They are the all-important questions around talking to young girls and puberty: When do I begin the conversation? How do I do it? What do I say?
It’s not always an easy conversation to have but, clinicians can agree, it’s a critical one.
If you’re looking for tips on how to approach the conversation, look no further than Amy Kelley, M.D., who specializes in obstetrics and gynecology in adolescents at Sanford Women’s and is passionate simply about age-appropriate education and awareness about puberty and transitioning into adulthood.
Puberty for girls is all-encompassing, Dr. Kelley told Sanford Health News, and typically begins between the ages of 8 and 11 years old.
“It’s not just about menstruation,” Dr. Kelley said. “Your whole body changes during puberty with growth and transitioning into adulthood.”
When puberty begins in girls
Early physical signs of puberty typically include breast development and pubic or underarm hair which is followed by a quick growth spurt within about six months. Those early signs of puberty typically lead into the first period about two years later.
“It could be a little less or a little more but that’s the common physical and medical milestones of puberty,” she said. “A lot of times, people are focused on body changes and maturing into womanhood but some of the most profound changes actually happen in the brain.”
These changes include subtle signs like feeling more emotional with the sudden onset of reproductive hormones.
Once that starts to happen, Dr. Kelley said one of the most common questions she hears from adolescent girls is, in some variation: “Am I normal?”
“It’s a very normal milestone both cognitively and socially for women and girls at the time of puberty,” she said. “Middle school is typically where adolescents often wonder if they fit in so the hard part about that time is, they don’t want to feel different because they think it’s a bad thing.”
Sometimes, she says, it’s just reassuring for them to know these changes are normal.
“If girls haven’t seen those early signs by 12 years old or their period by 15 years old, we want to see them to make sure everything is normal and figure out why it hasn’t started yet,” Dr. Kelley said.
Things that make puberty challenging
When parents express anxiety over approaching the conversation with their prepubescent daughters, Dr. Kelley tries to remind them it’s nothing to fear.
If a young woman enters puberty earlier or later than the normal age range, that can pose some challenges as they could receive unwanted attention from peers and may not have the emotional maturity to handle that.
In some cases, the internet and social media aren’t doing us any favors.
“Girls are growing up in a super heavy technology-based world right now,” Dr. Kelley explained. “So they have information at their fingertips and so they can search for anything.”
The fear is what they talk about and do with their friends via social media without parents knowing, seeing or hearing it.
“It’s really important to filter the social media and to keep tabs on their use of technology, because we don’t want them hearing wrong information. We want to be able to talk with them firsthand about it.”
Pro tips for beginning ‘the talk’
Dr. Kelley’s biggest advice is don’t wait to have the conversation and always be open and attentive to it if they approach you first.
“It can be really hard because, for some of us, our parents didn’t talk to us about it so we know it’s a big conversation we know is super important but nobody knows how to do it.”
The goal is to keep that line of communication open throughout the young woman’s life so it won’t be such a “big talk” when it’s time to have it.
“They respond really well to that and they’ll have a lot of questions,” Dr. Kelley said. “It’s a lot easier if the girl can drive the conversation and ask the questions because then you have a foundation.”
Dr. Kelley has the following tips to make the conversation as comfortable and effective as possible:
- Sit down to explain puberty before she gets her first period
- Consider talking to her in a group, pairing up with her friends or other loved ones of the same age
- Give her a heads up that you want to talk about puberty and ask her to prepare three questions of her own
- Start a conversation through journaling if face-to-face seems uncomfortable
- Take a drive in the car or a place she can’t run away; you can avoid eye contact and it feels less vulnerable for them
- Use real medical terms when talking about body parts
The conversation isn’t just about sex or that first period, it’s all about body image and all the changes their body endures during those adolescent years.
Adding discussion about sex assault, abuse
National statistics show the average age of sex abuse is 9 years old which is another reason to have the conversation early.
“You are protecting your children by telling them, through age-appropriate dialogue, what sex is,” she said. “If they are ever tricked or forced into an uncomfortable or illegal situation, they will have an understanding and hopefully be able to communicate without any confusion.”
As horrible as it is to think about that, Dr. Kelley says abuse is common.
Learn more: Keeping children safe at Sanford
“You can help your child not be one of those statistics or at least help them communicate with you if they know some of those things.”
When it’s time to see the OB/GYN
If you’re wondering when it’s time to transition from the pediatrician to an OB/GYN, Dr. Kelley said it depends on the girl.
The American College of Obstetrics and Gynecology (ACOG) suggests that first adolescent gynecology visit between ages 13 and 16 years old. In reality, that can vary from adolescent to adolescent.
She said pediatricians will see their patients up until 21 years old in some cases.
“I think pediatric care is important for a lot of young women who have certain medical conditions like asthma that’s not well controlled, diabetes or other medical issues. They still need to see their pediatrician and they might just need to see me in addition,” she said.
However, she added, pediatricians and family medicine providers have some gynecologic training so it’s dependent on how comfortable the patient is with their current providers and medical history.
“So much of it is about having a relationship with your patients, establishing that trust and connection to make them feel comfortable talking to you about sensitive things and asking the seemingly uncomfortable questions,” she said.
Some of her youngest patients include those with puberty-related concerns, painful periods or other symptoms that are keeping them from missing school or normal activities. Other patients in their later teen years, who may be transitioning from high school to college, will discuss topics like sex and contraceptives.
Typically once they hit 21, they will begin needing pelvic exams and Pap smears as part of their care routine.
Additional guidance and resources
Dr. Kelley encourages parents to allow young women to embrace the changes.
“We like to focus a lot on nutrition and exercise, and filtering out what is acceptable and what is not on social media,” she says. “Help them to embrace the changes and realize they’re one of a kind. These changes are making them into the women that they’re becoming so they should own and accept it.”
She recommends the following books as additional resources:
- “Girlology: A Girl’s Guide to Stuff that Matters,” by Melisa Holmes and Patricia Hutchison
- “There’s Something New About You: A Girl’s Guide to Growing Up,” by Melissa Holmes
- “The Care & Keeping of You,” by American Girl
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