Adolescence is a very important time in life. It is a time of many changes, emotional as well as physical. Many decisions that you make now will affect your life and health for years to come. We have written this booklet to address some common questions and concerns as well as to give you information that we feel is important in making these decisions.

Aside from the physical changes that you see occurring to your body as it changes from a child's to an adult's, there are important mental changes going on as well. You are thinking about things differently now and that is important and expected. Before you become an adult you must decide several different issues: your moral and ethical framework, which may be different from your friends' or parents'; what kind of work or career you will follow; your ideas about sex and intimacy, and the ability to have a satisfying relationship; and the ability to separate from your parents and family - emotionally and financially. In other words, you must become your own person.

Now that you are no longer a child (if not yet an adult), we will be treating you differently as well. There may be issues that you need to discuss, some of which you may feel you are not ready to discuss with your parents. Anything that is said to us will be kept confidential, and, except in situations that may be dangerous to you or others, we will not tell your parents without your permission. If we need to talk to your parents without your permission, we will tell you first, and explain why we feel it is necessary. For that reason, we encourage you to see us without your parents present, if you feel comfortable doing so, and also to call us directly with any problems or questions.

Back to Top

Puberty is a term that refers to the time when your body changes from a child's to an adult's, and becomes physically ready to create a baby. This is a process that takes several years. The age at which you first notice changes in your body and feelings varies from person to person - it usually starts earlier in girls than in boys. Because there is a wide range of "normal" in terms of how old you are when these changes first start, there usually is some concern if you start much earlier or later than your friends. The following is an explanation of the pattern and timing of changes in both boys and girls, which may help answer some of your concerns. If you have questions or worries, please ask.

We usually talk about the changes of puberty in stages. Stage I is a child and Stage V is an adult. These stages apply to both boys and girls, and since certain events are most common at certain stages, we will use that term here.

Girls: For girls, the first external sign of her changing body is the development of the breasts. This is referred to as stage II, and occurs anywhere from 8 to 14; the average age is 10. It is normal sometimes for one breast to be a little larger than the other, or to grow faster; don't worry, it will even out in the end. About 6 months after the first breast growth is seen, pubic hair starts to grow (hair on the labia, or lips, around the vagina). When the hair first starts to grow, it's thin, straight, and usually lighter in color than it will be when you are older.

In stage III, the breasts become larger, and each nipple and areola (darker skin around the nipples) become larger. This is the stage where you will probably need to wear a bra, at least under some of your clothes. The pubic hair becomes thicker and more curly and grows higher on your abdomen. During this stage many girls notice a clear or white vaginal discharge. This is normal and not a sign of an infection. It is a sign of increased production of the hormone estrogen. If you have a lot of discharge, you can wear a panty liner, but powders and feminine deodorant sprays are not necessary and may cause irritation or an allergic reaction.

During stage IV, the breast, areola, and nipple continue to grow in size. Some girls will notice a brief time when the nipple and areola seem swollen, and actually form a second small mound on the breast. The pubic hair continues to thicken and become more curly, and is the adult pattern except that it doesn't extend to the inner thighs.

You will have some underarm hair by now and may need to use deodorant. You have been growing faster throughout this time, but suddenly you may seem to grow very fast, becoming taller than many of the boys in your class. This is termed a growth spurt and after the growth spurt stops is when most girls will start their menstrual periods.

Menstruation, or menses, (your period) is when the lining of the uterus separates and leaves the body if it is not needed to nourish a baby. Your body has a reproductive cycle that averages 28 days, although this will vary from person to person and from time to time in the same person. The cycle is counted from the first day of your previous period. The estrogen (female hormone) level starts to rise and continues until the 14th day (mid-cycle) when signals are sent that cause one of the ovaries to release an egg. This is called ovulation. Once this occurs you can become pregnant if you have sex. If sperm (from a man) joins the egg, this is termed fertilization, and a baby starts to grow. After ovulation the ovary starts to produce a hormone called progesterone. This causes the lining of the uterus to become able to nourish a fertilized egg. If the egg is not fertilized in 2 to 4 days after ovulation it dies, and gradually the production of progesterone from the ovary stops as well. When the hormone levels fall, the lining from the uterus separates and leaves the body from the vagina. This is called the menstrual flow, and is formed from blood and tissue that your body no longer needs. Then the cycle starts again.

It is normal for the first year or two after your periods start to be irregular; you may even miss a couple of months. Also, the duration of your period can vary from month to month at first. The average cycle is 28 days and the average duration is 5 days once things have settled down.

The choice of whether to use a pad or a tampon for your period is a personal one. Discuss it with your mother. Certainly there are circumstances where a tampon is more convenient, such as swimming. Girls that are virgins can use tampons, and they cannot get "lost" inside. However, they must be changed about every 4 hours and should not be worn all night, or when flow is light.

Stage V is adult. The breasts have stopped getting larger and the pubic hair is the adult distribution, extending to the inner thighs and in some women up the abdomen. You may now wish to shave or wax these areas to wear swimsuits. Most of your growth in height is now finished. Most girls have reached this stage by age 14 to 15.

Many girls have concerns about their weight, and most would like to be thinner. Most of the weight that women gain during puberty is extra fat, primarily in the breasts, buttocks, and thighs. This is normal and necessary for the female shape. Girls that do not have enough body fat will not have normal periods. This is nature's way of ensuring you have enough energy stores to grow a baby. Models and actresses are thinner than average and not everyone will be able to look like they do. If you have concerns about your weight, please discuss it with us. Fad diets and rapid weight loss are not healthy at any age.

Boys: For boys, the first sign of pubertal changes is an increase of the size of the testicles or testes (balls), and the scrotum (skin covering the testes) becomes darker. This happens between the ages of 9 to 13 1/2; the average age is 11 1/2. About 6 months after the testes start to grow, you will notice the growth of hair at the base of the penis. This is called pubic hair, and at this stage is rather thin and only slightly curly. These changes are part of Stage II.

Stage III changes cause a further increase in the size of the testes, and now an increase in the size of the penis as well, primarily in length. The pubic hair will become darker, thicker, and more curly, and spread to cover the base of the penis. During this stage most boys will have nocturnal emissions (wet dreams). This is the release of semen from the penis during sleep. It is a natural body function, very common during adolescence. It is not "bad" or harmful in any way. Also, most boys start having more erections. This is when the penis fills with blood and becomes "hard". It is usually caused by sexual stimulation (physical or mental), but can be caused by any strong emotion. Although it can be embarrassing if it occurs in public, try not to worry about it. You will have more control as you get older.

During stage IV there is further growth of the scrotum and the penis, this time mostly in width. The pubic hair is now adult type and is starting to spread up the abdomen. Although your rate of growth has been slowly increasing since stage II, it is now that most boys have their "growth spurt", and may grow one or more inches in just a few months. It is also during this time that you will notice increased muscular development, especially of the chest and arms. The increase in muscle is from the increased levels of testosterone (male hormone) that are present. However, this increase in testosterone can also cause problems with acne. Many boys during this stage will notice a temporary increase in breast size. It is seen to some extent in about 60% of all 14 year olds. Although it can be embarrassing, and sometimes quite tender, it is perfectly normal, and usually lasts less than 2 years. This is also the stage when most boys will notice the growth of facial hair. Your ethnic group and heredity determine the amount of facial hair. It is not an indication of how masculine you are.

Stage V is the adult stage. The penis and scrotum are adult size and shape, and the pubic hair has the adult distribution, spreading to the inner thighs and up the abdomen toward the umbilicus (belly button). The average age to reach stage V is 15. Although girls have essentially finished growing by stage V, boys will continue to have increases in height and muscle tissue for several years.

The deepening of your voice is due to the effects of testosterone on the larynx (voice box). This can start during any of the above stages. In some boys, their voices will completely change over a few months; in others it make take years for the voice to finish deepening. Both variations are normal, and the pattern runs in families.

It can be very frustrating to be a "late bloomer". Besides being different from your friends, it is hard to compete athletically with kids who are much taller and more muscular than you are. Try to find sports such as tennis or swimming where size is less important. Until your body is ready to grow muscles, all the protein drinks or weight lifting won't give you the build you might like. Try to be patient, the changes will come when your body is ready for them.

For both boys and girls, the rapid growth and changes during puberty require proper nutrition and enough rest. Most teenagers do not get enough sleep during this time. Try to get 8 to 10 hours per night. Also you need a proper diet: enough calories, vitamins, calcium, and protein to allow your body to grow. You should be getting 3 to 4 servings of dairy products, 3 to 4 servings of protein, 4 to 6 servings of fruits and vegetables, and 6 to 8 servings of grains, rice, pasta, or potatoes per day. Most teens eat too much fast food, which is too high in salt and fat and does not include enough fruits and vegetables.

Back to Top

Acne or "zits" is a common skin problem. It usually starts in adolescence, and almost all teenagers have some problem with it at times. It is caused by the hormonal changes that occur during the teenage years and the effect of those hormones on the oil glands that are located just beneath the surface of the skin. The hormones cause these glands to become more active.

The oil glands empty onto the skin through tiny tubes, or ducts. The increased oil production sometimes causes those ducts to become "plugged". If the opening to the surface remains closed, then whiteheads appear. If the duct is open, then the plugged material will turn dark on exposure to the air and blackheads are seen. If bacteria infect the plugged material, then the result is acne.

Acne is not caused by greasy foods, lack of sleep, sex, masturbation, or not washing properly. Heredity does seem to play a role, and if one or both your parents had trouble with acne, chances are you will too. Boys have a tendency to have more severe problems with acne, because of the increased amounts of testosterone present. Some girls will notice an increase in skin problems right before their period because of hormone shifts. Some people also note that certain foods or increased stress seem to aggravate their acne as well.

Acne is treated by:

1) Keeping the openings of the oil glands unplugged

2) Keeping the bacterial count of the skin as low as possible.

If you have mild acne usually washing your face well with a mild cleanser twice daily, and using one of the over the counter preparations, such as Oxy-5 or Clearasil is enough. If this does not seem to work after a couple months, please let us know. There are many treatments for acne that are available. However, no matter what method is used, the pimples that are already present will need to heal - the treatments are primarily to prevent new pimples from forming. You have to use any treatment consistently for 4 to 6 weeks to see results. Unfortunately, there is nothing that will magically clear your face overnight.

DO:

Wash your face twice a day or more with a mild soap.

Keep hair off your face.

Keep hair free of oil by shampooing frequently.

Men should shave as lightly, and as infrequently as possible.

Women should avoid makeup, and when makeup is need use only noncomedogenic (non acne forming) makeup.

Eat a balanced diet, with fruits and vegetables to maintain a good complexion.

DON'T:

Squeeze and pick at pimples and blackheads (this can lead to scarring).

Use greasy or oily cosmetics or oil based sunscreens.

Use greasy or oily conditioners or treatments on your hair.

Acne related sites to visit: Acne Information

Back to Top

---

MENSTRUAL CRAMPS

Cramps with your period are very common. Almost 60% of teenage girls have some discomfort occasionally. Only 15% will have pain sufficiently severe to miss school and participation in usual activities. There are medications that can help.

At the time of your period the lining of the uterus releases chemicals called prostaglandins (PG). These chemicals cause the walls of the uterus to contract, which causes the separation of the uterine lining, and the menstrual flow. Some people either produce too much PG or their body is too sensitive to it. This excess PG causes the painful uterine cramping, pain in back or thighs, nausea, vomiting, or diarrhea that some girls experience. If you have any of these symptoms with your period, we recommend using ibuprofen (Motrin, Advil, Nuprin, etc.) to relieve your discomfort. This medication acts to directly inhibit the PG, and therefore works much better than aspirin or acetaminophen. If you weigh under 110 pounds, you make take 2 tablets (400 mg) every 6 hours, and if you weigh over 110 you may take 3 tablets (600 mg) every 6 hours. Usually taking this medication during the first 2 days of your cycle is enough.

During the first 1-2 years after you start your periods, you may not be ovulating. That is why some girls are very irregular at first. Usually cramps don't start until you are ovulating. If the ibuprofen does not relieve your symptoms please let us know. There are other medications that can be tried.

Back to Top

---

BREAST SELF EXAMINATION

Breast cancer is the number one killer of American women. It is not seen in the teenage years, but is occasionally seen in women in their 20's. It is an important habit to develop now. We recommend that you start examining your breasts around age 14. You should examine yourself the same time each month, since hormonal changes can cause the breasts to enlarge slightly or to feel different. The best time to do it the last day of your period.

First you want to look at yourself in a mirror. Notice any difference in the size or shape of the breasts, any dimpling of the skin, or any change in the position or the appearance of the nipple. Now make the same observations with your arms raised over your head. Next gently squeeze the nipple, and the dark area around the nipple and note whether there is any discharge.

Now you need to feel the breasts for any lumps. You can either do this in the shower - some women find it easier when the skin is slippery with soap - or lying down on your bed. Use your left hand to feel the right breast. Start at the upper edge, and gently feel around the outside of the breast. Now move the fingers in toward the nipple an inch, and again feel around the entire breast. Do this procedure again, moving toward the nipple, and feel underneath the nipple as well, until you have felt the entire breast. Repeat the procedure with the opposite hand on the other breast. If you feel anything unusual, let us know. Lumps during the teen years are not cancer, but some lumps should be watched, and some may need to be removed if they continue to grow.

That's it! It is easy to do. Remind your mother to check herself as well.

Back to Top

---

TESTICULAR SELF EXAMINATION

Cancer of the testicle is rare, but it can be found in men as young as 15. It is curable if it is discovered early, and therefore it is important that your examine yourself on a regular basis, so that you will learn what your own body feels like, and let us know about any changes.

Once a month you should feel your testicles carefully. Compare the right to the left, and make sure that they have the same consistency. Feel for any lumps, or a section that feels harder, or larger than usual. Also note whether the testes are about the same size. It is normal for one to be slightly larger than the other, but you should note any recent change. If you discover any changes, or have any worries or questions, please let us know.

Back to Top

---

DEPRESSION

Many teens have feelings of depression - feeling sad, disappointed, and discouraged - at times. These feelings are normal. However, if these feelings last too long, or are too extreme, then the term "depression" is used. This is an awful way to feel and many people that feel this way for a long time will try drugs or alcohol to try to make these feelings go away. However, usually drinking or drugs make these feelings worse. Sometimes when these feelings are very severe, people may think that killing themselves (suicide) is the only way to escape feeling bad.

There are ways to cope with depression and to make yourself feel better. If you have any of the feelings below, and they last more than a few days, please let us know. If you notice that any of your friends seem to feel like this, let someone know, so that they can get help.

Signs of depression:

1. Feeling sad, hopeless, and discouraged almost all the time

2. Loss of interest and pleasure in usual activities

3. Noticeable changes in eating and sleeping habits

4. Radical personality change

5. Unusual neglect in appearance

6. Loss of energy

7. Feelings of guilt and worthlessness

8. Unable to think or concentrate

9. Drop in grades

10. Recurrent thoughts of death and/or suicide

11. Giving away prized possessions

Back to Top

---

DRUGS, ALCOHOL, AND CIGARETTES

You have probably read a lot and heard a lot about drugs and that you should just "say no". We want to tell you a little about some of the risks of drug, alcohol, and cigarette use on your health, so that you will hopefully decide that these substances do not belong in your life. If you do drugs, drink alcohol, or smoke, we ask that you tell us, since these habits directly affect your health and may affect medications that you are taking.

People take drugs to change their mood and the way that they feel. Obviously people that use drugs are not happy with themselves or their circumstances, or they would not need to use them. Unfortunately, using drugs to change your mood or feelings doesn't work - while you're using them you can't think about or change things that may be bothering you, and when you come "down", those same problems and feelings are still there. The "high" that you may feel from drugs is artificial and not nearly as satisfying as the "high" you can get from accomplishments and relationships that are yours alone.

Drugs are dangerous since they can affect your judgement and get you into situations where you can get hurt, or cause harm to others. In addition, many drugs are addictive, and since every one is different, there is no way of predicting how a certain drug will affect you. That is why even trying drugs can be a dangerous and unhealthy thing to do.

Your friends are very important, so if you hang out with kids that are into drugs, you are more likely to be tempted to try drugs and then start to become a regular user of drugs. Although it can be difficult to withstand pressure from your friends, NOT everyone uses drugs. MOST do not!

Alcohol is a drug as well, but in a special class, since society has accepted it's use for adults. However, as you are starting to discover, adults don't know everything and can sometimes make bad choices. Alcohol is quite addictive to some people. The tendency to become addicted to alcohol seems to run in some families. If anyone in your family has a problem with alcohol, that is a very good reason why you should not use it, since you also may have the tendency to become addicted. When you drink you cannot make good choices and your physical reactions are also impaired. NEVER drink and drive or ride with someone who has been drinking. Drunk driving is a leading killer of teenagers, even when they are not the ones that have been drinking.

Tobacco is one of the most addictive substance known. Smoking is the leading cause of lung cancer and a major cause of heart disease, the leading killer in this country. Often teens don't think about the risks of tobacco, since they usually occur to people that are older and have been smoking for many years. Teens often use cigarettes to appear more grown up and sophisticated like the ads appear to show, but sophisticated people do not smoke. Some effects of tobacco that occur right away are: damage to the lungs which will interfere with your ability to compete in sports; staining of the teeth; bad breath; and increased number of colds and chest infections. Adults are becoming more aware of the dangers of cigarette smoking and the effects of the smoke on people nearby. That is why more and more businesses, airlines, public buildings and areas are "no smoking" areas.

Since cigarettes are so addictive, it is important that you do not experiment with them. If you never start, you will never have to quit. If your parents or friends smoke, ask that they not smoke around you, and encourage them to stop.

Back to Top

---

ACCIDENTS AND SAFETY

Accidents are the leading cause of death in the teenage years. They are also the leading cause of handicaps and permanent disability. By definition accidents are preventable, but things do happen. We will discuss ways in which you make yourself safer.

Bicycles are a good way to exercise, and until you are old enough to drive bicycles are your main transportation vehicle. We are lucky here that biking is available throughout the year. However bikes can be dangerous, especially when riding in traffic. Now that you are older you will be able to go further on your bike, and be allowed to take routes that younger kids are not. That makes wearing a helmet when you ride even more important. Injuries to the head are the most serious injuries that we see with bikes, and even if you survive, bike accidents are a leading cause of paralysis and permanent handicap.

We know that helmets may not be "cool" to wear in your circle of friends, but set an example for them and for younger kids. Professional bikers wear helmets. When enough kids start using them then they will be cool.

Drowning causes many deaths each year, most often of very young children, but teenagers are the next largest group. It is not that teenagers don't know how to swim, but they take risks around water. You should always swim with a friend. Never dive in an area you don't know and where you can't see the bottom. Alcohol and drugs do not mix with swimming - your judgment will be affected. And take a CPR course so that if anyone is in danger of drowning, you will know what to do.

The most serious accidents are automobile accidents. You should always wear a seatbelt, every time you are in a car, as a driver or as a passenger. Remind your parents and friends to do the same. Once you are old enough to drive remember to drive safely. Never, never drink or take drugs and drive, nor ride with anyone that has. If you are at a party and the driver is drinking or taking drugs, don't ride with them! Call your parents, or call a cab to get home.

Back to Top

---

INFECTIOUS MONONUCLEOSIS ("MONO")

Infectious Mononucleosis, or "Mono", is an illness commonly associated with teenagers, but can occur at any age. It is caused by a virus (Epstein Barr Virus, or EBV), and therefore antibiotics will not help. The illness typically causes fever, sore throat, white or yellow spots or streaks on the tonsils, swollen lymph glands, and usually an enlarged spleen. In the older patient there is extreme fatigue that can last for 2 to 4 weeks, even after the sore throat and fever have gone. The virus is passed through the saliva, which is why it is sometimes called the "kissing disease", but you can catch it even if you haven't kissed anyone.

If the spleen becomes enlarged as a result of this infection, it can be problematic. Usually the spleen is protected by the ribs, but when it enlarges, it drops beneath the ribs and can be easily injured. This is why football and other contact sports are avoided for several weeks. If you develop mono with an enlarged spleen, we will not let you return to your usual activities until the spleen has returned to normal size.

Since the symptoms of mono are similar to those of Strep throat and other illnesses, an appointment for evaluation in the office is necessary. There are laboratory tests that can be done to diagnose mononucleosis, but since there is no specific treatment, these tests are not usually necessary.

Scoliosis is a term that refers to an abnormal curvature to the spine. You may have already had your back checked by us, or by the school nurse and wondered why. Scoliosis often appears during the teen and early teen years when you are growing so rapidly. Many people have a slight curve to the spine, but if the curve becomes too great, it can look funny, making one shoulder or hip higher than another, or if really severe interfere with how well you can breathe.

If a curve is detected when we look at your back, we may send you for X-rays to determine exactly how big a curve there is. If it is slight we will look at your back several times a year until you stop growing to make sure that it is not getting worse. If the curve is greater we may recommend that you see an orthopedic (bone) doctor. He/she may give you special exercises or have you wear a brace at night for a while to make sure that the back grows straight.

Back to Top

---

SPORTS INJURIES

Hopefully, most of you are active and participate in some sports or recreational activities - it's fun and good for your overall health. However, accidents and injuries do occur. Obviously, we will see you if the injury is severe, but it is important for you to know what to do for minor bumps, strains, and sprains that may not need a doctor visit.

All soft tissue injuries are treated the same way to start: Rest, Ice, Compression, Elevation (RICE). It is important to rest the injured area as completely as possible for 48-72 hours. This lets your body start to heal the injury, and prevents you from aggravating or reinjuring the same area. Ice is most important and should be applied as soon as possible after the injury occurs. However, it should only be left in place for 20-30 minutes at a time, since longer exposure to ice can cause damage to the skin and tissues. Also, always use a damp cloth or elastic bandage next to your skin - don't apply the ice directly. You should continue to apply ice for the first 24-48 hours after an injury, 20 minutes at a time, at least four times a day. After the first 48 hours, mild heat is often helpful to increase blood flow and speed the healing response.

Compression of the injury helps keep any swelling to a minimum. This may be accomplished by using an ace wrap or elastic bandage around the injured part. It should not be tight enough to cause discomfort. Swelling at the site if an injury will mean that it will take longer to heal, and make movement more painful. Elevation of the injured area also helps reduce the swelling, and is especially important when the legs or feet are injured.

Injuries are painful at times and certainly acetaminophen (Tylenol) or Ibuprofen (Motrin, Advil, Nuprin) are fine to take. Ibuprofen has added anti-inflammatory activity in addition to pain relief, making it superior to acetaminophen for many injuries. Avoid taking aspirin for injuries. Aspirin makes it harder for your blood to clot properly and can make bruising worse.

You need to be seen by a doctor if:

There is a deformity of the arms/legs.

You have a cut which is gaping or the bleeding can't be stopped.

You have been unconscious, even for a brief period, or you can't remember what happened.

You are unable to use your arms/legs.

You are not doing better after using the above treatment.

Back to Top

---

STEROIDS

There has been a lot of information lately about steroid use in athletes, even as young as junior high. The world has become a very competitive place, and its tempting to think that just taking a pill will give you an "edge" in the competition. It is important that you know the risks of using these drugs to improve athletic performance or appearance.

Anabolic steroids are derivatives of the male hormone testosterone. In combination with a high protein diet and vigorous workouts, they do increase muscle mass and strength. Just taking the hormone without the training does not seem to do anything. There is no evidence that using them will improve overall athletic performance - they have no effect on endurance or aerobic capacity. Also, the increase in muscle mass that is seen after steroid use doesn't last after the drugs are stopped. The body will return to its usual state.

Because these drugs are often taken intermittently, and taken in various combinations, side effects are sometimes not predictable. Also, many of the drugs in this area come illegally from Mexico, and the same "pill" may have different potencies from batch to batch. In other words, you may not really be taking what you think that you are taking.

The following is a list of the side effects that have been seen in people that take steroids. They do not happen to everyone who takes them, and some of them are temporary, but they have happened to some people and could happen to you.

1) Growth Stunting - People who take steroids before they have finished growing will be shorter than they would have been had the growth finished normally. The bones fuse faster. This is especially important for teenage boys, since most will continue to grow until age 18 and some into their twenties. This effect is NOT reversible.

2) Liver Effects - Steroids cause an increase in the liver enzymes, and in some cases have been reported to cause a type of hepatitis, and liver tumors. Usually the jaundice and the change in the liver enzymes will go away when the drugs are stopped, the tumor will not. Although a rare effect, it can be fatal.

3) Cardiovascular Effects - Steroids can lead to an increase in blood pressure as well as increase in the cholesterol and fats in the blood that can lead to heart attacks in older people. The blood pressure changes seem to go away once the drugs are stopped, but the fatty plaques that may be formed from the increase in cholesterol may remain and lead to an increase risk of heart disease.

4) Psychological Effects - Steroids have a tendency to make you more aggressive than usual, which can get you into trouble even on the football field. There have also been some people who acted "crazy" while taking these drugs, actually hallucinating, and have been hospitalized. These effects seem to be reversible.

5) Endocrine Changes - Because these are drugs are similar to testosterone, most of the side effects are seen in this category. In boys, this can cause increased acne, a decrease in the natural testosterone production which causes the testes to shrink in size, a decrease in the sperm count, decreased sex drive, baldness, and increase in size of the breasts. In girls, the side effects seen are growth of facial hair, deepening of the voice, decreased breast size, baldness, and abnormal periods. Some of these changes are NOT reversible.

We strongly recommend that you do not use steroids. However, if you do take them please tell us, since they may cause abnormal lab results, or interfere with other medication. If you have questions, please ask.

Back to Top

---

SEXUALLY TRANSMITTED DISEASES - STDs

The abbreviation "STD" is used for a group of infections that are spread from person to person through intimate sexual contact including sexual intercourse. They have become an increasing problem in teenagers in the last 30 years. It is important that you know what to look for, and let us know if you have any symptoms. Also, if you are sexually active, and are diagnosed with any of these diseases, it is only fair that you let any partners know so that they may be checked as well.

GONORRHEA - This is caused by a bacteria, and can be treated with antibiotics. It is sometimes known as the "drip" or the "clap". Boys usually know when they are infected, since there is usually a discharge from the end of the penis, and it is painful to urinate. However, girls may not know that they are infected. The infection can spread from the vagina into the uterus and tubes, leading to a serious illness, or sometimes scarring which can prevent you from having children when you are older. Not having sex, or using a condom if you do have sex, will prevent this infection.

HERPES - This is caused by a virus that is similar to the virus that can cause cold sores. It causes painful ulcers on the penis, and around the vagina. There is no cure for this infection and it will be a lifelong problem for those that get it. Like cold sores this can reoccur, and each time there is an outbreak of the sores you can spread this to someone else. It is of particular concern to women since, if they have an active outbreak when pregnant, at the time of delivery they can pass the infection to the baby. Infants that are infected become very ill and may die. It has been reported that up to 20% of the population may be infected with this virus.

GENITAL WARTS - This is also caused by a virus, and leads to warty growths anywhere on the penis, labia, vagina, or rectum. They are usually not painful, but should be removed. There has been a link with genital warts and increased cervical cancer in women. It is important that girls with genital warts have a PAP smear every year.

CHLAMYDIA - This is a bacterial infection that will cause painful urination in men, and usually no symptoms in women. There is not as much discharge with this infection, as there is with Gonorrhea. This infection is the leading cause of fertility problems in young women. Because the infection is silent, there can be damage done to the female reproductive system. It is treatable with antibiotics.

SYPHILIS - This is a type of bacterial infection that has several different stages. Initially there is the appearance of a painless "lump" which can occur anywhere on the sex organs. It then erodes into an ulcer, which unlike Herpes is not painful. There may be swelling of the lymph nodes in the groin at this time. The ulcer heals, but then the infection moves into the body causing many different symptoms. There is often a flu like illness with muscle aches, low grade fever, and rashes. Specific parts of the body may be affected such as the brain, kidneys, and liver. If untreated, it can go on in some individuals and cause serious and fatal damage to the brain or heart. Syphilis is treated with antibiotics. It can be very serious in a pregnant women, since it can permanently affect the baby before it is born.

AIDS - You have probably heard a lot about AIDS recently. AIDS stands for Acquired Immunodeficiency Syndrome. It is caused by HIV (Human Immunodeficiency Virus), which attacks the body's immune system. HIV is passed from person to person by sexual activity including intercourse, or through sharing needles or other blood products. When first infected there are no symptoms, and the virus can lie dormant in your body for several years. This is termed "HIV positive". You may have no symptoms, but during this time you can infect other people. Eventually, symptoms develop: such as weight loss, certain tumors, and recurrent infections. This is when someone is said to have AIDS. There is no cure for AIDS and at this time it appears to be 100% fatal. The only way to completely protect yourself is not to have sex, and not to share needles. The term "safe sex" has been used. This refers to sex in a monogamous relationship (you both only have sex with each other), and using a condom every time you have sex if either one of you is not a virgin, for at least six months, until tests for AIDS virus are negative.

HEPATITIS B - Hepatitis B is one of the most serious forms of hepatitis with over 300,000 new acute cases each year and an estimated one million carriers in the U.S. This disease is more prevalent and infectious than AIDS, and may lead to scarring of the liver, called cirrhosis, cancer of the liver, and fatal liver failure, particularly if the acute infection occurs in childhood. The initial illness of Hepatitis B is called acute hepatitis and may be mild or severe. When the virus continues to attack liver cells beyond a six month period, causing inflammation and cirrhosis, the condition is called chronic hepatitis.

Hepatitis B can be transmitted through infected blood, blood products and needles. It is also frequently spread through sexual contact by carriers of the virus who may not be at all ill and at birth from mother to baby. The virus is also found in high concentrations in saliva, but it is not known if this is a common source of spread of the infection. Nearly one third of all new cases of hepatitis B occur with no "risk factors". In those cases, we do not know how the infection was acquired.

Vaccination is recommended for all newborns, infants, and teenagers. Beginning with the 1997 school year, the Arizona Department of Health Services is requiring that all students entering the school system (Kindergarten and First Grade) have the Hepatitis B series of vaccines. The Committee on Infectious Diseases of the American Academy of Pediatrics recommends "universal immunization" of children with particular emphasis on infants and adolescents. They note that the age group of children most at risk for acquiring Hepatitis B is the adolescent.

It is important for you to know the risks of sex, so that you can make responsible decisions about your life. If you have any questions, please ask us, or talk to your parents.

Back to Top

---

CONTRACEPTION

This section discusses methods for preventing pregnancy for those who have decided to become sexually active. It is very important that both boys and girls think carefully about all of the possible consequences before they decide to have sex. Yes, you can get pregnant the first time that you have sexual intercourse. In fact, 20% of girls will become pregnant within the first month after they become sexually active, and 50% within 6 months if protection is not used. The intimate contact of sex dramatically increases your risk of infections called Sexually Transmitted Diseases (STDs). STDs include AIDS (HIV Infection), Gonorrhea, Hepatitis B, Chlamydia, and Syphilis. If you have questions regarding this, please ask.

CONDOMS AND FOAM - This is probably the best method for sexually active teens to use. It is the least expensive, and can be obtained without a prescription. It is also the only method of birth control that offers protection against sexually transmitted diseases. A condom, or rubber, is a latex sheath that fits over the penis to prevent sperm from entering the vagina. It is easy to use, and one size fits all. When used with a spermicidal jelly/foam, it is over 95% protective against pregnancy, BUT STILL NOT 100%. It must be used every time for it to be even 95% successful.

THE PILL - This is a popular method, and is a very effective way to prevent pregnancy, but does have many disadvantages. The pill is a series of small amounts of the female hormone that are taken daily to prevent the release of the egg (ovulation) or to prevent the egg from implanting in the uterus if it becomes fertilized by sperm. If ovulation does not occur, then you cannot become pregnant. Likewise, if a fertilized egg cannot implant, it will pass through the body and no pregnancy will develop. However, for the pill to work, you must take it every day. If you forget even once you may not have any protection from pregnancy that month. Unless you are having sex very often it is easy to forget to take it. Also, it does not give any protection against AIDS or other sexually transmitted diseases. It requires a visit to the doctor and a prescription. It can also be expensive - $15-20 per month. It is a safe method for most teenage girls, but some girls with diabetes and migraine may have problems with it. Similar contraception with these hormones is also available by monthly injections or as a surgical implant that slowly releases the hormone.

THE DIAPHRAGM - The diaphragm is a rubber device shaped like a saucer that fits over the cervix (the entrance to the uterus) that prevents sperm from entering and causing pregnancy. If used correctly, with a spermicidal jelly, it is as effective as a condom. However, it is harder to insert correctly, and must fit exactly - unlike a condom. It does require a doctor visit to fit the device and to learn how to insert and remove it properly. It offers some protection against sexually transmitted disease, but will NOT protect against AIDS.

IUD - This is not recommended for teenagers. It involves insertion of a metal or plastic device into the uterus, which prevents the fertilized egg from implanting and growing. The insertion is done in a doctor's office and may be uncomfortable. Also, many girls have increased cramping with their periods if an IUD is in place. It does not protect from sexually transmitted disease, and in fact can cause more serious illness if an infection does occur.

SPONGE - This is similar to the diaphragm. It is a spongy material with spermicide already present, and is inserted into the vagina to cover the cervix to prevent sperm from entering the uterus. It is sold without a prescription. It is not as effective as a diaphragm alone since it does not have an exact fit. However, if used with a condom, it can be effective. It must be inserted properly, so read the directions carefully. Unless used with a condom, it does not offer protection against sexually transmitted diseases.

WITHDRAWAL - This method does not work. The theory is that the male removes the penis from the vagina before ejaculation (when the sperm is released) and orgasm. This requires more control than most boys have. Also some sperm is released before ejaculation occurs. There is no protection against sexually transmitted diseases.

RHYTHM - This method involves timing intercourse so that it only occurs during the "safe" time of the month. Pregnancy can only occur if you have sex for about 5 days of the month - from 2 days before through 2 days after ovulation occurs. However, that is very difficult to time in most girls, especially teenagers. The cycles are usually quite irregular during the teen years, and some girls are never regular. This method is only effective about 40% of the time. It does not protect against sexually transmitted disease.

ABSTINENCE - This refers to not having sexual intercourse. This method is 100% effective in preventing pregnancy and sexually transmitted disease. There are other intimate physical activities that couples find pleasurable, such as kissing and petting, that pose considerably less risk of sexually transmitted disease and no risk of pregnancy.

Back to Top  

---

Copyright: East Valley Children's Center

 

EVCC Main