The onset of puberty is a difficult time for children and parents alike. I think it’s important to tackle the issue with sensitivity. After the problems we have faced in our adult life, we may have forgotten how uncomfortable it was to talk about our bodies as we entered adolescence. Just as it’s important to give children a chance to understand what puberty is all about, it’s important to take their concerns seriously.
Not surprisingly, the issues for girls are different from the issues for boys. I would like to identify some of these issues briefly so you can help your children be prepared. For girls menstruation is mostly a nuisance unless they are not prepared for its arrival. Menstruation occurs about two years after the onset of breast development in most girls, so there’s no excuse for not spending some time explaining what’s going to happen and why as well as explaining the proper use of feminine hygiene products. Girls should have the opportunity to practice with these products and have a stash at school. They should also be aware that the school nurse has lots of experience dealing with girls who have pain or leakage. What’s embarrassing is early breast development because young boys can be obnoxious and focus on the obvious changes that they see. Girls should be allowed to wear a bra even if they really don’t need to if it makes them feel less conspicuous. From my point of view the most embarrassing aspect of puberty for girls can be the doctor’s visit. I remember patients whom I’d seen since infancy who suddenly realized that a male would be seeing them and became very upset. Mothers who had discussed the visit with their daughters ahead of time could find out just how uncomfortable their daughters might be. Some girls really didn’t care. But some certainly did. We offered to let them see one of the female providers or have one come in to do the sensitive part of the exam. But early in my career I can remember girls actually crying from the emotional discomfort.
As you might expect, boys are much less shy about their bodies – most of the time. And the genital exam is really very brief. There is one thing that is upsetting to boys, and most parents aren’t aware how common it is. The medical term is adolescent gynecomastia. Simply this means that boys, like girls, can develop breasts at the onset of puberty. Fortunately, most boys have little or no breast development, but for those where it is significant, it can be very upsetting. Up to 50% of boys may have some enlargement under the nipple. It may be on both sides or only one. The reason for this occurring is not entirely clear but may be related to an inherited ability to change androgen to estrogen. During puberty the amount of androgen rises very quickly and an enzyme called aromatase may change some of that androgen to estrogen, which stimulates breast development. For most boys an explanation is the only treatment they need to put up with the small sometimes tender bumps for a few years. More significant breast development can be treated with medications that inhibit the enzyme or block the effect of the estrogen; however, the medications are not always successful. Surgery is a last resort. For more than the smallest growths we can do blood tests and often refer to an endocrinologist (hormone specialist) to avoid missing the rare cause that needs aggressive treatment.
Smart parents who have always taken their children’s concerns seriously will be able to talk about sensitive subjects as their children enter puberty. Children should not have to experience the changes of adolescence unprepared.
Robert B. Golenbock, MD
