Prevention & Recovery

Teen sexuality

Author: Canadian Living

Prevention & Recovery

Teen sexuality

Excerpted from Canadian Living family editor Christine Langlois' book, Understanding Your Teen (Ballantine Books, 1999)

The stats are clear. More than 80 per cent of North Americans have their first sexual intercourse as teenagers. It's a major step into adulthood and one that a teen should feel comfortable discussing with his parents. But few do feel comfortable. Many kids even say they're reluctant because their parents are too serious about sex or take too long to answer their questions. They also complain that parents don't talk about the associated feelings. Most parents do talk about all the frightening negatives - the dangers of contracting a sexually transmitted disease (STD), the possibility of an unwanted pregnancy, and the pain of being abandoned by someone you thought loved you.

For many parents, adolescent sexuality is a highly charged emotional issue. Despite the statistics, most parents have difficulty acknowledging the emerging sexuality that accompanies their teen's increasing independence of thought and action. As parents, you can't control your teen's behaviour and you can't preserve her from all the risks inherent in taking on more adult roles. Most parents know that the majority of teenagers move from kissing to more intimate sexual behaviours, then to intercourse. But if you don't talk about sexual behaviours, your teen may interpret the lack of acknowledgment as disinterest in her feelings and even disapproval of all sexual activity. That won't stop her from exploring her own sexuality, but she may explore under a blanket of guilt, fear, and misinformation. Rather than risk losing your respect by asking you questions about topics that make you uncomfortable, she risks disease and pregnancy.

It's true that the stakes are high. Your teen might become entangled in an emotional relationship that he is too immature to handle. Your son could make his girlfriend pregnant. Either son or daughter might contract an STD, which could cause illness or infertility, or they could become infected with HIV (human immunodeficiency virus), which most often leads to AIDS (acquired immune deficiency syndrome).

When parents do discuss sexuality and responsible sexual behaviour with their teens and answer questions or direct them to appropriate resources, the young people eventually gain enough self-confidence and information to behave responsibly in sexual situations. Teens certainly need the facts about the potential pleasures and pains of sexual relationships. But they also need the opportunity to talk with adults about what's most on their minds: How do you know at what point in a relationship the time is right? How do you tell your boyfriend No when the time isn't right? How do you become a good lover and have sex that's mutually pleasurable?

Sue McGarvie, an Ottawa sexual health educator, believes that parents don't talk to their kids about sex with enthusiasm because they're afraid their kids will want to have sex. "But what's wrong with that?" she asks. "After all, why do people have sex? Because it feels great." McGarvie suggests that parents should remember to include positives about sex along with the negatives. At her talks with parents and kids, McGarvie raises the topic of orgasms, although parents are often shocked. "But if your kids are going to be having sex, you want them to be having orgasms," she says. This kinde of discussion helps kids learn about positive sexuality as part of a real, loving relationship.

Some aspects of sexual relationships needn't always be treated as serious topics. After all, much of what our culture considers humorous has sexual connotations. Help your teen relax about the topic and view sex as a natural part of life, at the same time learning how to keep private intimacies private.

Parental silence about sexual behaviour may provide a fertile ground for a teen's curiosity: She might respond to older teens or adults who prey on the uninformed; or the silence may breed anxiety that interferes with her ability to eventually enjoy a sexual relationship. Teenagers who are unaccustomed to discussing their sexuality may also deny to themselves that they want to have sex and, as a result, won't take precautions against either STDs or pregnancy.

The majority of sexually active teens use contraception on an ongoing basis, but about 20 per cent use no contraception; 19 per cent of the girls who do use the pill don't also use condoms for protection against STDS. Often the boy expects the girl to take sole responsibility for protection, but she may not be fully informed about the various methods. Information and openness are key: There's evidence that teens whose parents teach them or encourage them to learn the facts and myths about sexuality and discuss sexual health openly are more likely to delay involvement in sexual intercourse until they're older. They're also more likely to decide to use some method of protection against sexually transmitted diseases and a method of birth control if they do decide to engage in sexual intercourse.

Even if your own beliefs and values lead you to disapprove of birth control or of sexual intercourse before marriage, even if you prefer that your teen wait until she's older and is involved in a loving relationship, discuss the facts and implications of sexual intercourse because your teen may, as an independent thinker, choose to take her relationship that far. Make sure she has information not only to prevent an unwanted pregnancy but also to avoid contracting STDS that might prevent a future wanted pregnancy.

When and how?
Meg Hickling, a registered nurse and sexual health educator in Vancouver, believes that parents don't talk to teens about sexuality nearly as often as they could or should. Most kids don't want to talk about it when there's intense, eye-to-eye contact with their parents, and they don't want to answer direct questions about their own behaviour. But they would like to have more general discussions with their parents. Hickling suggests that parents use situations in which their kids are a captive audience. Long car rides often give parents and teens the chance to do their best talking. Teens will also talk more openly with parents when everyone's busy together, making dinner, tidying the kitchen, cleaning out the garage. Approach the subject from a sidelong direction. Develop a conversation from an item you watched on the news together. Certainly there are ample references to sexuality and sexual behaviours on television and in movies to serve as lead-ins to frank and open conversations between parents and teens.

Answering your teen's questions
"When am I ready?" Your son isn't likely to look up from his breakfast cereal and ask you this question, but you can bet it's on his mind. As his parent, your role is to be a wise influence and provide information; when to become sexually active is your teen's choice. If you would like to influence his decision, here are some topics you might think about so that you can offer your own version at an appropriate time.

• Sexual intercourse should be part of a loving relationship, and each partner should feel both sensitive to and protective of the other. Some people believe you're ready to have sex if you're comfortable telling your partner what feels good to you. Others feel you're ready to have sex when you can go to the drugstore and buy condoms with your own money, or when you can make an appointment with your doctor to get backup birth control.

• If teens put off having sexual intercourse until they feel confident about discussing these topics, it may ultimately make their first experience better. But they may feel they're abnormal or may fear rejection by others if sexual intercourse isn't part of their relationship. Both males and females might use variations of the line "You'd do it, if you loved me" on each other. Give your teen a possible response: "If you loved me, you wouldn't pressure me." Or suggest helpful relationship books that reveal favourite "lines" and responses that can deflect unwanted attention with humour or with compassion.

• Remind your teen that she is in charge of her own body and can set limits on sexual behaviour. If your daughter doesn't know how to raise the topic with her partner, suggest some openers: "I really like the kissing, but I don't want to go any further." She might also add, "if I have to worry about stopping you from going further, it keeps me from the fun of kissing you."

• Let your teen know that he can enjoy sexual feelings and give and receive sexual pleasure without having intercourse. And he needs to know that abstinence from sexual intercourse is the most effective method of preventing both pregnancy and sexually transmitted diseases.

• Teach your teen that when one partner says No, the other partner must stop whatever sexual activity he's doing; teach her not to put herself in vulnerable situations, in any place, with any per son or group that makes her uncomfortable or uneasy; teach him not to make himself vulnerable by using alcohol or other drugs that decrease his inhibitions or cause him to act irresponsibly.

Birth Control

The basic information every teen needs to know before having intercourse should include birth control. Be sure your teen knows that every time a man and a woman have sex, there is the possibility that they might make a baby. Despite lines to the contrary, a girl can get pregnant the first time, during her period, using withdrawal, standing up, or while on drugs.

The 1995 Canadian Contraception Study revealed that almost all Canadian women between fifteen and forty-four knew about oral contraceptives and condoms. Why some teenagers choose not to use birth control isn't clear. Some girls may fear that discussing contraception makes them appear too easy or rather sex-crazed. Some teens just conclude that pregnancy happens to others - not to them.

Some research shows that teenagers who are accustomed to talking openly with their parents about sexual matters are not less sexually active, but they are more likely to use birth control. Supply your teen with the information she needs in case she's considering having sexual intercourse with her boyfriend. Saying "Use precautions" isn't enough. You wouldn't teach her to drive with such vague instructions, but sexual intercourse can have enormous consequences on her health and well-being.

Give her all the details she needs through discussions, pamphlets, books, as well as access to medical counselling. If you feel awkward about opening the discussion, try, "I understand that a lot of people your age get involved in sexual intercourse, so it's really important to me that you learn about protecting yourself from disease and pregnancy."

Your teen has a wide range of birth control options. But none, except abstinence from sexual intercourse, is 100 per cent effective.

The pill The birth control method used most frequently is the pill. The pill stops ovulation and alters the pH of the vagina, making it inhospitable for sperm; it also thins the endometrium so that eggs can't implant. Most birth control pills are very effective; the failure rate of less than 1 per cent includes those women who sometimes forget to take the daily pill. The pill has several positive side effects along with some negative ones. It reduces the severity of menstrual cramps and headaches; it reduces acne and anemia. But it may cause some nausea, breast tenderness, irritability, and spotting between periods. It's also advisable for women who smoke not to use the pill.

The condom In addition to providing birth control, the latex condom is the only protection against STDs. Girls should not be shy about asking a partner to wear one. When fitted snugly to the penis, a condom contains the male's ejaculate and prevents the sperm from entering the woman's vagina. The user and his partner must learn how to put on a condom and how to squeeze out any air bubbles to prevent pressure that might result in breakage. Condoms have an expiration date, and teens should know to check the date on the package and open it carefully to prevent tearing. They should also know that condoms can sometimes fail. An oil-based lubricant like lotion, oil, or petroleum jelly weakens a latex condom, possibly causing it to break. Using a spermicide such as nonoxynol-9 improves protection from pregnancy. Although many condoms are lubricated with nonoxynol-9, it is more effective when applied in the vagina.

Other birth control Teens should know: that a spermicide protects against STDs while it also kills sperm; that a woman must be "fitted" for a diaphragm or cervical cap, which provides a barrier between the sperm and the uterus; that the contraceptive sponge absorbs sperm and inactivates it with a spermicide.

Emergency contraception pill (ECP) Parents and teens should know that their family doctor can prescribe this "morning-after" pill and that it is effective not just the morning after but up to 72 hours after intercourse. Some clinics and rape crisis centres also keep it on hand. It cannot be used by women with heart disease, a blood-clotting disorder, or severe migraines.
More birth control information is available from a variety of sources. Direct your teen to her doctor, to Planned Parenthood, telephone talk lines, teen clinics, and the library. If she seems unsure or unwilling, pick up some brochures for her, and leave them in her room.

Unwanted Pregnancy
Although any sexually active teen couple can make a baby, some teen couples are at higher risk. Parents who don't discuss sex at all or who talk only about abstinence from sexual activity leave their children without important knowledge that might prevent their daughter from becoming pregnant or their son from impregnating his partner. The teens in these families may not know enough about the sexual acts their bodies want to perform and the consequences of those acts, let alone about protection. A teenage girl with little sexual knowledge is more likely to be coerced into sexual intercourse by an aggressive older partner. The statistics from a Toronto public health office show that 26 per cent of teen mothers age fifteen to seventeen and 31 per cent of teen mothers age eighteen to nineteen had partners who were twenty-five or older.

If your daughter does get pregnant, she needs your support. Accidents happen - his condom breaks, her diaphragm doesn't fit properly, or she forgets to take the birth control pill regularly. Teens are about as consistent about birth control as adults are. Two-thirds use contraceptives the first time they have sexual intercourse; more than three-quarters use contraception on an ongoing basis. Trying to assign blame won't change your daughter's situation.

Discuss the choices she has: abortion, or taking the pregnancy to term and either raising the child or giving the baby up for adoption. Help your daughter find realistic information and counselling, if she wants it, about the positives and negatives of each choice. It may be very difficult for you not to impose your own beliefs. Let her know how you feet about the choices, but ultimately it is her decision.

If your son impregnates his partner, fight the feeling of panic and concentrate on his needs. The decision about what to do about the pregnancy will be primarily his partner's, but the situation is also painful for the young man involved - although his trauma is not usually acknowledged. Avoid laying blame, and help him get the information he needs to deal with his questions and his fears. Let him know you support him, and help him get counselling, if he wishes.

Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are acquired during sexual intercourse (vaginal, oral, or anal) with an infected person. Adolescents have the highest rate of STDs of any age group - one in six sexually active teenagers contracts an STD each year. The infections are caused by different organisms, usually bacteria or viruses. Even a person who doesn't look or feel sick can be infected, so partners should always take precautions before sexual intercourse. All teenagers should learn the signs and symptoms of STDS.

The most common symptoms are warts, lumps, and sores in the genital region; discharge from the vagina or the penis or from the anus; a burning sensation when urinating; a sore throat; itching in the genital or anal region; and lower abdominal pain or pain in the groin. Some STDs are totally without symptoms but can still lead to internal complications when not detected and treated. Until she is eighteen or twenty, a young woman's cervix has immature cells that are more susceptible to diseases such as chlamydia and the papilloma virus (which can cause cervical cancer). If left untreated, some STDs are life-threatening.

Prevention
The most successful way to prevent acquiring or transmitting STDs is to not engage in sexual intercourse. However, those who choose to have sex can lower the risk of infection by always using a condom, even while engaging in oral or anal sex. Using the spermicide nonoxynol-9 along with a condom kills some STD-causing germs. It also reduces the risk to limit the number of different partners, to not have sex with an infected person, and to abstain from sexual intercourse if you have and are being treated for an STD.

Washing the genitals with soap and water and urinating right after sexual intercourse might eliminate some STD-causing germs before they cause infection. Women should not douche - most odours come from outside the vulva, so douching is not necessary for cleanliness, and it may actually spread infections. The chemicals in douches may also irritate a teen's vagina, upset the balance of healthy bacteria, and increase the risk of getting pelvic inflammatory disease.

Diagnosis and treatment
Most STDs can be diagnosed during a doctor's physical examination. He may test a culture of the secretions from vagina or penis, or perform a blood test. STDs caused by bacteria can be treated with antibiotics, but those caused by viruses have no definitive cure. However, early detection of STDs can limit how far and how fast they spread and progress.

STDS caused by bacteria

Chlamydia has relatively few symptoms, especially in women. If there are symptoms, they usually include itching around the vagina, pain during sex, painful or frequent urination, or an odourless, yellow vaginal discharge. Other symptoms are a dull pain in the pelvic area and bleeding between menstrual periods. Chlarnydia can also cause pelvic inflammatory disease which causes infertility in women. Symptoms in males include painful urination and a watery, milky-coloured discharge from the penis.

Gonorrhea (the clap or the drip), like chlamydia, has few symptoms in women, but when present they include white, green, or yellow vaginal discharge and painful urination. Men may experience a thick, yellow penal discharge and painful urination. Gonorrhea has been linked to pelvic inflammatory disease and arthritis.

Syphilis shows the same symptoms in both sexes. The early signs include chancres (painless red sores) that appear on the areas of sexual contact-the genitals, anus, tongue, and throat. The glands near the chancre might swell. A few months later, a sore throat, fever, lack of appetite, or joint pain may occur. The sufferer may develop a scaly rash on the soles of the feet or the palms of the hands. After these symptoms have disappeared, there may be no signs for a few years. When the symptoms recur, the tertiary stage of syphylis affects the brain, the spinal cord, and the skin and bones. Syphilis also causes heart damage, blindness, and death.

STDS caused by viruses
AIDS (acquired immune deficiency syndrome) results from infection with HIV (human immunodeficiency virus), which lives in an infected person's blood and other body fluids. HIV attacks the immune system which protects against bacteria and infections. With a compromised immune system, people with HIV become susceptible to every infection and cannot easily recover from even a minor illness.

Most people who contract HIV have become infected in one of the following ways: from the blood, semen, vaginal secretions, and open sores of an infected person; from sharing a needle previously used by an infected person to inject drugs or to pierce or tattoo the body; from a transfusion of the untested blood of an infected person; by getting the blood of an infected person in an open, bleeding sore. Contracting HIV through exchanging saliva while kissing has never been known to happen. Because the virus cadt survive long outside the body, it isdt transmitted through casual contact such as touching, shaking hands, or hugging. The virus also cannot be transmitted just by swimming in a public pool, using public telephones, water fountains, or toilets , nor from insects such as mosquitoes.

Anyone who thinks he is at risk should consider getting tested for Hiv. A woman who is or suspects she became pregnant during unprotected sexual intercourse should get tested. An Hiv-infected mother may transmit the virus to her fetus or through breast-feeding the baby, but treatment during pregnancy can decrease the effects on the baby.

Most tests for the Hiv antibody are accurate if done three to six months or longer after the time a person might possibly have been infected. Anyone who is reluctant to reveal his concern to his family doctor can go to a clinic that provides anonymous testing. If, however, the test result is positive for HIV, the affected person must consult his doctor immediately to discuss the options for treatment. If the test result is negative for HIV, the person concerned must still take into account that the symptoms of AiDs can develop up to eight years after infection by HIV.

Hepatitis B has the same symptoms for both sexes. They are fever, tiredness, loss of appetite, muscle pain, headaches, and dizziness. As the disease progresses, symptoms include loose, light-coloured stools, yellow skin and eyes, dark urine, and tenderness in the liver area. Hepatitis B may lead to liver cancer or liver failure.

Herpes shows the same symptoms in men and women. The first signs are itching or tingling around the genitals. Small blisters may form in this area and burst, causing a burning feeling, especially during urination. Eventually, these sores turn into scabs. Other symptoms include fever, body aches, and swollen glands. Although herpes outbreaks may occur for many years, even a lifetime, they become less frequent and less painful with time.

Human Papilloma Virus (HPV) may cause the growth of painless, soft, flesh-coloured warts around the genital area or on the cervix. Sometimes the virus causes warts that cannot be seen by the naked eye. HPV has also been linked to cervical cancer and cancer of the penis. Common treatments include burning the warts off with liquid nitrogen or laser surgery.

Mononucleosis, caused by the Epstein-Barr virus, is a type of herpes virus. Although "mono" can affect anyone of any age, it is more common in teenagers and young adults and is usually spread by sharing beverages, by kissing, or by any activity that results in direct contact with infected saliva. Mono has a 30- to 50-day incubation period. Not everyone who is infected experiences the symptoms: a very sore throat, fever, fatigue, chills, enlarged lymph glands, and usually an enlarged spleen or liver. Less common are jaundice, rashes, and bleeding gums.

Your family doctor can request a blood test to detect the antibodies to the Epstein-Barr virus, which will confirm infection. She might also request other tests to rule out strep throat and meningitis which resemble mono. Because antibiotics are ineffective against a virus, the usual prescription for mono is lots of rest and plenty of fluids. Acetaminophen or ibuprofen can ease any pain and headaches. Mono goes through an acute stage lasting two weeks, but the fatigue may last for several months. Most people can resume normal activities after the acute stage, but should avoid strenuous activity until their doctor says they've recovered. Heavy lifting or contact sports could cause the spleen to rupture even if it isn't visibly enlarged.

Trichomoniasis (trich) Caused by an organism called Trichomonas vaginalis, trich is acquired during unprotected sexual intercourse with an infected person. If left untreated, trich can cause a urinary tract infection. Men rarely have symptoms, and women can be infected for a long time before they experience any signs. Symptoms include a watery, yellowish or greenish, bubbly vaginal discharge, an unpleasant odour, and pain and itching during urination. Trichomoniasis can be treated with antibiotics.

Sexual Orientation

Many teens question their sexual preference during adolescence, and homosexual crushes are quite common. Some teens worry about the implications of being approached sexually by a person of the same gender. They fear this might indicate that they themselves are homosexual. Statistics show that about 18 per cent of boys and 6 per cent of girls have participated in at least one homosexual act by the age of nineteen. Your teen needs to know that questioning one's sexuality is normal during the teen years and not always an indication of his sexual orientation. Just knowing that other kids have the same questions and that about 1 in 10 people is gay or lesbian can be very reassuring to a teen.

Some teens may be reluctant to discuss sexual orientation, but if you want to maintain open communication with them, don't avoid the topic. If there's a news report about the progress being made regarding gay people's rights, you might comment, "Isn't it too bad that we can't just let people be who they are?" By conveying your own willingness to accept people as they are, you may release your teen, who's wondering about her own sexuality, to talk with you. As a parent, you should be prepared for the possibility that your child's sexual orientation may be homosexual.

If you sense that your teen is struggling with this question, give him every opportunity to discuss it with you, even if you find it difficult and painful. Many adults have strong beliefs about homosexuality, and if your child suspects that he is gay, he may be afraid to talk with you. As a result, he may suffer a profound sense of isolation and loneliness, which may even lead to suicidal behaviour. Don't let your unwillingness to talk set him up for a life of pain and secrecy. Reassure your child that he is loved, no matter what his sexual orientation. A sympathetic professional with experience in the issues of gender orientation may be able to help both of you deal with your teen's sexual preference. Contact a support group such as Parents, Families and Friends of Lesbians and Gays (PFLAG). Check your phone book for a local chapter.

A Teen's Point of View: My Body

My body is changing so rapidly that it can scare me. If I'm a late developer, I may worry about being left behind. I need your help to accept what's happening to me.

Age Thirteen
All Kids

• My bones grow faster than my muscles, so I'll start looking awkward and uncoordinated.
• I get jumpy when I have to sit for a long time.
• I may not be at my best first thing in the morning on a school day. I like to go to bed late and sleep in the next morning.
• I may mumble in my sleep.
• My nose may stick out until the rest of my face grows to catch up with it.
• I have a very healthy appetite. Please don't tease me or make an issue out of how much food I need to eat.

Girls Only
• I could be well on my way to physical and sexual maturity, while most of the boys are just beginning puberty.
• If my periods haven't started yet, they likely will this year, although they could start any time up to age seventeen. And if I'm like most girls, the onset of my periods won't mark the first stage of my sexual development, but one of the last stages.
• One breast may be bigger than the other. It may always stay bigger, just as I have one hand or foot bigger than the other.
• From so much rapid growing, I might get red-purple stretch marks on my hips or breasts. They'll fade with time.
• The hair on my legs gets darker. I get more hair under my arms and in my pubic area.
• My oil and sweat glands become more active. I may have acne.
• Very gradually, my voice continues to get lower.

Boys Only
• I'll grow taller this year, but I probably won't have my big growth spurt until next year.
• My penis gets longer but won't necessarily get thicker yet, so it may look thin in proportion. The skin of my scrotum gets clarker. One testicle will probably hang lower than the other.
• I get more pubic hair and more underarm hair. If I haven't used deodorant yet, I'll probably need to start.
• I get erections more and more often. They happen spontaneously, sometimes when I least expect them-for example, in the middle of class. This can cause me a lot of embarrassment.
• I get wet dreams, which cause me to ejaculate involuntarily in my sleep.
• The hair at the corners of my upper lip-what will ultimately be my moustache-gets a little darker, but I don't need to shave yet.
• My voice may start to change, getting deeper and maybe cracking a little.

Age Fourteen
All Kids

• I have a lot of energy and enthusiasm. I'm usually up for anything.
• I like to be busy all the time. If I have too much time on my hands and not enough activity, I get bored and restless.
• I'm less likely to need reminders to go to bed an school nights. I recognize when I'm tired and I don't fight it. If I push myself too hard during the day, I might need the occasional nap after school.
• I talk in a loud voice, even when you're sitting right beside me. I'm not doing it on purpose: As my body grows and changes, I'm not always aware of the strength of my own voice.
• I continue to have a good appetite. I may still wolf down everything that's put in front of me, or I may become a little more discriminating.
• I'm developing my own style in clothes. I'm less influenced by fads than I used to be.
• My face, neck, and shoulders look bigger and stronger.
• If I've been wearing glasses, I may be ready to try contact lenses.
• I'm more likely to act on my sexual urges, especially through masturbation. I may go through some confusion about my sexual orientation.

Girls Only

• I look more like a young woman than a girl. My hips are rounded, and my breasts continue to become fuller.
• My pubic hair is becoming thick and full. I may have some downy growth on my lower abdomen or upper thighs.
• I'm careful about my appearance. I shower regularly and I use sanitary pads quite lavishly. I may not feel ready to try tampons.
• I'm close to my adult height, especially if I've started menstruating. (Bones usually don't grow much in length once menstruation has begun.) But if I haven't had my first period yet, I could do a lot more growing in the interim.

Boys Only

• This is the year when I'm likely to have the most rapid growth in height. But even if I don't grow much now, I still have lots of time. I may not reach my full height for another five years.
• My "fat stage," if I had one, is over. My body is looking more muscular.
• I look ungainly because of the way my bones grow. First my hands and feet get bigger, then my forearms and lower legs, then my upper arms and thighs, and finally my hips and chest.
• My lower jaw gets bigger, changing the contours of my face.
• My voice continues to deepen. It may happen gradually, or my voice may crack and sound hoarse as my larynx and vocal cords grow.
• My Adam's apple becomes more prominent.
• My penis gets a little longer and a lot thicker.
• My pubic hair becomes darker and denser. It may start growing up toward my belly button.
• If I haven't had wet dreams before, I'll have them now.
• I get a little more hair on my upper lip and chin, and my sideburns grow longer. If my facial hair is especially dark and dense, I may need to shave, although probably only a couple of times a week. If the hair is fair and sparse, I may not need to shave for another few years.
• The hair on my arms and legs gets darker.
• I could start getting acne.

Age Fifteen and Up
All Young Adults

• I'm definitely looking more like an adult than a child. My features become sharper and more defined.
• My posture may still look a little awkward. I may hunch over when I'm standing, or lumber when I walk. But gradually my stance will look relaxed, and I'll slowly develop a new sense of poise.
• My appearance matters to me, although I don't agonize over it so much anymore. I spend a lot of time on my hair. My room, though, may still be a mess.
• My sexual orientation becomes more firmly established. I'm more likely to act on my sexual desires.

Young Women Only

• My physical and sexual development is almost complete. I'll continue to gain some weight, and my breasts and hips may get fuller.
• My reproductive organs are fully developed. But the tissue around my cervix may continue to undergo changes for a few years, making me particularly vulnerable to long-term problems from sexually transmitted diseases.
• I may or may not masturbate regularly and have involuntary orgasms in my sleep.
• If my periods have been light and sporadic, they'll gradually become more regular. But my cycle may be longer than 28 days, possibly 40 days or even longer, and may go on that way for several years.
• My appetite settles down now that my phase of rapid growth is over, but it's still vital that I eat well-balanced meals.
• way I eat now will affect my future long-term health. I need you to make sure that I don't skip breakfast or eat only fries for lunch.

Young Men Only

• I'm still growing. I need to eat a lot of food in order to fuel these changes, and I will for another few years. I might need a huge snack only an hour after dinner.
• My shoulders broaden and my muscles continue to develop, sometimes appearing to bulge beneath my skin. My veins, especially in my arms, become more prominent.
• By sixteen, I'll likely need to shave, but probably not every day yet.
• I may get hair on my chest and abdomen.
• My sperm are fully mature.

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