SEX EDUCATION TO ADOLESCENTS
( By Dr. Vithal Prabhu )

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Problems of Adolescents

Problems of Girls



  1. Unmarried Motherhood: It is not uncommon for a boy to lure a girl, make her feel that he loves her, have sex with her, and abandon her when he knows that she is pregnant. It is a very difficult situation for the girl of that age. She feels cheated, dejected, rejected and depressed. There is a sense of guilt, shame and violation. This is horrifying for her and becomes a nightmare. One thing she should not think of is to kill herself. She need not torture or punish herself for the fault which is not solely hers. She should think of the life ahead which is full of opportunities. Losing once is not the end of the world. She should tell her mother first. She can legally terminate the pregnancy and start a new life. Even if the experience is bitter, she should not have a callous attitude towards all the boys.

    In every sphere there are good things and bad things. Fortunately good things prevail. She should think that she was unfortunate enough to come across a bad thing. She should take this as an experience for the guidance of future new relationship. Failures should be pillers of success. Medical Termination of Pregnancy (MTP) upto 10 weeks of conception is quite safe. If the pregnancy is of over 20 weeks, MTP is not legal and should not be attempted, since it carries a risk also. In such a case, a full term delivery should be conducted and the child should be given for adoption. Marrying a boy because he made her pregnant is not a wise decision, since such marriages do not last. There are about three crores of unmarried mothers in the world, the commonest cause being the ignorance about the act that can lead to pregnancy, the consequences of which a girl has to suffer solely.


  2. Teenage Mother: In some cultures a girl gets married at the age of 16 years or even earlier. Teenage pregnancy should be discouraged. A girl is able to give birth to a child as early as at 13 to 14 years. The risks she and her child run (eg. of illness, injury and death) are far greater than those in a mature woman in her twenties. Anaemia in mother, retarded growth of the child, premature birth, complications during delivery are higher in a teenage mother. Risk of her own death during pregnancy and labour, and that of her child during the first year of life are higher than in women over 20 years of age. Getting pregnant during the adolescence, when her own growth is not complete, is highly risky. The growth of a girl is complete by 18 years.


  3. Size of the Breasts: Many girls attribute beauty to the size of their breasts. If the breasts are small in size, they get worried. If the breasts are large, then too they get worried. Nature has provided females with breasts for the purpose of feeding milk to newborn babies. The size of the breast depends upon the content of the fat in it and has nothing to do with the production of milk. Small breasts can produce enough amount of milk when needed. There is no treatment for small or large breasts. The size and shape of the breasts is governed by the hereditary factors. The best thing to do is to accept them as they are and not to develop an inferiority complex. Girls having small breasts may use a padded brassiere for aesthetic purpose.


  4. Menstruation Problems: Girls complain of irregular menstrual periods. During adolescence the hormonal levels fluctuate and this is manifested by early/delayed or scanty/profuse periods. A large number of women never have their menstrual period regularly after every 28 days as expected. Variation is a rule. A cycle of 21 to 35 days and bleeding for 2 to 6 days should be considered as normal.

    Some girls get their first period (menarche) as early as at 11 years of age; while some get it as late as at 16 years. Age of menarche varies depending upon general health of the girl, her heredity, living conditions, climate, etc. The average age is 13 years. If a girl does not get the menstrual period even upto the age of 16 years, she should see a doctor. The reason could be absence of or defect in the uterus, vagina or ovary, a hymen without a perforation, deficiency of sex hormones or a genetic defect. Poor diet, malnutrition and TB can also delay the onset of menstruation. A few days before the period starts, some girls may experience symptoms like tired feeling, irritability, tension, excitability, nausea, pain in lower abdomen or in lower back or tenderness in the breasts. These symptoms disappear after the menstruation starts or thereafter.

    Some girls experience emotional changes before and during menstruation. Most girls feel only little discomfort. These symptoms are due to the changes in the hormonal levels. Pain is due to the contractions of the muscles of the uterus and difficulty in opening of the mouth of the uterus to allow the blood flow out. All these changes are natural. The girls should continue to do their usual activities, like playing, cooking, bathing, socialising, as menstruation is physiological function of the body and not a disease. Drinking plenty of fluids, taking nutritious diet (milk, egg, fish, vegetables, fruits, pulses), and outdoor activities would help. Lying on back with bent knees, placing a hot water bottle on lower abdomen or on back will help in relieving the pain. Rarely she may have to consult a doctor who would prescribe a tablet of Mefenamic acid, Dicyclomine, Paracetamol, Pentazocin, Acetaminophen, or hormones in rare cases.


  5. Vaginal Discharge: A clear or whitish discharge from the vagina a few days prior to or after the menstruation or midway between the period is normal and is a sign of growing up. If the discharge is continuous, excessive, frothy, milky, yellowish, associated with itching, burning or foul smell, she should consult a doctor, Invaribaly this condition is due to lack of hygiene followed by Trichomonal or Monilial infection.


  6. Underweight / Overweight :Adolescent girls like to be attracted by the opposite sex. Some look very thin and some very fat; that makes them feel unattractive. If they want to increase their weight, they should consume food items containing more calories and should take three to four meals instead of usual two. Their daily diet should contain more of butter, ghee, cheese, curds, egg, mutton, whole milk, sugar, jaggery, banana and ground- nuts. If they are overweight, it is invariably due to overeating and lack of physical exercise. They need food items having low caloric contents and not less quantity of food. They should take fruits like sweet limes, oranges, green vegetables, salads, soups, skimmed milk without sugar, fish, egg-white, and cream cracker biscuits. They should take less of rice and less number of chapatis (or bread slices), avoid fried food and the food items advised above for the underweights.

    Daily swimming, cycling, running and fasting once a week will help to reduce the weight.


Problems of Boys



  1. Penis Anxiety and Masturbation Guilt: For adolescent boys the penis becomes a centre of attraction. Penises are in all sizes. It is not true that a boy with a large penis is sexually more potent and powerful than the boy with a small one. The size of the penis does not matter in giving or receiving sexual pleasure or in sexual performance. The vagina is a three inch long collapsible tube and is sensitive only in its outer one inch. A penis of the size of little finger is sufficient to perform all its functions. Some boys get worried about the girth, angle or curvature of the penis. Vagina being soft and malleable can accomodate any size, any shape and any angle of the penis. Many boys attribute the tilt and curvature of penis to “excessive” masturbation. This is not true. Masturbation does no harm and there is nothing like “excessive” in masturbation. Any organ in our body functions better by using it and never deteriorates when used. There is a saying, “Use it or loose it.” Therefore boys need not worry about the size, shape and curvature of penis or about masturbation.


  2. Wet Dreams: A sexually exciting dream that is associated with ejaculation of semen in boys is called “wet dream” or “nocturnal emission.” This is a sign of puberty and is normal. He may or may not be able to recall the dream, but may get up from sleep by the feeling of wetness of the semen. In fact, all boys get erection of penis after about every 90 minutes in the sleep. When they get an erotic dream, they ejaculate. Wet dreams do not cause weakness and are absolutely harmless. But because this scientific information is not provided to the adolescents, they feel worried and get depressed by the “loss” of semen. Such problem cannot be ventilated to any one else other than their friends who are equally ignorant about it. Their friends too endorse the “bad” effects of wet dreams. This leads to their further depression. In reality, it is the natures attempt to keep the sex glands functioning by throwing out the accumulated secretions periodically; a sort of “servicing” of the reproductive machinery.

    Those who do not have wet dreams, may not be able father a child later. Absence of wet dreams is suggestive of a block in the reproductive passage or non functioning of the sex glands. Semen is like any other secretion from the body meant to be thrown out (e.g., tears, saliva, perspiration) and hence harmless when lost. The fequency of wet dreams is inversely proportional to the masturbation. Boys who masturbate periodically, have less frequency of wet dreams and vice versa. In a way, wet dream is a “masturbation” done by the nature to keep the individual sexually fit.


  3. Scanty Hair on the Face: An adolescent gets an inferiority complex if he does not have an exuberant growth of moustaches and beard on his face as his friends have. Growth of hair could be hereditory. No treatment is required if his rest of the growing up features are already present (e.g., hair around the genitals and in the armpits). Like Chinese and Japanese he has limited hair buds on his face and hence scanty hair. This is absolutely normal. All that he needs is reassurance.


  4. Phimosis and Paraphimosis: Phimosis is a condition where the foreskin (prepucc) is too tight to retract over the glans of the penis. The smegma accumulates under the foreskin. Smegma is a foul smelling secretion and can lead to either infection or cancer in later years. Therefore, the doctors advise “circumcision”, the removal of foreskin by surgery. After circumcision the glans of the penis remains exposed and the smegma does not accumulate. In children phimosis to a certain extent is normal.

    Circumcision is not advised. As the child grows and attains puberty, the foreskin naturally retracts over the glans of the penis. However, if it cannot be retracted completely over the glans for the purpose of cleaning, circumcision is advised. An adult who may be able to retract the foreskin over the flaccid penis but finds difficulty in doing so over the erect penis. He has no difficulty in cleaning; but if he finds intercourse uncomfortable or painful, he should undergo circumcision operation. In some of the individuals, the foreskin may get retracted behind the glans of the penis and may remain there, being unable to pull it forward to its usual position. This condition is called “Paraphimosis.” This should be treated as an emergency and the circumcision should be done promptly. Otherwise swelling of the foreskin appears hampering the blood supply of the penis. Amongst Jews and Muslims circumcision is done for religious purpose.

    Due care should be taken to preserve Frenulum, the most sex-sensitive band of skin on the under surface of glans of the penis. It should be done by a surgeon. There is a myth that circumcised individual has increased sexual sensitivity and increased duration of intercourse. This is not true. Is circumcision done in women? Medically, it is not necessary. However, it is done in some countries. When done by an unscrupulous person the female genital anatomy is mutilated.


  5. Swelling in the Breast: At puberty, boys develop painful swelling in their breasts. The swelling is as big as a marble. The swelling could be in one or both the breasts. The swellings disappear soon. No treatment is required except fomentation with hot water. Some boys develop breasts like girls. Though painless, they feel shy to expose their chest and feel worried as to whether they would partly turn into girls. This is called “Gynaecomastia.” It is due to deposition of fat and is a harmless condition. The fat could be removed through surgery by a plastic surgeon for aesthetic reasons.


  6. Pimples (Acne): Both girls and boys get pimples during the adolescence. The sites are face, shoulders, chest, and back. These may get infected and pus may be formed. If squeezed by fingernails, a permanent scar is left behind. Therefore the pimples should not be squeezed by the nails. Not every adolescent will get pimples. The reason could be genetic predisposition. Under the influence of increased levels of sex hormones, there is over production of the oily substance called “Sebum” through the skin. The surface of skin becomes thicker and hence narrows the pores through which the sebum comes out. The sebum is trapped inside the skin and forms a plug with a raised top, which when exposed to air, becomes a black head. When infected, a pimple is formed.

    Avoid use of greasy oils and cosmetics. The face should be washed several times a day with soap and warm water. Take a diet containing fresh fruits and vegetables. Exposure to sunshine helps since ultra violet light dries up the grease and peels the top layer of the skin. Tetracycline capsules by mouth and Benzoyl Peroxide or Tretinoin cream application may be necessary in extreme cases. These should be used only on doctor’s advice. The effect of treatment is temporar. The nature itself cures pimples permanently after some years.


  7. Pain in the Testis: Some boys complain of pain in one or both the testes, though there is no history of injury. During the adolescence the erection of the penis is a frequent episode which leads to congestion of blood in the sex organs, causing pain in the testis. The only way to relieve the congestion is through masturbation and by warm water fomentation. Paracetamol or Nimesulide tablet taken orally helps to relieve the pain.


  8. Bleeding from Frenulum of the Penis: At a forceful retraction of the prepuce during the act of masturbation (or during intercourse), the blood vessel in the frenulum gets torn and bleeding occurs. A pressure by cotton wool (or by fingers, in emergency) for 3 minutes will stop the bleeding. No treatment is required.


  9. Exposure to commercial Sex Worker: Adolescent boys have a strong desire for sex. To have an experience of sex just once, some boys visit red light area to enjoy sex with the commercial sex worker. This single episode is sufficient enough to devastate their lives. Not only they are at risk of getting STD/or HIV infection, but also of terrible psychological trauma. Therefore, such risks should be thoughtfully escaped avoiding even a single visit to the commercial sex worker.


  10. Pornography Photoes or blue films of naked persons depicting sexual acts, or obscene literature is called “pornography.” Pornography triggers sexual response in some individuals. It is more liked by males than by females. Seeing, thinking or hearing of sensuous stimuli trigger the action of the sex-centre in the hypothalamus of the brain, which brings about sexual response through the spinal cord and through the blood vessels supplying the sex organs and therefore, pornography leads to erection of penis in the men. Pornography is entirely made for the sexual entertainment of the males. It does not serve the purpose of sex education. In fact, it is antagonising to sex education since it passes wrong messages. It endorses myths and misconceptions. It shows exaggerated actions with exceptionly large sex organs. The viewers tend to get depressed when they don’t have or can’t do what they saw. Youths view pornography as a source of information on sexuality. If proper sex education is made available to them, the sale of pornography will decrease. This has happened in Denmark. Children should be prohibited from seeing pornographic films or reading obscene books. The females do not like to view pornography. They enjoy seeing films or reading literature full of love and romance.


  11. School Dropouts Flagging interest is an acute problem of adolescents. More boys than girls are affected. At the age of 15-17, the boys are going through the peak of sexual drive, are trying to accommodate physical and psychological changes; emotions are turbulent; body needs are strong. Angry criticism at poor scholastic performance and parent's high expectations provoke them to give up studies. Some may run away from home and some may commit suicide. Family plays a significant role in the lives of adolescents. A good parent-adolescent communication leads to better ability to cope up with problems. The adolescent should feel wanted and important. Loving, understanding and supportive family is adolescent’s best defence against any problem.


  12. Addiction Adolescents are more liable to get addicted to smoking, alcohol or drugs. The reasons are many. Peer pressure, desire to establish freedom, rebellious attitudes, emotional detachment with parents, insecurity, frustration, blindly following the West, incapacity for decision making, inhability to weigh pros and cons of action are some of the causes.

    All the addictions lead to deterioration of mental and physical health and ultimately to death. It is easy to enter into this death trap, but difficult to come out of it. Therefore, the best policy is to avoid the temptations of such addict-forming substances. Parents should be careful about their college going children, who feel “free” to do anything they like. If a boy/girl comes late at night, fails in examinations repeatedly, frequently asks for pocket money, dresses shabbily, deteriorates in health, quarrels frequently and if costly articles are found to be missing from home, the parents should suspect of addiction in their child. Addiction should be considered as a disease and the addict should be treated at a deaddiction centre under the supervision of a psychiatrist. Is it possible to prevent addiction? To a certain extent, yes.

    We cannot change the society, cannot stop cut-throat competition at every level; but we can definitely provide love, security and protection to our children. Parents should have a good communication with the adolescents, provide them emotional support, keep vigilance on their friends and on their ways of spending pocket money. Criticism and scolding do not work. In fact these create a barrier between the parents and the children. Parents have to spend more time with their children to have a dialogue with them and should treat them as friends.

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