Ask your health care professional when you should schedule your next one.
Here's how a regular Pap test is done:
In an examination room, after you are comfortably lying on an examination table, a health care professional will gently insert a small plastic or metal instrument called a speculum into your vagina and lightly brush cells from your cervix. The cell sample will be placed on a slide and sent to a laboratory where it will be examined under a microscope for abnormalities in the cell structure.
If any abnormalities are found, you may need to have a Pap smear more often than one time per year. Abnormalities could be signs of cervical cancer or viral infections such as human papillomavirus (HPV).
Your annual visit may include a breast exam. If so, your health care professional will examine both of your breasts for any unusual lumps and other abnormalities such as redness, pain or discharge. He or she will do this both by sight and by touch. You may feel embarrassed during this exam. Try to keep in mind, however, these types of examinations are critical for your health and are part of learning to take good care of yourself as you grow older. Your health care professional can also teach you how to do regular breast self-exams so that you can monitor your own body and become aware of any concerning changes.
Remember: the discussions you have with all of your health care professionals are confidential. Some of the topics you may discuss with your health care professional include menstrual problems and general women's health including mental health issues, sexual activity or sexual problems, contraception, preventing and screening for sexually transmitted infections (STIs) and pregnancy. (See under Resources, "What to Ask During Your First Gynecologic Appointment.")
Dating
As if puberty isn't confusing enough, this is also the time most teenagers start dating. School dances and parties are dating opportunities, although most of these activities do not require a date. Rather, some girls choose to go to these events and others like them with another girl or a group of friends. And while some girls are romantically interested in boys, some are romantically interested in girls, and some are romantically interested in both. Sexual orientation is defined by whether you fall in love with, are attracted to, or engage in behaviors with someone of the same sex or someone of the opposite sex. Sometimes, if your sexual orientation is not toward the opposite sex, you may feel sad, worried or even different. Talking to a health care professional about these issues may help you feel better or get you the support that you might need.
If you are asked on a date, ask yourself these questions to help make sure it's something you want to do and that you'll be safe and have fun:
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Do you trust the person?
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Do you have common friends and/or interests?
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Do you feel pressure from this person in any way at all, to become sexually intimate or to do something you feel is wrong?
If this person is someone you decide you would like to spend time with, starting a relationship and friendship could be exciting. This person could become someone special in your life—someone you can trust and depend on. You could be the same to him or her. Through your relationship, you could teach each other about respect, honesty, communication and loyalty.
If you date one person for a while, you might feel pressure to become sexually intimate. Friends will be curious and question you whether you've "done it." Your parents might start talking to you about making the right choices about sex, and your partner may start letting you know that he or she would like to have a more sexually intimate relationship. But just because you have been dating the same person for a while is not a reason to have sex, especially if you're not ready!
Besides the possible physical outcomes—such as getting pregnant or becoming infected with an STI—there are emotional factors connected to sex to consider as well. You could feel regret, anger, shame or guilt afterwards. Most parents, health care professionals and others will advise you to wait until you are an adult to have sex. You'll be far more able to handle the personal and health responsibilities that go along with having sex. Consider these issues before you have sex:
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If you don't want to get pregnant, are you prepared to use contraception?
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What if you became pregnant? What would you do?
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What if you contracted HIV and developed AIDS? Are you ready to deal with a heavy-duty sickness and possibly the end of your life?
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What if you contracted another STI and got sick, or and passed it on to another person? How would you feel?
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What if you had sex with someone before you were really ready and it turned out to be an unhappy experience?
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Can you consider saying "no" to your partner if you're not ready to have sex, and not feel pressured by friends who ask you about your sexual experiences?
Your parents, a health care professional or any adult with whom you can confide can help you to think through these issues before you find yourself in a situation where you might feel pressured to have sex before you're really ready.
Self-Esteem
Self-esteem is the way you think about yourself and what you expect of yourself. The foundation for positive self-esteem is built at an early age and is influenced by relationships between you and your family. Your feelings about yourself will change as you grow. Praise and criticism from parents, friendships at school and attitudes from teachers will continue to affect you from preschool through high school. Persistent criticism, teasing and failures can make you feel worthless. Praise, support and finding something you are good at can help you develop confidence in yourself.
That confidence, or lack of it, may affect decisions made during puberty. All kinds of peer pressure and outside influences can guide you as a teenager and affect your decision making process. The depth of your self-esteem also affects those decisions, whether it's about playing one sport over another, who to hang out with, which electives to take in school or other situations such as smoking, drinking or deciding to have sex. (See under Resources, "Boosting Your Self-Esteem")
Tough Decisions
Are you ready for sex? Deciding when to engage or not engage in sexual relations is one of the most important decisions a person, of any age, can make. Some girls you know may already be sexually active. About 53 percent of all teenage school girls are not having sex, according to a 2002 study by the U.S. Centers for Disease Control and Prevention (CDC). It is a decision that could affect the rest of your life. Take it seriously and know the risks, from getting pregnant to becoming infected with a sexually transmitted disease, not to mention other emotional and physical risks that can come into play when teenagers have sex.
If you are sexually active, the best way to prevent getting a STI is by using a latex condom. This is true for oral, vaginal and anal sex. Lesbian couples who practice oral sex can use a dental dam to prevent getting an STI. The use of latex condoms during vaginal sex also prevents pregnancy. You can also use additional forms of birth control to prevent getting pregnant. These other types of birth control are called "contraception." No method, however, is 100 percent safe. The only foolproof way to keep from getting pregnant or avoiding getting an STI is not to have sex.
Sexually Transmitted Infections (STI)
STIs are spread by sexual intercourse or genital contact. You can contract an STI from having oral, vaginal and/or anal sex with an infected partner. Almost four million cases of sexually transmitted infections occur among teenagers every year, according to the CDC.
You may have heard about some STIs, such as HIV/AIDS, chlamydia, gonorrhea and herpes. But there are many other STIs to know about, so read on.
You are most likely to get an STI during your teen and young adult years—more than two-thirds of all STIs occur in people younger than 25. Because STIs often cause no symptoms (especially in girls and women), health care professionals recommend that sexually active girls and women routinely be tested or screened for STIs. If you are too embarrassed to talk to your health care professional, discuss the issue with a school nurse or call your local health department, Planned Parenthood or the U.S. Centers for Disease Control and Prevention's STI hotline. There are many places in your local area where you can get free and confidential STI counseling and testing. (See list of hotline numbers at this Web site)
Treating some STIs is a snap—you simply have to take antibiotics. But the health consequences of an untreated STI can be severe. Unfortunately, the most common STIs, human papillomavirus (HPV) and herpes, are viral diseases that can't be cured. Lack of treatment may result in more consequences, including permanent damage to your reproductive organs, which could make getting pregnant when you are older difficult. Some STIs can also cause problems during pregnancy or delivery. (See under Resources, "STI Symptom Checklist")
The more common STIs are listed below:
Having unprotected sex and/or multiple sex partners places you at higher risk for STIs. Many STIs have no symptoms when you are first infected, so you may have an infection without knowing it. If you are sexually active, be sure to have regular check-ups that include STI screenings; that way if you have an infection, it can be detected and treated (if possible) at its earliest stages.
More than half of teens who are sexually active say they used a condom the first time they had sex, according to a 2002 CDC survey. However, only about one quarter of teens say they regularly use a condom.
When used correctly, male latex condoms and female condoms used during sexual intercourse can help reduce your risk of getting many STIs, including HIV (the virus that causes AIDS); male and female latex condoms don't prevent all STIs transmitted by skin-to-skin contact, however.
And for HPV, now there is something you can use to protect yourself against HPV/cervical cancer in addition to regular pap tests and safe sex: An HPV vaccine. The FDA recently approved the vaccine—called Gardasil—for women ages 13 to 26 after clinical trials showed the vaccine is safe and 100 percent effective in preventing HPV strains 16 and 18, which cause 70 percent of cervical cancers. Gardasil, given in three injections over six months, is also 99 percent effective in preventing HPV strains 6 and 11, which cause about 90 percent of genital wart cases. Although Gardasil prevents the bulk of HPV strains, it doesn't protect against all of them, so the FDA recommends it as a complement to pap tests. Furthermore, the vaccine does not work if you are already infected with one of these HPV types. It has to be given before infection. Talk to your health care professional about Gardasil if you are sexually active or considering having sex.
You may feel awkward and embarrassed to ask questions about sex, but if you are sexually active or even considering having sex, not knowing about how to prevent STIs and pregnancy is dangerous. That lack of knowledge can harm you. Get the facts from someone who knows, whether it's a parent, brother or sister, health care professional or teacher.
Mental Health
Overall health means more than simply being in shape and eating properly. Mental health, which includes your thoughts and feelings, is just as important as physical health.
During your teenage years, various things may make you sad or get you down. For example, if someone makes fun of your clothes or if you don't do well on a test for which you thought you were prepared. But if you are constantly feeling down or upset about something, you could be depressed. Depression is a mental illness, but it is treatable once it is accurately diagnosed. Many teenagers experience depression.
Take the following quiz:
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Do you cry more now than you used to?
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Do you think your life is hopeless or meaningless?
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Do you have a hard time sleeping, either sleeping too much or falling asleep at night?
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Do you spend more time alone than you used to?
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Do you ever think of hurting yourself?
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Do you often feel worn out?
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Have you felt unusually irritable lately?
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Have you gained or lost weight in the last month or two?
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How is your appetite? Are you overeating or undereating?
If you answered "yes" to several of these questions, talk to someone about getting help and feeling better. This person could be a teacher, a coach, your parent, an older sibling or someone else you trust, but TALK WITH SOMEONE. Take a few minutes to make a list of people who you can call.
Depression, if untreated, may cause you to feel like hurting or killing yourself. Suicidal feelings are a very real problem that should be taken seriously. According to the American Academy of Pediatrics, suicide is the fourth leading cause of death for adolescents between 10 and 14 years of age and the third leading cause of death for those 15 to 24 years old. A 2003 CDC Youth Behavior Risk survey showed 21.3 percent of girls | 
