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 Women's Health

september 2012
Not a Girl; Not Yet a Woman!
Dr Rooma Sinha
Adolescence is probably the most difficult phase of one’s life. It is a stage of life where one is caught between two worlds; letting go of the carefree childhood to step on the threshold of adulthood and maturity. And, as if the emotional adjustment is not bad enough, nature deals a rotten hand too with a host of physiological issues that make the in-between years even more difficult to get through.
For an adolescent girl, this period is very trying as her body goes through a lot of changes. Owing to social customs, taboos or incorrect information, she is not fully aware of the implication of the changes and neither is she prepared to deal with them. Several gynaecological problems can be prevented, if young girls are given the proper information through the right means at the appropriate time.

Gynecological signs and symptoms that may require medical attention
  • Bleeding between periods
  • Frequent and urgent need to urinate, or a burning sensation during urination
  • Abnormal vaginal bleeding, particularly during or after intercourse
  • Pain or pressure in your pelvis that differs from menstrual cramps t Itching, burning, swelling, redness, or soreness in the vaginal area
  • Sores or lumps in the genital area
  • Vaginal discharge with an unpleasant or unusual odour, or of an unusual colour or consistency
  • Increased vaginal discharge
  • Pain or discomfort during intercourse
Menstruation Cycle
The reproductive organs of growing girls mature during adolescence, leading to menstruation cycles. Menstruation is a cyclical discharge of the inner lining of uterus and blood through the vagina. Menarche, start of the menstrual cycles, sets in approximately between the ages of nine years to 15 years.

It is generally agreed that the normal menstrual cycle is between 24 and 35 days in length, measured from the first day of menstrual flow of one cycle to the first day of the next cycle. The usual duration of menstrual flow is 4-6 days, but many women may have it for as little as 2 days or as much as 7 days. However, if the duration of the cycle is less than two days or more than seven, it is considered abnormal.

Normal menstruation also tends to be consistent in the amount of blood that is lost. The usual volume of menstrual blood loss is 30 ml and a menstrual flow greater than 80 ml is considered abnormal. In practice, usually, doctors determine the blood loss by the number of sanitary pads used per cycle and the absence or presence of clots during periods.

PMS (Pre Menstrual Syndrome) is a condition that affects most women and young girls are no exception. It presents itself as pelvic pain, bloating, backache, painful and heavy breasts, mood swings and irritability, a few days before menstruation. However, these are common symptoms and not a cause for concern. If your periods are very heavy and irregular, and the pain so severe that it forces you to skip school/ college, it is better to get a check up from a gynaecologist.

Changes in female body during pre-puberty and adolescence

  • Breast budding: 8 years- 13 years
  • Onset of pubic hair: 9 years- 14 years.
  • Maximal growth: 10 years- 14 years.
  • Menarche: 9 years-15 years.
  • Adult breast: 12 years-18 years.
  • Adult pubic hair: 12 years- 18 years.
Tips To Deal With Periods
  • Do not restrict daily activities
  • When using sanitary napkins, change the pads frequently (2/3 times a day). Wrap and throw the used napkin in the dustbin. Do not flush.
  • Bathe daily and keep yourself clean and dry.
  • Wear well fitting cotton panties and keep the pads handy.
  • Pain during periods can be relieved by using hot pads or by taking hot showers.

Vaginal Discharge
Stained panties are often a cause of confusion for growing women. The stain is the result of vaginal discharge, a normal mucous like substance, which is produced during the menstrual cycle. Vaginal discharge varies in colour and viscosity as the menstrual cycle progresses. You will have days of white, clear-stretchy, clear-watery and brown discharge. Stay alert for discharge that is green or yellow; it is an indication of a likely infection especially if it is thick or has a bad smell. Be careful about white discharge accompanied by itching too. It can be indicative of yeast infection.

Mood Swings
Temper tantrums and mood swings are hallmarks of adolescence. As the body undergoes changes, so does the mind. Hormonal changes lead to emotional upheaval, which in turn cause mood swings. Concern about physical changes, conflicts with parents or other family members, peer pressure and the desire for independence, all play a role in these emotional outbursts. Though mood swings are a normal part of growing up, bad behaviour however, is not acceptable.

Polycystic Ovarian Syndrome (PCOS) is a common ailment with girls these days. It is a hormonal imbalance that causes irregular periods, acne and unwanted hair growth. If PCOS is suspected, consult a gynaecologist. Women with PCOS may find it difficult to conceive later in life. Moreover, the acne and excess hair growth looks unattractive too. Its incidence is more these days because of sedentary lifestyles and poor dietary habits.

Early management of the syndrome by changing the lifestyle can help. Exercise daily, try to reduce excess weight and follow a healthy diet without skipping meals

Weight Woes

Adolescence is the time when you come into your own being and want to look your best too. Unfortunately, it is also the time when girls seem to put on weight. Hormonal changes, which cause breast development and hip widening, can cause your body to store fat. At such a time, crash dieting may seem like a good idea, but, your body is growing and depriving it of necessary nutrients will lead to deficiency diseases with long term effects. Anaemia, PCOS and osteoporosis are some of the most common illnesses associated with a bad diet. To stay healthy, make smart choices:
  • Eat fresh fruits, vegetables, whole grains, lean protein and other natural foods.
  • Avoid fried or processed foods and sugary eatables. Their saturated fats cause weight gain and harm the skin and hair too.
  • A sensible diet and regular exercise are the best way to ensure your weight is at a healthy level.
  • A healthy weight is weight that falls within your normal Body Mass Index (BMI) range.

Acne is a condition wherein different types of bumps are visible on the skin surface. These bumps may be pimples, cysts, blackheads or whiteheads. Acne is caused by overactive oil glands in the skin. In teens, hormonal changes cause the oil glands to work overtime, causing acne. Lack of physical exercise adds to the problem leading to skin outbreak.

There are several over-the-counter medications available for treating acne. In case of severe outbreak, consulting a dermatologist is the best option.

Tips to prevent acne
  • Drink plenty of water and get adequate exercise to prevent acne t A good balanced diet reduces the chance of skin problems
  • Avoid oily foods before periods to decrease acne
  • Maintain good skin hygiene by washing your face with a good face wash. But, at the same time, too much washing can dry out your skin, so do not wash it more than three times a day.
  • If you use make-up, make sure you take it off thoroughly before going to bed.
  • Buy good quality products which do not clog the pores (noncomedogenic/ non-acne(i)genic)

Sex & Health

Talking about sex and associated issues is a difficult and embarrassing topic. Adolescent sexual behaviour has undergone a lot of changes in the past decade. For girls, the risks of unwanted pregnancy add to the problems of dealing with attraction to the opposite sex, dating and sexually transmitted diseases (STD).

While attraction towards boys is perfectly normal, girls should remember that a certain level of maturity is necessary before taking any serious decisions. In case you are sexually active, get in touch with your gynaecologist to discuss contraception options and safe sex. Risks of STDs such as syphilis, hepatitis B and AIDS are things you should be aware of. AIDS is something to be especially aware of. People infected with HIV virus are in perfect health in the initial days of infection and are also at their most infective during that time. Just because someone looks in perfect health, it does not indicate that s/he is not HIV positive. Sexually active women should also undergo regular gynaecological checkups including the PAP test.
Dr Rooma Sinha is Consultant Gynaecologist & Laparoscopic Surgeon, Apollo Health City, Hyderabad