By Judy Licht
Special to The Washington Post
March 16, 1999; Page Z19

Last year, Celia Shapiro noticed that her daughter and other girls in their third-grade class were "starting to get figures, a little shape in their hips and breasts. Though these sweet little girls were oblivious to the changes in their bodies," Shapiro said, "as a woman I could see their physical futures beginning to unroll."

Shapiro, a computer systems engineer who lives in Chevy Chase, wondered what to tell "a 9-year-old about getting her period and how babies are made in an informative yet pleasant way." Shapiro bought books and began talking with her daughter about the physical, emotional and spiritual aspects of puberty and sexuality.

Open, honest dialogue about menstruation and sex is something that Shapiro and women throughout the generations did not get as children. "I'm 46 years old," she said, "and I'm still waiting for my mother to tell me the facts of life."

Shapiro's sense that 9-year-olds are at the cusp of puberty is right on target. A survey of more than 200 doctors' practices across the country, published in the journal Pediatrics last year, found that the onset of puberty, signaled by pubic hair and breast development, typically begins at 8 or 9 years of age for African American girls. White girls, the study found, typically start puberty by the time they are 10. There are genetic differences among ethnic groups that may account for earlier menstruation in African American girls, said Gilbert August, chairman of endocrinology at Children's National Medical Center in Washington. But there is no consensus in the medical community about what causes these differences.

Shapiro's efforts to link discussions of puberty and sex are also indicative of the way society has changed. "When I was growing up," she said, "There was no connection between getting my period and having sex."

That's no longer true. Today's girls are getting their periods earlier than their grandmothers did. In 1890, according to the New England Journal of Medicine, girls began menstruating, on average, at 14.8 years of age. A survey conducted last year by the National Center for Health Statistics found that girls today are getting their period, on average, at 12.6 years of age.

"One hundred years ago, women may not have had their first menstrual period until they were 15 or 16, and within a couple of years they were likely to be married," said Michael McGee, vice president for education at Planned Parenthood Federation of America in New York, a nonprofit reproductive health organization. Today, he said, girls typically get their period when they are 12 years old and typically have their initial sexual intercourse when they are 17.

"People are getting married much later than they were 100 years ago, and puberty is happening several years earlier," McGee said. "The time frame [in which] a girl has the capacity to get pregnant and [when she marries] is a much larger gap than it was in my grandmother's time."

Americans have not learned to cope with the fact that adolescents are maturing earlier, he said. "We make a big deal about a girl becoming a young woman, yet intellectually and emotionally she's not there yet. When the hormones kick in in a big way, there are a lot of changes. Girls have urges and feelings that are new."

Until puberty, girls are considered the stronger sex, said Joan Jacobs Brumberg, professor of human development and women's studies at Cornell University and author of the book "The Body Project." "They have fewer emotional and physical problems than boys."

Beginning at puberty, "studies show that girls shut down in a lot of ways. They stop raising their hands in school," Brumberg said. They become self-conscious, obsessive about the way they look, and vulnerable to developing eating disorders, such as anorexia, bulimia and obesity.

"More and more girls are commenting on the fact that boys beginning in sixth grade are making them feel weird or uncomfortable about their bodies," she said. "It is as if the young male tongue has been disinhibited by the culture in which we live."

It is a culture that Brumberg complains is "selling sex so persistently--from Spice Girls, to the Internet, to advertisements in the New York Times magazine for children's clothing. Children's bodies are eroticized, and growing up, our girls are having more problems than ever before."

Brumberg worries about the impact on girls who are having their periods at a younger age. "It's a different thing to have most girls menstruate at 12 than at 15," she said. "Most people say that the younger age has to do with improved nutrition and the decline in infectious diseases."

But what concerns her is that "while we're seeing them coming to sexual maturity earlier, we don't know that there is any parallel escalation in their cognitive thinking and emotional abilities," Brumberg said. "They are fertile younger and we don't give them any particular supports to help them with their new sexuality. It is kind of a mismatch between biology and culture."

Many families don't discuss periods, said Kathy Woodward, medical director of adolescent ambulatory services at Children's National Medical Center.

It is not unusual in Woodward's practice "to see a lot of girls who get their period when they are 9 or 10 years old." One recent patient, a 9-year-old, had gotten her period every three weeks beginning last April. From July 13th until August 17th, when she first saw Woodward, the girl bled every day without stopping. "It wasn't until her mother realized that a box of 40 pads had disappeared and the girl was asking for more that she became aware there might be a problem."

Woodward examined the girl and found that although she was menstruating, she was not ovulating. To artificially normalize her cycle, Woodward prescribed progesterone, a hormone produced in the ovaries during the second half of a menstrual cycle. In its absence, a girl can have prolonged or irregular bleeding or missed periods.

But it may not be enough to fix just the physical problems. The mother of one of Woodward's patients who got her period when she was 9 said that her daughter "can't manage the emotional component. To her, it is just a problem. She goes to a sleep-over and we think her period is going to start and she has to be prepared. Last year in school, she wasn't feeling good about herself. Her grades went down. I think she was preoccupied about when it was going to come."

Another normal biological element of early puberty is an increased libido with the onset of endocrine functions, said Woodward. "As estrogen levels in children rise to adult levels, there's also increasing reflex responses to hormonal stimulation," she said. "Watching people kiss doesn't excite a 6-year-old, but a girl who is pubertal . . . begins to feel early sensations of sexual arousal."

It's a matter of timing. "A young person who becomes fertile at 16 or 17 is having a different experience than a young person becoming fertile at 11," said Felicia Stewart, director of Reproductive Health Programs for the Henry J. Kaiser Family Foundation in California. "When your hormones get turned on, that's when you look mature, have a sex drive and appear to other people to be mature. So it isn't surprising that it would have an impact on what actually happens sexually."

What's happening is that kids are having sex at younger ages. In a survey of 12,000 adolescents published last year in the Journal of the American Medical Association, 17 percent of seventh- and eighth-grade boys and girls reported having had sexual intercourse.

High rates of sexual activity among teenagers are reflected in the fact that 4 million teens contract a sexually transmitted disease and 1 million girls become pregnant every year, according to the Centers for Disease Control and Prevention. What's more, up to 50 percent of the new human immunodeficiency virus (HIV) infections in this country each year occur in people under the age of 25.

"Young adolescents are concrete thinkers," said Michael McGee of Planned Parenthood. "They have a hard time foreseeing the consequences of having sex or having unprotected sex." They may be curious about sex, think they are in love, or feel like there is pressure for them to be a grown-up, he said. "Sometimes they do it because they feel rebellious against their parents or because they are hoping for an intimate experience where they feel valued or loved."

His organization has learned from research on adolescent development and sexual behavior that "when kids feel close to their parents, they are more likely to be sexually healthy," said McGee, a psychotherapist. And they are likelier to delay intercourse and protect themselves from unwanted pregnancy and disease.

He has told his own kids, an 18-year-old daughter and a 14-year-old son, "that when they have sex, which I hope is after they've earned their PhD, I want it to be a wonderful experience."

Parents must teach their children to take personal responsibility to protect themselves from pregnancy and disease, he said. "You want to give your kids both roots and wings. Roots are the values about sexuality and relationships and the security that you are cared about in a family. The wings," he added, "are a parent's ability at some point to let children go and develop on their own as sexually healthy adults."

Ironically, at a time when parental involvement and open communication is the first line of defense against risky behavior, many parents are working more and spending less time with their children. That time together is "about 16 hours less [per week] than it was 25 years ago," said Richard Udry, professor of maternal and child health and sociology at the University of North Carolina in Chapel Hill. "Kids who spend less time with their parents don't do as well."

They are more likely to engage in risky behavior when their parents are not around, said Brent Miller, head of the department of family and human development at Utah State University in Logan, who has reviewed 20 years of research on child-parent relationships.

Udry argues that although youngsters are pressured to follow their friends' leads, "Parents shouldn't get sucked into the idea that adolescents are only influenced by their peers. It's not true. Parents need to make opportunities to keep the conversation flowing with their children."

Girls need reinforcement that biological development is natural and healthy and puberty is a time to set academic or athletic goals.

"One of the interesting things to do is to talk to your daughter about your own experience at menarche," said Joan Brumberg of Cornell. "Develop some sort of intergenerational dialogue about what it means to grow up in a female body. Introduce the idea that her body will be changing and this is a positive experience. She doesn't need to worry about the fat that will appear; that is natural."

Brumberg proposes that parents "continually reinforce the message of what her body can do rather than what it looks like. I see my granddaughters now and I don't always comment on how cute they are. I move the conversation off appearance to healthfulness, asking instead, 'How fast can you run?' "

In many cultures, women have created rituals marking the transition to womanhood, "but in our society we don't celebrate rites of passage," said Monica Rodriguez, director of education at Siecus, the Sexuality Information and Education Council of the United States, a nonprofit organization based in New York.

"I think it would be great if we did more of that. It would be better if a girl getting her period looked at it as a cause of celebration rather than as the dreaded curse."

But focusing solely on a celebration or on the traditional "big talk" about sex misses opportunities to lay the foundation for a value system that a child can rely on to make the right decisions.

"Parents don't need to know all the answers. They can even tell their children if they feel uncomfortable or embarrassed about talking about sex," Rodriguez said. "But they should become what we call 'askable parents,' and be willing to engage in the conversation. We know that kids want information about sexuality from their parents, but studies show that they don't feel they get it."

Sheila Ford, principal of Horace Mann Elementary School in Washington, has been an educator for 28 years. "We never used to talk about human sexuality issues," she said, "but now society is asking us to do more and more. We are the central entity for so many young people."

It is hard for schools to "assume more family-oriented activities because of our academic requirements," Ford said. Nevertheless, she believes schools have to provide accurate information and help children learn to have healthy relationships.

At Horace Mann, fifth- and sixth-graders participate in a six-week course on human sexuality and development. The program is coordinated through the school nurse, guidance counselor and physical education teacher; it encourages children to ask questions. The school also offers them an opportunity to talk privately with a staff member before or after school, Ford said.

Though studies show that children prefer to learn about sexual development from their parents, they will turn to their friends for information if their needs are not being met. "Peer influence," Ford said, "is much greater by the end of fifth grade." Before that, she said, parents have a window of opportunity for reaching their children.

My Little Girl's Metamorphosis

One morning last summer, my daughter woke up and her body had changed. She wasn't a string bean anymore. She was exploding out of her clothes, and I looked at her in awe. What had happened overnight to my 8-year-old? And then it hit me. She was growing up.

I wasn't ready for the metamorphosis. Thoughts of puberty seemed years away. But staring me right in the face was a little girl evolving into a young woman. She had hips and tiny breasts and a new graceful air of maturity. Her development so far has been pretty predictable and smooth, but these next few years may take us on a more turbulent ride. The trip into adolescence can be bumpy at times.

The first hints of maturity are subtle physical changes. Small breasts pressing through a tight T-shirt, jeans pulling at the hips, evidence of pubic hair. Within two years of these changes, girls usually get their first period.

Timing is the uncontrollable element for every child. Menstruation can begin as early as 8 or not until high school. Girls who start early often feel unprepared emotionally, just as those who get their first period when they are older worry they may be coming late to the dance.

As parents, it's hard to look forward to some of the hormonal changes our children will face. We remember embarrassing, awkward stages--the oily skin and pimples, greasy hair and body odor. How do we explain to our daughters that for the next 30 or 40 years they will bleed vaginally every month for up to a week? And how about the menstrual cramping, mood swings, headaches and bloating they'll experience?

Fortunately, there are ways to prepare girls. Cathy Raisher, the nurse at Lafayette Elementary School in Washington, spends a lot of time talking with girls about what to expect. It is important, she said, to have frank discussions with both boys and girls to "dispel all the myths" about reproduction and development. "These kids don't want any surprises," Raisher said. "They want to know exactly what to expect. Around fourth grade, girls get curious about what pads and tampons are."

Raisher finds that the questions become very direct in fifth and sixth grade. "The biggest thing they are concerned about is 'What happens if I start my period at school?' " she said. "I tell them to come to my office. I keep sanitary pads and tampons, starter kits and pamphlets, in a closet right inside my office. I bring the girls down, show them where everything is, and tell them they can come here if they need to."

She tells them "that usually a period doesn't start suddenly as this gush. If they're paying attention, they'll notice that something is going on. About six months to a year before they get their period," Raisher said, "they'll be aware of a white discharge. When that happens, they should be mindful that this is a sign. From then on, if they feel a dampness, they need to go to the bathroom and take a look."

In Raisher's experience, girls want reassurance that what is happening is normal. "They'll come and ask me about the way their breasts are changing. I've had girls say, 'I feel something hard under my nipple, is this right?' Or 'I just got my period and my back hurts. Is there something wrong?' "

Others may have mild cramping, and she tells them to exercise and drink lots of water. She also talks with them about mood swings. "I let them know they may feel a little crabby and not know why, but not everyone has PMS. We also talk a lot about personal hygiene and that it is important to bathe more often."

What is surprising, Raisher said, are the sexual questions. "The girls see things on TV and in magazines and they ask very blunt questions about sex. Eleven-year-olds are worried about what age is right to have sex. They want to know how condoms prevent pregnancy."

Ironically, just as they are facing maturity, girls become more emotionally vulnerable. "I think self-esteem and puberty are intertwined," said Ellen Feingold, director of adolescent medicine at the Alfred I. DuPont Hospital for Children in Wilmington, Del.

"Body changes very often are looked upon negatively," she said. "It could be a function of the media, but we have focused on the impossibly thin in an age when many kids have become very fat." Parents have to support "body changes as wonderful and new, exciting and inevitable. Self-esteem is the key. I find it is the underlying focus for just about every disease I am treating in my clinic."

Changing schools, shifting friendships, moving and many of the normal transitions of life can be very stressful for teenagers if they are feeling unsure of themselves. "Kids don't seem to be as resilient as we'd like them to be," said Feingold. They're struggling with finding their independence while remaining dependent on their parents at the same time.

Before school today, my daughter came into my room pulling on the sleeves of her shirt. "Mom, this doesn't fit anymore," she complained. Since early summer, I've become accustomed to that observation, and I'm trying to get used to the idea I'll be watching her outgrow more than just her clothes over the next few years.

A Single Dad's Story

Michael Richardson has been a single parent of twin daughters since they were 2 years old. They are 13 now, and he has been talking to them about sexual issues since they were 8. "I never had a parent who spoke much about those things with me," he said.

"We learned in the locker room or from books, magazines or friends. I stumbled upon a book in my mother's drawer, and that's where I learned about the anatomy of women."

With his daughters, Richardson "established early on the idea of family conferences. Anyone could call one, and you are allowed to ask anything. There is no downside. I can't get mad. I can't shut it off."

It is in these conferences that questions about sex have arisen, said Richardson, a Washington pulmonologist. "I suppose my feeling is that the girls are going to have crushes and interests and feelings about things, but that doesn't necessarily have to translate into intercourse," he said.

"Because they look like young women, I can see boys look at them differently. The chance that some young man at 16 or 17 is going to try to get them into a compromising situation is much higher."

Richardson tells them, "You can go out with a boy. You can like him. You can even kiss him. But remember, his job is to try to get you to have sex with him. That's what he is going to be trying to do because he is a man."

He worries about "the stuff they look at: the TV shows, from cartoons right through first-run movies, teen magazines and records; what is said now is sex."

His generation listened to oldies, looked at magazines. "People talked much more about romantic love, sometimes in much more silly ways," he recalled.

"Now what is talked about is sex. My daughters already know that the image of growing up today as a young woman has a sexual imprint to it, and I have to deal with that."

© Copyright 1999 The Washington Post Company

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