ESPECIALLY FOR TEENS

What is puberty?

Puberty is the time when your body changes and becomes more like an adult.

When does puberty start?

It is normal for changes to start as early as 8 years old or as late as 13 years old. Puberty starts when your brain sends signals to certain parts of the body to start growing and changing. These signals are called hormones. Hormones are chemicals that control body functions.

What changes occur during puberty?

During puberty, hormones cause the following changes:

You grow taller and gain weight.
Your hips may get wider.
Your breasts grow.
You grow hair under your arms and around the vulva.
Your body odor may change.
You may get acne or pimples.
You get your first menstrual period (also called menstruation).

How will my breasts change?

As your breasts start to change, the darker areas around the nipples (called the areolas) may look swollen. The breasts also grow rounder and fuller. One breast may seem a little larger than the other. They may feel sore at times. This is all normal.

What is menstruation?

Beginning in puberty, every month, your body will prepare for a possible pregnancy. Hormones signal the ovaries to release an egg each month. The egg moves into one of the fallopian tubes. At the same time, the lining of the uterus begins to grow and thicken. If the egg is not fertilized by a man’s sperm, pregnancy does not occur. The lining breaks down and flows out of the body through the vagina. This is called menstruation, the menstrual period, or just your "period."

When does menstruation begin?

Most girls in the United States start between the ages of 12 years and 14 years, but some start earlier or later.

How long do menstrual periods last?

Periods usually last between 2 days and 7 days. They normally come every 21–45 days. They often are not regular at first. You may miss a period. You may have two periods in 1 month. This is normal. It can take about 6 years after your first period for your body to get on a regular cycle. Keep in mind that if you have had sexual intercourse, a missed period can be a sign that you are pregnant.

How can I prepare for my menstrual period?

It is best to be prepared for your period, even if you have not started yet. Have pads or tampons ready at home and carry them with you to school.

How do pads and tampons work?

Pads attach to the inside of your underwear. They absorb the blood as it leaves the vagina. Tampons are inserted into the vagina. They catch the blood before it leaves the body.

How often should I change my pad or tampon?

You should change your pad or tampon at least every 4–8 hours. On the first days of your period, you may need to change it more often because your flow may be heavier.

Do menstrual periods cause discomfort?

Some girls have cramps (tightness and pain) in the lower abdomen and back at the start of their periods. Some girls get headaches or feel dizzy. Some get diarrhea.

How can I ease cramps?

To help ease cramps, you can try the following:

Take ibuprofen or naproxen sodium (if you do not have an allergy to aspirin or severe asthma).
Exercise.
Place a heating pad on your abdomen or lower back.

What problems with my menstrual period should I see my doctor about?

Talk to your doctor or your parents about your period for any of these reasons:

You are 15 years old and have not had a period.
Your periods were regular each month and then they stopped being regular.
Your period comes more often than every 21 days or less often than every 45 days.
Your periods come 90 days apart (even if that happens only once).
Your periods last more than 7 days.
Your periods are so heavy that you have to change pads or tampons often (more than once every 1–2 hours).
You have bad cramps that keep you from doing your regular activities and they are not helped by pain relievers.

When should I begin seeing an obstetrician–gynecologist?

An obstetrician–gynecologist is a doctor who specializes in the health care of women. Girls should have their first gynecologic visit between the ages of 13 years and 15 years. The first visit may be just a talk between you and your doctor. You can find out what to expect at future visits and get information about how to stay healthy. You can ask questions about your body, growing up, and sex.

What is acne?

Acne is caused by overactive glands in the skin. They make a natural oil called sebum. During puberty, these glands make extra sebum that can clog the pores in your skin.

What can I do if I get acne?

Wash your face often with water and mild cleanser to help get rid of the extra sebum. This will help reduce pimples and acne. Avoid products that dry or irritate your skin. Do not scrub or pick at your skin. If you have concerns about acne or pimples, some medications can help. Talk to your doctor about your concerns.

Glossary

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Hormones: Substances produced by the body to control the functions of various organs.

Menstruation: The blood and tissue that comes from the uterus each month when an egg is not fertilized (also called your menstrual period).

Obstetrician–Gynecologist: A physician with special skills, training, and education in women’s health.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Puberty: The stage of life when the reproductive organs start to function and other sex features develop.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called "having sex" or "making love").

Sperm: The male sex cell produced in the testes that can fertilize the egg from the female.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vulva: The external female genital area.

What is puberty?

Puberty is a time when your body begins to change to become more like an adult’s. Starting your menstrual period is one of these changes.

What is a menstrual period?

When puberty begins, your brain signals your body to produce hormones. Some of these hormones prepare your body each month for a possible pregnancy. This is called the menstrual cycle. Hormones cause the lining of the uterus to become thicker with extra blood and tissue. One of your ovaries then releases an egg. This is called ovulation. The egg moves down one of the two fallopian tubes toward the uterus.

If the egg is not fertilized with a man’s sperm, pregnancy does not occur. The lining of the uterus breaks down and flows out of the body through your vagina. The discharge of blood and tissue from the lining of your uterus is your menstrual period (also called "your period").

When will I start my period?

Most girls start their periods between the ages of 12 years and 14 years, but some start earlier or later.

How long do periods last?

When you first start having your period, it may last only a few days. Your first few periods may be very light. You may only see a few spots of reddish brown blood. Anywhere from 2 to 7 days is normal.

How often will I get my period?

A menstrual cycle is counted from the first day of bleeding in one month to the first day of bleeding in the next month. The average menstrual cycle is about 28 days, but cycles that are 21–45 days also are normal. It may take 6 years or more after your period starts for your cycle to get regular.

Why is it a good idea to track my period?

If you do this every month, you may notice a pattern. It may become easier to tell when you will get your next period. Check online or on your smart phone for apps that can help you track your period.

How can I track my period on a calendar?

To track your period on a calendar, mark the first day your bleeding starts on a calendar with an "X." Put an X on each of the following days that you have bleeding. Count the first "X" as day 1. Keep counting the days until you have your next period.

What personal care products are available for me during my menstrual period?

Pads are used to soak up the menstrual flow. Tampons and menstrual cups catch the flow from inside your vagina. Pads, tampons, and menstrual cups can be used at different times. Some also can be used together.

How are pads used?

Pads are worn inside your underwear to collect your menstrual flow. They come in different sizes, styles, and thicknesses. Some have extra material on the sides called "wings" that fold over the edges of your underwear to help keep the pad in place and give better protection. A thinner, shorter version of a pad is a "panty liner." Some girls wear panty liners on the last days of their periods when the flow is light or on days when they think their periods will come.

How often should I change my pad?

Change your pad at least every 4–8 hours or whenever it seems full or feels wet and uncomfortable. Some girls change their pads each time they urinate.

How are tampons used?

Some tampons have a plastic or cardboard applicator tube that helps slide the tampon in place. Some tampons do not have applicators and are inserted with just your fingers. A short string attached to the end of the tampon hangs out of your vagina to help you remove it later.

How do I choose a tampon?

Just like pads, tampons come in different sizes for heavier and lighter periods. The tampon package will tell you how much fluid it will absorb. A "super" tampon, for example, is thicker and is meant for heavy flow. A "slim" or "junior" tampon is slender and is meant for lighter flow.

How often should I change my tampon?

You should change your tampon at least every 4–8 hours. Leaving a tampon in for a long time has been linked to toxic shock syndrome. When your flow is heavier, you may need to change it more often.

What are menstrual cups?

Menstrual cups are made of plastic or rubber. They are inserted into the vagina to catch the menstrual flow. You remove and empty the cup every 8–12 hours. Some cups are used only once and thrown away. Others can be washed and reused.

Does having a period cause pain or discomfort?

Some girls have a cramping pain in the lower abdomen or back or breast tenderness just before and during their periods. Some girls get headaches or feel dizzy. Some get nausea or diarrhea.

To help ease cramps, you can try the following:

Take ibuprofen or naproxen sodium (if you do not have an allergy to aspirin or severe asthma). Always follow the directions on the bottle about how much to take.
Exercise.
Place a heating pad, heat wrap, or other source of heat on your abdomen or lower back.

What is amenorrhea?

Amenorrhea means not having a period. It is normal for some girls not to start their periods until age 16 years. However, your doctor may want to see you if you have not started by age 15 years. You also should see your doctor if you have started your period but it then stops for more than 3 months.

What if I am having heavy bleeding?

If you are bleeding so much that you need to change your pad or tampon every 1–2 hours or if your period lasts for more than 7 days, you should see your doctor. See your doctor right away if you are light-headed, dizzy, or have a racing pulse.

What if I have irregular periods?

You should tell your doctor if your periods are usually regular but then become irregular for several months. You also should see your doctor if your period comes more often than every 21 days or less often than every 45 days.

Glossary

Amenorrhea: The absence of menstrual periods.

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Hormones: Substances produced by the body to control the functions of various organs.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Ovulation: The release of an egg from one of the ovaries.

Puberty: The stage of life when the reproductive organs become functional and secondary sex characteristics develop.

Sperm: A male cell produced in the male testes that can fertilize a female egg.

Toxic Shock Syndrome: A severe illness caused by a bacterial infection.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

When should I have my first gynecologic visit?

An obstetrician–gynecologist (ob-gyn) is a doctor who specializes in the health care of women. Girls should have their first gynecologic visit between the ages of 13 years and 15 years.

Is it normal to be nervous before the first visit?

It is normal to feel nervous about your first visit. It may help if you talk about it with your parents or someone else you trust. You may want to let your doctor know you are nervous. He or she can help put you at ease.

What should I expect at the first gynecologic visit?

The first visit may be just a talk between you and your doctor. You can find out what to expect at future visits and get information about how to stay healthy. You also may have certain exams.

Your doctor may ask a lot of questions about you and your family. Some of them may seem personal, such as questions about your menstrual period or sexual activities (including vaginal, oral, or anal sex). If you are concerned about confidentiality, you and your doctor should talk about it before you answer any questions. Much of the information you share can be kept confidential.

What exams are performed?

You may have certain exams at the first visit. If you choose, a nurse or family member may join you for any part of the exam. Most often, these exams are performed:

General physical exam
External genital exam

You usually do not need to have a pelvic exam at the first visit unless you are having problems, such as abnormal bleeding or pain. If you are sexually active, you may have tests for certain sexually transmitted diseases (STDs). Most of the tests that teens need can be done by the doctor with a urine sample. You also may have certain vaccinations.

What happens during a general physical exam?

During the general exam, your height, weight, and blood pressure will be checked. You also will be examined for any health problems you may have.

What happens during an external genital exam?

In this exam, the doctor looks at the vulva. He or she may give you a mirror so that you can look at the vulva as well. This exam is a good way to learn about your body and the names for each part.

What are the pelvic exam and Pap test?

Even though you probably will not have a pelvic exam, you should know what one is. Another test that you will have later (at age 21 years) is a Pap test. This test checks for abnormal changes in the cervix that could lead to cancer.

The pelvic exam has three parts:

1. Looking at the vulva

2. Looking at the vagina and cervix with a speculum

3. Checking the internal organs with a gloved hand

Pelvic Exam and Pap Test

The doctor will use a speculum to look at your vagina and cervix. When you have a Pap test, a sample of cells is taken from your cervix with a small brush.

To check your internal organs, the doctor will place one or two gloved, lubricated fingers into the vagina and up to the cervix. The other hand will press on the abdomen from the outside.

What are vaccinations?

Vaccinations or immunizations protect against diseases caused by bacteria and viruses. Some are given on a routine basis. Other vaccinations are offered to women who are at an increased risk of certain diseases. Your doctor may ask you about your medical history and suggest you receive certain vaccinations.

What vaccines do teens need?

The following vaccines are given to all young women aged 11–18 years on a routine basis:

Tetanus–diphtheria–pertussis (Tdap) booster (once between ages 11 years and 18 years for those who have never had a dose of tetanus–diphtheria [Td] booster; those who have had a Td booster should get a dose of Tdap 5 years after they received Td)
Hepatitis B virus vaccine (one series for those who have not been vaccinated)
Meningococcal vaccine (once between ages 11 years and 12 years; once at about age 15 years for those who have not been vaccinated)
Varicella (chickenpox) vaccine (once between ages 11 years and 12 years for those who have not had chickenpox or have not been vaccinated)
Measles–mumps–rubella vaccine (once between ages 11 years and 12 years for those who did not receive the two-shot vaccine during childhood)
Human papillomavirus vaccine (one series between ages 11 years and 12 years; one series between ages 13 years and 26 years for those who have not been vaccinated; it also can be given to girls aged 9 years or 10 years)

In addition to routine vaccines, special vaccines may be given to young women who are at an increased risk for certain diseases. Listed are some of these vaccines:
Influenza vaccine
Hepatitis A virus vaccine
Pneumococcal vaccine

What special concerns can be discussed with my ob-gyn?

Many young women share the same health concerns. Most of these concerns are a normal part of growing up:
Cramps and problems with menstrual periods
Acne
Weight
Sex and sexuality
Birth control
STDs
Alcohol, drugs, and smoking
Emotional ups and downs

What can I do to stay healthy?

Making good lifestyle choices can help you to be strong and healthy for years to come:

Maintain a healthy weight by eating a well-balanced diet and exercising often.
Avoid smoking, drinking alcohol, and using illegal drugs.
Seek help if you have emotional ups and downs or feel depressed.
Use birth control if you are having sex and do not want to have a baby.
Protect yourself from STDs by using a latex condom. Know your partners and limit their number.
Keep up with routine exams, tests, and immunizations.

Glossary

Birth Control: Prevention of pregnancy.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Condom: A thin sheath used to cover the penis during sex to prevent sexually transmitted diseases and pregnancy.

Menstrual Period: The discharge of blood and tissue from the uterus that occurs when an egg is not fertilized (also called menstruation).

Obstetrician–gynecologist (ob-gyn): A physician with special skills, training, and education in women’s health.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact.

Speculum: An instrument used to hold open the walls of the vagina.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vulva: The external female genital area.

 

Adolescent Growth and Development

Adolescence is a time of physical, intellectual, emotional, and social development. The timing, duration, and complexity of the changes vary greatly among individuals. Adolescents and their parents have many questions and concerns about what is normal and what to expect as development progresses. This guide includes resources for information about physical and psychological development during adolescence, especially the pre-teen and teen years, for health professionals, parents, and adolescents. It does not include resources related to cognitive, social, and spiritual development, which can be found in the literature of child development, psychology, social work, and education. Resources related to adolescent sexual development may be found in the Resource Guide: Adolescent Sexuality and Sex Education.

Resources related to adolescents with disabilities may be found in Reproductive Health Care for Adolescents with Disabilities, a supplement to Guidelines for Adolescent Health Care (ACOG, 2011). Books “for young adolescents” listed in the Resource Guide:  Adolescent Sexuality and Sex Education have much information about physical and emotional development and can be used by parents and professionals to educate adolescents with limited cognitive development.

Many of the books listed “for parents” address a variety of behavioral concerns including sexual behavior, substance use, poor school performance, sleep problems, and delinquency, in addition to normal development and behavior. They include advice on effective communication and parenting styles as well as  recognition of and appropriate responses to problem behaviors.  Health professionals may find these useful in strengthening the education and recommendations they provide to adolescents and their families.

Adolescents and Suicide

Suicide is the third leading cause of death for persons 15 to 24 years old and the second leading cause of death for Caucasian non-Hispanic females 15-19 years old. The actual number of completed suicides is relatively small – approximately 12/100,000 males and 2/100,000 females ages 15-19 years. However, there are many more attempts, some resulting in serious injury and even permanent disabilities. According to the 2009 Youth Risk Behavior Surveillance (Center for Disease Control and Prevention), among high school students, 17% females and 10% males reported serious consideration of suicide in the past year, 13% females and 9% males reported having a suicide plan, and 8% females and 5% males stated they had made a suicide attempt. Roughly one-third of the attempts led to medical attention.

The most common means of suicide are firearms, suffocation/strangulation, and toxic ingestions. The strongest predictor of suicide is previous suicidal behavior. Risk factors for suicide include both mood and anxiety disorders, alcohol and/or drug use disorders, physical and/or sexual abuse history, and disruptive behavior disorders. Increased vulnerability to suicidal behavior has been observed in sexual minority and culturally alienated youth and in adolescents who have recent experience of the suicide of a friend, sibling, or other family member.

Obstetrician/gynecologists and other providers of health care to adolescents are very likely to encounter patients who are at risk for suicide. It is not harmful and may be extremely helpful to ask a youth if she or he has ever considered suicide, if she or he has current thoughts of suicide, and, if so, if she or he has a plan for how, where, and when. Adolescents who admit serious consideration of suicide require prompt referral to a crisis mental health agency or emergency department for further assessment.

If a parent is concerned about suicide risk in his/her child, he/she should consult the child’s primary health care health professional for guidance and appropriate treatment and/or referral.

Adolescents and Tobacco

Adolescents use all forms of tobacco including cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, and hookahs as well as new tobacco products including snus, electronic cigarettes, dissolvable tobacco strips.  According to the 2009 Youth Risk Behavior Surveillance (Centers for Disease Control and Prevention), among high school students, 46% of females and males report ever smoking at least one cigarette, 19% of females and 20% of males have smoked in the past month, and 6% of females and 8% of males have smoked on at least 20 of the past 30 days. Of those who are current smokers (use in the past month), 54% of females and 48% or males have tried to quit one or more times. While 15% of males reported use of smokeless tobacco, only 2% of females did so. Of concern is that 9% of females and 12% of males smoked their first cigarette before age 13 years. While the majority of adolescents are nonusers, they often are exposed to second-hand smoke from their peers or family members.

Adolescents may initiate use of tobacco to express independence, to “feel” and “act” like adults, and to be socially accepted. Some smoke to try to control their weight, some smoke to reduce stress. Risk factors for regular tobacco use include having parents, siblings, or peers who use tobacco, poor school performance and limited goals, tendency to risk-taking behaviors, and use of alcohol and/or other drugs. Despite debate about the roles of media portrayals of tobacco use as normal, natural, and safe and  marketing that appears targeted to the young, many researchers suggest a strong influence of these on underage smoking.

Nicotine, the major active ingredient in all tobacco products, is highly addictive. Research has shown that addiction to nicotine develops more quickly and at lower doses in adolescents than in adults. The younger one becomes a regular user of tobacco, the more difficult it is to discontinue use.  There are no safe tobacco products and casual or social tobacco use is strongly associated with subsequent tobacco addiction.  The long-term health hazards of tobacco use and of exposure to secondhand tobacco (e.g. cardiovascular diseases, hypertension, numerous cancers, pulmonary diseases, dental diseases) are well known to adolescents but often discounted as too remote for current concern. Tobacco use can affect performance in sports, increase respiratory symptoms in those who have asthma, seasonal allergies, or even upper respiratory infections, stain teeth, and lead to foul breath and smoky smell in hair and clothing. Tobacco use poses risk to the fetus, especially in the pregnant adolescent who is not yet diagnosed or in denial. Adolescent tobacco users can incur legal penalties – in most states, it is illegal to purchase cigarettes  under age 18 or to purchase cigarettes for someone who is under 18.

ACOG recommends that Obstetrician/Gynecologists and other providers of health care for adolescents should ask about use of tobacco and other forms of nicotine and exposure to second-hand smoke as part of the routine medical history at every preventive health visit  and when there are clinical indications, such as counseling about hormonal contraceptives or treatment of chronic respiratory problems such as asthma. Pregnant adolescents should be asked about use of tobacco as well as alcohol or other drugs. Adolescents who report current use of tobacco in any amount or any form should be encouraged to discontinue use and offered assistance with cessation.  The National Smoker’s Quitline has counselors trained to assist adolescents with smoking cessation and to provide the adolescent or his/her family with local smoking cessation resources (1-800-STOP NOW). At this time, tobacco cessation aids including nicotine replacement therapy, bupropion and varenicline are not approved for adolescent use. 

Adolescents and Substance Use

Experimentation with a variety of substances, especially alcohol, tobacco, and marijuana, is common among adolescents. Many adolescents use substances frequently, even daily, including legally available substances (alcohol, tobacco, inhalants, prescription drugs, wild plants) as well as illicit drugs (marijuana, cocaine, narcotics, numerous hallucinogens.) According to the 2009 Youth Risk Behavior Surveillance (Centers for Disease Control and Prevention), among U.S. high school students, 34% of females and 39% of males have used marijuana at least once, 18% of females and 23% of males have used it in the past month. Five percent of females and 10% of males report using marijuana for the first time before age 13 years.  Inhalant use is reported by 13% of females and 10% of males, Ecstasy by 5% of females and 7% of males.

The most serious short-term risk of substance abuse is unintended overdose and even sudden death due to ignorance of the harmful effects of a specific amount of any substance, unawareness of unidentified additives, or misperceptions of safety in its use. Intoxication with any substance can produce drowsiness, inattention, or loss of coordination leading to risk of injury while driving or participating in any physical activity. Intoxication can affect judgment in sexual relationships, increasing the risk of unintended, often unprotected sexual intercourse and even acquaintance rape. Some substances increase aggressive behavior leading to interpersonal violence. Substance use can complicate underlying chronic illnesses such as hypertension or diabetes. Many substances pose risk to the fetus, especially in the pregnant adolescent who is not yet diagnosed or is in denial. Intravenous use, uncommon in adolescents, carries risk of  infections (skin bacteria, hepatitis B or C, HIV). Buying, selling, or even using any illegal substance can lead to arrest and detention.

Adolescents may try one or more substances (experimentation), especially when coaxed or pressured by friends, but many do not continue use or use very infrequently. Adolescents may use substances to satisfy curiosity, to experience pleasurable feelings (“get high”), to be socially accepted, or to deal with boredom or stress. Risk factors for substance abuse (problem drug use) include substance abuse by parents, siblings, or peers, family problems, poor school performance, mood or anxiety disorders, use of tobacco and/or alcohol, history of physical or sexual abuse, and other behavioral problems.

ACOG recommends that Obstetricians/Gynecologists and other providers of health care to adolescents should ask about use of substances, as well as alcohol and tobacco, as part of the routine health history during any preventive health visit. If the adolescent admits use, the extent and potential risks of use of each substance should be addressed. The CRAFFT questionnaire has been validated for assessing alcohol and substance use in adolescents.  A positive response of 2 or more items indicates that substance use is problematic due to frequency, extent, and/or health risks.  The adolescent should be assisted in further evaluation and treatment and referred directly to a substance abuse treatment provider or to his or her primary care provider. In addition, female adolescents who are abusing substances should be counseled and assisted in using effective contraception. Parents who are concerned about possible substance use/abuse in their daughter or son should be directed to their child’s primary care provider or the state’s public health substance abuse agency for further discussion and appropriate evaluation and referral.  To find an appropriate substance abuse provider within a geographic area, go to the SAMHSA substance abuse treatment finder: www.findtreatment.samhsa.gov.

Adolescent Sexuality and Sex Education

Sexual development is an integral and important part of human development. Sexual health is an important component of health throughout the life-span. Sex education is a major component of comprehensive health education, the goal of which is to help children and adolescents become healthy adults with responsible health behaviors. “Family life education” often is considered to be a euphemism for “sex education,” however sex education is only one part, albeit a vital part of family life education. Family life education encompasses a broad range of topics that prepare young people for marriage, parenthood, and family responsibilities. Sex education often is approached with great anxiety and addressed in little detail in schools, in community programs, and even in the home.

There is a pervasive fear in the United States that sex education will promote adolescent sexual activity and increase the risk of pregnancy, sexually transmitted infections (STIs), and HIV infection among teenagers. Careful and objective scholarly research during the last two decades has shown that sex education does not increase rates of sexual activity among teenagers and does increase knowledge about sexual behavior and its consequences. It also increases prevention behaviors among those who are sexually active.

Young people are exposed to numerous influences upon their sexual attitudes and behaviors every day from the media, their peers, their parents, and other adults. Sex education/family life education is valuable in its ability to truthfully educate young people about sex and its risks, to provide them with knowledge to protect themselves from unwanted pregnancy and STIs, including HIV infection. Young people must have accurate and sufficient information to make responsible choices and to become responsible adults. Teaching correct information about sexuality or any other topic in school does not prevent any parent from teaching and modeling values and expectations in the home, rather it should assist parents in providing opportunities for family communication.

Adolescents and Alcohol

Alcohol is the substance (drug) most often used and frequently abused by adolescents. According to the 2009 Youth Risk Behavior Surveillance (Centers for Disease Control and Prevention), among high school students, 74% of females and 71% of males have had alcohol at least once and 43% of females and 41% of males have had alcohol in the past month. Binge drinking in the past month is reported by 23% of females (3 or more drinks in a row) and 25% of males (5 or more drinks in a row.) Of concern, 18% of females and 24% of males say they had their first drink of alcohol prior to age 13 years. The earlier the onset of alcohol use in adolescence, the greater likelihood of problem drinking in adulthood.

While alcohol may be used as a beverage and/or for religious rites in many families, excessive alcohol intake to the point of intoxication is a primary factor in many unintended injuries (motor vehicle crashes, drowning, falls from heights, and fires), especially in adolescents and young adults. In the 2009 YRBS, 7.6% of female and 11.6% of male high school students say they have driven a car while or after drinking alcohol in the past month – 29% of females and 28% of males have ridden with a driver who was or had been drinking. The influence of alcohol often impairs judgment regarding sexual relationships leading to unintended, often unprotected sexual intercourse and even acquaintance rape. Although alcohol is a legal substance, states laws govern its availability and provide penalties for its abuse, e.g. public drunkenness, driving under the influence. Because 21 is the legal age to purchase, possess, or drink alcohol, those under age 21 risk legal penalties for buying, selling, or even using alcohol as do those adults who provide alcohol to youth under 21 years.

Adolescents may use alcohol to express independence, to “feel” like adults, to be socially acceptable, to enhance sexual interactions, to deal with boredom or stress, and often just to “party.” Risk factors for alcohol use and especially abuse include alcohol use by parents, siblings, and/or peers, family problems, poor academic performance, mood or anxiety disorders, physical or sexual abuse, use of tobacco and/or other substances, and media depictions of alcohol use as normative, desirable, and safe, even for young people. There is debate about whether adolescents should abstain from all use of alcohol until age 21 or be taught to drink responsibly in the context of family. There is broad consensus that problem drinking by adolescents should be prevented.

Adolescents and Obesity A Resource Guide

Since 1980, the prevalence of obesity among youth ages 12-19 years has more than tripled from 5% to 16%, according to the National Center for Health Statistics. In children and adolescents, "obesity" is defined as a BMI (body mass index) greater than the 95th percentile for BMI for age. Children and adolescents with a BMI greater than or equal to 85th but less than the 95th percentile are considered "overweight."

Obesity has become the most common medical condition of children. Obesity in young people has been associated with increased serum lipids, decreased hepatic function (non-alcoholic steatorrheic hepatitis), increased blood pressure, impaired glucose tolerance and risk for diabetes mellitus type 2, sleep apnea with resultant school problems, slipped capital femoral epiphyses, Blount disease (tibia vara), and psychosocial consequences including stigmatization and victimization from bullying. There is increasing consideration of identifying the metabolic syndrome, the clustering of abdominal obesity with hypertension, insulin resistance, and dyslipidemia, in adolescents.

Obstetrician-gynecologists will be concerned with obesity in young women in evaluation of menstrual disturbances, especially when considering polycystic ovary syndrome (PCOS), in selection and follow-up of hormonal contraceptives, and in prenatal care. The ACOG Committee on Adolescent Health Care has recommended that all adolescents be screened annually by calculating BMI from height and weight and asking about eating patterns. A BMI table reproduced from the AMA Guidelines for Adolescent Preventive Services is included in the in the ACOG Tool Kit for Teen Care

What is prenatal care?

Prenatal care is the health care you get while you are pregnant. It includes medical care, education, and counseling. The earlier you get prenatal care, the better your chances are for a healthy pregnancy and baby.

What may happen at my first prenatal care visit?

At your first prenatal care visit, your health care provider will ask you many questions. You will be asked the date of the first day of your last menstrual period. Your health care provider uses this date to figure out how many weeks pregnant you are and estimate when your baby will be born (your due date). You will have a complete physical exam, which may include a pelvic exam. You also may have a urine test and some blood tests. You may be tested for certain sexually transmitted diseases (STDs).

What are childbirth classes?

In childbirth classes, you can learn more about pregnancy, giving birth, breastfeeding, and being a parent. There may be special classes for pregnant teens. There also are classes that can teach you how to take care of your baby. This includes how to feed, diaper, and bathe your baby and how to keep your baby healthy and safe. You can ask other mothers, family members, or health care staff to teach you, too.

What are things I can do to help ensure a healthy pregnancy?

It is important to eat healthy foods, exercise regularly, and get plenty of rest. You should avoid things that could harm your baby, such as alcohol, tobacco, and illegal drugs. You also need to talk to your health care provider about any prescription drugs you are taking as well as drugs you can buy without a prescription, like vitamins and pain relievers.

Why is it important to eat a healthy diet during pregnancy?

Eating the right food is good for your health and helps your baby grow. This is the time to make healthy choices. An online program called MyPlate (www.choosemyplate.gov) can help you plan a balanced diet. MyPlate makes it easy to remember what to eat at each meal. One half of your plate should be fruits and vegetables. The other half should be grains and protein foods. You need a small amount of dairy foods at each meal as well.

Are there any foods that I should avoid?

While you are pregnant, there are some foods you should not eat or eat only in small amounts:

Certain types of cooked fish—While you are pregnant, avoid shark, tilefish, king mackerel, and swordfish. You should limit albacore tuna (but not "chunk light tuna") to about one small can a week. These fish may have high levels of mercury, which can be harmful during pregnancy.
Caffeine—Caffeine is found in coffee, tea, chocolate, energy drinks, and soft drinks. It is a good idea to limit your daily intake of caffeine to less than 200 milligrams, which is the amount in two small cups of brewed coffee.
Sushi—Raw fish may be harmful during pregnancy.
Unpasteurized milk and cheese—These foods can cause a disease called listeriosis. Avoid cheeses that are made with raw milk (such as some feta, queso fresco, and bleu cheeses).

How much weight should I gain during pregnancy?

How much weight you should gain during pregnancy depends on your weight before you were pregnant. If you were underweight, you need to gain as much as 40 pounds. If you were a normal weight, you should gain 25–35 pounds. If you were overweight or obese, you need to gain as little as 11 pounds.

What vitamins are necessary during pregnancy?

An important vitamin for pregnant women is a B vitamin called folic acid. Getting enough folic acid (400 micrograms of folic acid daily before pregnancy and 600 micrograms of folic acid daily during the first 8 weeks of pregnancy) may help prevent major birth defects of the baby’s brain and spine. Iron also is important. More iron is needed during pregnancy to make extra blood that carries oxygen to your baby.

How can I be sure I am getting all of the necessary vitamins during pregnancy?

One way to get the all the vitamins and minerals you need during pregnancy is to take a multivitamin pill. There are special ones for pregnant women. At your first prenatal care visit, tell your health care provider about any other vitamins you have been taking. You may want to bring the bottles with you. Excess amounts of some vitamins can be harmful. Your health care provider will help you decide which vitamin pills to take.

Why is exercise important during pregnancy?

Exercise can help give you more energy, ease some of the discomforts of pregnancy, and make you stronger for labor and delivery. Most teens should exercise 30 minutes or more on most, if not all, days of the week. The 30 minutes do not have to be all at one time. For example, you can do three 10-minute periods of exercise.

Should I expect to feel tired during pregnancy?

During early and late pregnancy, it is common to feel very tired. It is important to get plenty of rest while you are pregnant— your body needs 8.5–9.5 hours of sleep each night. Listen to your body. During the day, take breaks and rest when you feel tired. Exercise and a healthy diet may help boost your energy.

Should I be taking medications during pregnancy?

Some teens need to take medicine during pregnancy for their health or for the health of the baby. Tell your health care provider about any prescription medicines you are taking or bring the bottles with you to your first prenatal visit. Be sure to talk to your health care provider before taking any over-the-counter medicines, herbal remedies, vitamins, or minerals.

Can using alcohol, tobacco, marijuana, or other illegal drugs cause harm during pregnancy?

Alcohol, tobacco, marijuana, and other drugs can harm you and your baby. If you use any of these substances, now is a good time to quit. If you want to stop, but cannot, ask your health care provider. He or she can help you find ways to quit.

Do teens have any special pregnancy risks?

Pregnant teens are at higher risk of certain health problems (such as high blood pressure or anemia) than pregnant women who are older. Pregnant teens are more likely to go into labor too early. This is called preterm birth. These risks are even greater for teens who are younger than 15 years or for those who do not get prenatal care.

Teens also are more likely to have STDs. You may have an STD and not know it. If you have sex during pregnancy, you could get an STD. Using a latex condom can help prevent getting or spreading some STDs (see the FAQ How to Prevent Sexually Transmitted Diseases).

What should I know about breastfeeding?

Breastfeeding is the best way to feed newborns and infants. Breast milk helps the baby resist diseases and allergies. Breastfeeding also is cheaper than bottle-feeding and may help you return to your prepregnancy weight more quickly. Even breastfeeding only for a few weeks or months has health benefits for the baby.

When you go back to school or to work, you can still feed your baby breast milk. You will need to get a breast pump to collect and store milk. Your workplace or school should have a place where you can do this.

When should I see my health care provider after I have the baby?

You should see your health care provider 4–6 weeks after your baby is born. During this visit, your health care provider will do a complete exam to be sure that you are healing and in good health. This is a good time to ask questions about your future health, breastfeeding, birth control, weight loss, sex, or your emotions.

Glossary

Birth Control: Methods to prevent pregnancy.

Listeriosis: A type of food-borne illness caused by bacteria found in unpasteurized milk, hot dogs, luncheon meats, and smoked seafood.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Preterm: Born before 37 weeks of pregnancy.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).