Host: A very common question for pediatricians is, parents want to know, how old the child has to be to start discussing this terrible word called sex? What would be the appropriate age, say with a female patient who come to you, when do you think that parents should start talking little bit about sex?
Guest: I would hope that our parents who have talked about sex to young children, we obviously don't wait until a specific age 12,13,14. In fact if you wait that long, your children could probably tell you a awful lot more than you want to hear.
Children learn about sex as soon as they are born, you know whether they are six or seven months old, but they know the difference between boys and girls. As they grow, they become more and more curious about their own bodies and then as they grow up they start learning more and more about others. So the term 'sex' is one of those very emotionally sort of topics. We don't talk to a two year old the same way as we talk to 12 year old or a 22 year old. So I think the answer is basically is to discuss sex and gender differences, males and females differently, depending on the age of the child.
Host: If the child starts menstruating of your female patient, is there anything you should be telling them at that particular point?
Guest: Well I think the discussion of menstruation needs to start very very young. Certainly as girls mature the closer they are to going into puberty that's when it's appropriate to talk about their change in bodies. What's appropriate to talk about menstruation, well I think personal hygiene is the beginnings of that discussion, talking about the fact that you, as you are going to puberty, will begin to experience changes in your body. Your breast will grow, hair will grow on particular parts of the body and eventually you will have menarche, which is the medical term for the first menstrual period.
Once the first menstrual period is started, we think it's important to talk to girls about the fact that the first two years after they have their period, they may be irregular, that is they may not have period every single 28 days, or 30 days. As their bodies mature and become more adult like, they may start having a period every single month. So talking about menstruation for girls, I think it's important to talk to them about importance of keeping a menstrual calender, knowing when your period started, when it ends, how many days it goes on for and also the importance of talking to their pediatrician or their personal physician about cramps. Cramps, the medical term is dismenoria, cramps in a very very common in teenage girls and many of them suffer needlessly because there is medication that can help.
Host: Why would you be concerned when they have never had a period?
Guest: Any girl who hasn't had their first period by 14, I start wondering if everything is normal, certainly about the time a girl is 16. She should already have her first period. But I think it's girl early on for the pediatricians to deal with these issues. By 12, 13 girl should be usually gone in to puberty, started puberty and by 14 we expect them to already have their first period, if they are going to puberty at an appropriate time.
Host: If a girls is very athletic, is there a chance the periods might be a little bit later?
Guest: We know many things will lead delay in periods. We know if a girl is super competitive athlete, whether that's in ballet or long distance marathon running or ice skating for example, that can delay periods. But there are reason for girls to have delayed periods. Eating disorders like Anorexia Nervosa may be a cause for delayed menses, delayed puberty. But other medical conditions like decreased thyroid, hypothyroidism is the medical term can also lead to delay in puberty and there are host of medical, other medical conditions that can lead to a delay in puberty and menstruation. So I think it's important for girls and families to speak to their primary care pediatrician.
Host: For a certain weight usually, they usually achieve when they usually get their first period?
Guest: It's not really weight based, it's not when you hit 85 pounds or 95 pounds or hundred. There is an interaction between and their height and their weight and their puberty itself.
Host: Thank you very much.
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