Puberty.
Dr. Sayeed Ahmad D. I. Hom. (London)

 

Puberty is the most obvious sign that an individual has entered adolescence. Technically, puberty refers to the period during which the individual becomes capable of sexual reproduction. More broadly, however, puberty is used as a collective term for all the physical changes that occur in a growing girl or boy as the individual passes from childhood to adulthood.

The physical changes of adolescence are triggered by hormones (chemical substances in the body) that act on specific organs and tissues. In boys, a major change is increased production of the hormone testosterone, while girls experience increased production of the hormones called estrogens. In both sexes, a rise in growth hormone produces a growth spurt. During this spurt, which lasts two or more years, an individual commonly grows 2 to 4 inches (5 to 10 centimeters) taller per year.

Sexual development. Many of the most dramatic changes of puberty involve sexual development. Internally, adolescents become capable of sexual reproduction. Externally, as secondary sexual characteristics appear, girls and boys begin to look more like mature women and men. The term secondary sexual characteristics refers to a variety of physical traits, such as body shape, voice, and facial hair.

Not everyone goes through puberty at the same time or rate. In Western industrialized societies today, the adolescent growth spurt occurs, on average, between the ages of 12 and 14 in boys, and 10 and 12 in girls. But some young people start puberty when they are 8 or 9, and others not until they are in their mid-teens. Generally, girls begin puberty about two years earlier than boys. The duration of puberty also varies greatly, from 11/2 to 6 years in girls and from 2 to 5 years in boys.

 

Disorders of Puberty

Amenorrhea

Amenorrhea, the absence of menstrual periods. It is called primary amenorrhea if it occurs at puberty, when a girl normally begins menstruating. Secondary amenorrhea refers to the lack of menstrual periods in women who have previously menstruated. Amenorrhea is normal in pre-pubescent girls and in women who have ceased menstruation due to pregnancy, breastfeeding, or menopause.

Any healthy girl who has not had a period by the time she is 16 years old has primary amenorrhea. Primary amenorrhea may be caused by the delayed onset of puberty. It also may be linked to infertility caused by Turner's Syndrome, a genetic disorder that prevents sexual maturing in girls. Some cases of amenorrhea are associated with birth defects that cause the vagina or uterus to develop improperly.

Secondary amenorrhea may result from a variety of factors. It sometimes occurs for the first few months after a woman has stopped taking birth-control pills. This type is called postpill amenorrhea. Secondary amenorrhea also may be caused by intensive physical exercise, including long-distance running or ballet dancing; extreme weight loss; disorders of the endocrine system (such as tumors of the pituitary gland), and various disorders of the ovaries. An ovarian disorder called polycystic ovary syndrome, or Stein-Leventhal syndrome, is characterized by an extremely irregular menstrual cycle in which ovulation may not occur. This disorder usually involves infertility, but treatment can help make the periods more regular.

Amenorrhea is often caused by psychological factors. Increased stress brought on by such major life events as losing a partner or loss or change of occupation can upset the normal menstrual cycle for a few months or longer. Increased stress can cause hormonal changes, such as raised levels of cortisol and prolactin, which affect menstruation. Periods normally return after the stress subsides.

Treatment of amenorrhea is determined by its cause.

 

Turner Syndrome

Turner Syndrome, relatively common genetic disorder that causes abnormal growth development and infertility in females. Turner syndrome is characterized by certain physical features, including short stature, loose folds of skin on the neck, a small jaw, and a higher incidence of heart, kidney, and thyroid problems. Some individuals with the disease experience learning difficulties.

Turner Syndrome occurs in about 1 out of every 2,000 live female births. Girls with the disorder do not develop secondary sexual characteristics, the body changes, such as breast development, that occur during puberty. They typically have underdeveloped ovaries, which prevents the onset of menstruation and also contributes to infertility later in life.

Turner syndrome is caused by a partially or completely missing sex chromosome. Chromosomes are gene-carrying structures found within the nuclei of cells. In the human body, all cells except for sperm and egg cells contain 46 chromosomes arranged in 23 pairs. Of these, 22 of the pairs each consist of chromosomes that are almost identical, while the 23rd pair contains special chromosomes that determine the sex of the individual. The sex chromosome pair in healthy males contains an X and a Y chromosome, while the sex chromosome pair in females contains two X chromosomes. In a female born with Turner syndrome, part or all of one X chromosome in her sex chromosome pair is absent. Scientists do not know what causes this chromosomal abnormality�it apparently occurs randomly and is not linked to factors known to increase the risk of a birth defect, such as a pregnant woman�s exposure to drugs, radiation, or disease-causing viruses or bacteria.

 

Harmones in Puberty

Androgen

Androgen, term embracing any of the male sex hormones, substances that induce and maintain secondary sex characteristics in males. The principal androgen is testosterone, produced in the testes of males and in the adrenal glands of both sexes. Testosterone circulates in the blood and is excreted in the urine. Androgens function principally, beginning at puberty, in the stimulation of such male secondary sex characteristics as development of the genital organs and maturation of sperm, growth of body hair, and changes in the larynx that lower the voice. Androgens have an anabolic effect�that is, they stimulate protein synthesis and inhibit protein breakdown, enhancing the growth of muscle and bone tissue in the developing male. An excess of androgens can lead to a variety of disorders, including the accentuation of male secondary sex characteristics in both males and females. Less frequently, an excess of androgens may cause testicular or ovarian tumors.

 

Estrogen

Estrogen, any of a group of female sex hormones that stimulate the appearance of secondary female sex characteristics in girls at puberty. Estrogens control growth of the lining of the uterus during the first part of the menstrual cycle, cause changes in the breast during pregnancy, and regulate various metabolic processes. Among the better known estrogens are estrone, ethinyl estradiol, and estriol, all produced primarily in the ovaries. Stilbestrol and ethinyl estradiol, two synthetic estrogens, are respectively five and ten times as potent as estrone; their activity is similar to that of natural estrogens. They are used to treat various conditions, including estrogen deficiencies in women (most commonly after menopause) and inflammation of the vagina. They may be used to stimulate lactation following childbirth and in the treatment, but not cure, of advanced and even disseminated cancer of the prostate gland in men.

Research has shown that when estrogen is administered as a post-menopausal hormone-replacement therapy, recipients experience a significant decrease in bone fractures. However, questions remain regarding the safety of estrogen in hormone-replacement therapy. Possible risks include breast or uterine cancer or cardiovascular disease.

 

Pineal Body

In humans the structure develops until the seventh year, when it is slightly larger than a pea; thereafter, throughout life, small mineral particles, particularly calcium, may be deposited in the pineal body. The mineral deposits can sometimes be seen in skull X-ray photographs.

 

Menstruation

Menstruation, periodic vaginal discharge in humans, consisting of blood and cells shed from the endometrium, or lining of the uterus. Menstruation accompanies a woman's childbearing years, usually beginning between the ages of 10 and 16, at puberty, and most often ceasing between the ages of 45 and 50, at menopause. Menstruation is part of the process that prepares a woman for pregnancy. Each month the lining of the uterus thickens; if pregnancy does not occur, this lining breaks down and is discharged through the vagina. The three to seven days that menstruation lasts is called the menstrual period.

In most women the menstrual cycle is about 28 days, but it can vary considerably even from one month to another. The cycle is initiated by hormones in the blood that stimulate the ovaries (the two female organs that produce ova, or eggs). Each month, hormones cause an egg in one of the two ovaries to mature (to become capable of being fertilized and develop into a fetus). The ovaries also produce hormones of their own, primarily estrogen, which cause the endometrium to thicken. About midway through the menstrual cycle, 14 to 15 days before the next period, the ovary releases the mature egg in a process called ovulation. The egg passes through the Fallopian tube to the uterus. If the egg unites with a sperm on its way to the uterus, fertilization occurs and pregnancy ensues.

The three to five days the egg takes to reach the uterus after being released by the ovary is known as the woman's fertile period. If fertilization does occur, the fertilized egg attaches itself to the enriched uterine lining and pregnancy continues. Menstruation does not occur during pregnancy, and a missed period is often the first indication of pregnancy a woman notices. If fertilization does not occur, the lining of the uterus does not receive the hormones it needs to continue the thickening process. Thus, the uterine lining breaks down and is discharged from the body during menstruation.

Many women experience premenstrual discomfort. Tenderness of the breasts and a tendency to retain fluid (bloat) are common one to seven days before each period. Some women also experience a condition called premenstrual syndrome (PMS), which is characterized by headaches, irritability, nervousness, fatigue, crying spells, and depression with no apparent cause. A few women also experience menstrual cramps (dysmenorrhea) during the first day or two of the period. Although premenstrual symptoms and discomfort during menstruation were once thought to be of psychological origin, research now indicates that hormonal and chemical changes are responsible.

 

Physical Changes

Beard

Beard, heavy growth of hair on the chin, cheeks, and adjacent parts of the face of the human adult male. The beard generally begins to grow during puberty, when the texture is soft and downy. In maturity the beard, often the same color as the hair on top of the head, is, as a rule, more wiry. The amount of facial hair varies among the peoples of the world. For example, the beard is especially luxuriant among Caucasian peoples, whereas among the Native North Americans it is markedly thin. In ancient times among many peoples the beard was considered a sign of strength and manhood; it was highly prized, and removal was regarded as a degrading punishment. The early Egyptians, however, usually shaved their beards, except in time of mourning. Among the Jews an unkempt, neglected beard was a sign of grief. In Greece all men wore beards until the 4th century bc, when the Macedonian conqueror Alexander the Great ordered his soldiers to shave as a precaution against being seized by the beard in battle.

 

Breast

Breast, one of a pair of glandular organs in mammals that secrete milk for newborns and infants. Also known as a mammary gland. In humans, the female breast has a distinctive rounded shape while the male breast remains flat and undeveloped. Only mature females can produce milk, which is rich in nutrients, antibodies, and other substances that aid in a baby�s growth and development.

The surface of a human breast has a circular, pigmented area in the center called the areola. The nipple, a rounded protruding structure, lies in the center of the areola. In mature women the breast contains a collection of 10 to 15 tubes, called ducts, that connect to the nipple. These ducts branch out from the nipple into the interior of the breast, ending in clusters of rounded cells, called lobules, that produce the milk. In addition to the structures directly connected with the production and outflow of milk, the breast is composed of fatty tissue and ligaments that provide support and shape.

In humans, a woman�s breast size and shape vary widely, depending on her age and whether she is pregnant or going through a menstrual cycle. Breast development begins in girls about 10 to 12 years old, when the ovaries start to produce the hormone estrogen. Completion of breast development, which occurs around 16 to 18 years old, requires the interaction of other hormones such as progesterone, prolactin, and corticosteroids.

After breast growth is completed, the breasts typically undergo monthly cyclic changes in response to fluctuating hormone levels in the blood that occur during the menstrual cycle. Just before the onset of menstruation, the breasts are often swollen and tender because the ductal system expands in preparation for pregnancy. If pregnancy does not occur, the estrogen level falls and the breasts return to normal.

During pregnancy there is a remarkable growth of ducts and lobules in the breast along with a thickening of the nipples. After a baby is born, the hormone prolactin stimulates milk production in the breast. Initially, the breast produces a thick yellow liquid called colostrum, which is particularly rich in the disease-fighting substances called antibodies. Within three to five days, the breast produces milk as the suckling infant stimulates the release of another hormone called oxytocin. This hormone causes contractions in the network of cells that surround the ducts and lobules, so that milk readily flows from the breast and into the mouth of the hungry infant. As a woman passes the childbearing age and enters menopause, the ovaries stop producing estrogen. The decreased stimulation from this hormone causes the milk-producing ducts and lobules in the breast to be replaced with extra fatty tissue.

Breasts are naturally lumpy, but any area of the breast that becomes more prominent than the surrounding tissue or feels unusually firm requires the attention of a physician. Breast lumps are a common problem in women and may range from a cyst, a fluid-filled structure that does not pose a cancer risk, to breast cancer, the most common type of cancer in women other than skin cancer. Also, in men between 20 and 40 years of age, breast enlargement can be a sign of testicular cancer, and breast lumps in men over 40, although rare, can be an indication of breast cancer.

Often one of the first diagnostic tests performed to evaluate a lump, an ultrasound is able to distinguish a cyst from a solid mass, a possible indication of cancer that requires further investigation. Solid lumps are evaluated with a special X-ray procedure called a mammogram, currently the best tool available for early detection of breast cancer. A mammogram may be followed by needle aspiration, a type of biopsy in which cells are removed from the lump and examined under a microscope. If these test results are normal, the lump is unlikely to be cancer. It may be removed or monitored carefully for signs of growth. If cancer is suspected, or if the lump shows signs of growth later, surgical removal is usually necessary.

As a preventive measure, physicians encourage regular breast self-examinations in which a woman uses her fingers to feel for changes in breast shape and fluid discharge from the nipple. Physicians also urge women to have regular mammograms, which can detect very small cancers before a lump begins to develop. These small cancers typically respond to treatment better than cancers that have grown large enough to produce a lump. The American Cancer Society recommends that women age 40 to 49 have a mammogram every 1 to 2 years and women age 50 and older have a mammogram every year.

 

Hair

In humans the development of the hair begins in the embryo, and by the sixth month the fetus is covered by a growth of fine hair, the lanugo. In the first few months of infancy the lanugo is shed and is replaced by hair, relatively coarse over the cranium and the eyebrows, but fine and downy over the rest of the body. At puberty coarse hair develops in the armpits and over the pubic region in both sexes; in males facial hair begins to grow coarse to form the beard. The rate of growth of the hair varies with the age of the person and with the length of the hair. When a hair is short, its rate of growth averages about 2 cm (about  in) per month; by the time the hair is a foot long, the rate of growth is reduced by one-half. The fastest growth is found in women from 16 to 24 years of age.

Disorders of the hair shaft or hair follicle cause abnormal growth or abnormal or premature falling of the hair. Certain abnormal conditions such as dull or dry hair are caused by physical or chemical agents. Too frequent use, for instance, of permanent-waving chemicals or of shampoos or lotions, especially those containing alcohol or free alkalies, often causes such conditions. The cause of excessive hairiness is obscure, but in several cases it has been traced to tumor of the adrenal cortex or to disorders of the pituitary gland, the thyroid gland, or the ovary. Premature graying of the hair is associated with anxiety, shock, deficiency diseases, and, in certain cases, hereditary elements.

Alopecia, or baldness, is also due principally to hereditary elements. Certain forms of baldness may, however, be due to other causes: alopecia prematura, in which the hair of a young person falls out without preliminary graying, may also be caused by seborrhea; while alopecia areata, in which the hair falls out in irregular patches, is believed by doctors to be caused by inflammation, nerve disorders, or local infections. Diffuse falling of the hair, ordinarily a normal phenomenon, may reach abnormal proportions after a fever higher than 39.4� C (103� F), during a debilitating disease, or as a result of invasive surgical procedures. No nonprescription hair "restorers" actually prevent hair loss or grow hair.

Infections of the hair follicle also cause a variety of hair diseases. Tinea favosa, or favus, is caused by the fungus Achorion sch�nleinii; it is characterized by the formation around the mouths of the follicles of small crusts, which frequently resemble a honeycomb. Tinea trichophytina, or ringworm, is caused by fungi of the genus Trichophyton. Hairy parts, particularly of the head and pubis, are subject to troublesome infestations by minute insects and mites, such as chiggers and lice.

 

Thymus Gland

Thymus Gland, name applied to a structure located just beneath the upper portion of the sternum in almost all vertebrates. The thymus gland consists chiefly of lymphatic tissue and contains a few small areas of epithelial tissue known as Hassall's corpuscles. The human thymus gland increases in weight in the first two years of life, and from then until puberty it grows slowly to a weight of about 43 g (about 1.5 oz). After puberty, it shrinks gradually and the lymphatic tissue of the thymus gland is replaced by fat. In the adult human the organ is chiefly composed of fatty tissue. Scientists generally agree that the thymus gland plays an important role in the development of immune responsiveness in early life. It is a site of formation of lymphocytes and a site of antibody production. Whether or not it has any other endocrine functions is uncertain.

 

Larynx

In the human larynx, two pairs of vocal cords are present. They are made of elastic connective tissue covered by folds of mucous membrane. One pair, the false vocal cords, extends from the epiglottis to the angle of the thyroid cartilage; these cords narrow the glottis (the pharyngeal opening of the larynx) during swallowing. Below the false cords are the true vocal cords, extending from the arytenoid cartilages to the angle of the thyroid cartilage. Vibration of this pair of cords by air passing out of the lungs causes the formation of sounds that are amplified by the resonating nature of the voice box. The pitch of the sound is voluntarily controlled by muscles that rotate the arytenoid cartilages toward the center of the body (slackening and lengthening the cords) for low tones, and toward the sides of the body (shortening the cords and pulling them taut) for high-pitched tones. The extent of the angle formed by the plates of the thyroid cartilage determines the depth of the human voice. The angle decreases in males at puberty, causing decreased tension of the vocal cords and a consequently deeper voice, and increases in most females at puberty, causing increased tension of the vocal cords.

The commonest affliction of the human larynx is inflammation, or laryngitis, often accompanying colds and accompanied by a temporary diminution or complete loss of voice. Other diseases commonly attacking the larynx include croup, diphtheria, and cancer. Laryngeal cancer has been shown to be caused by cigarette smoking and by the intake of large amounts of alcohol. Persons who smoke and drink excessively run an especially high risk of developing cancer of the larynx. It is treated by X-ray therapy, especially if diagnosed early, and by surgery. Surgical procedures include partial and total removal of the larynx. In instances of total removal, the patient must learn a new method of speech that involves, in part, swallowing air and bringing it up again. Various other surgical techniques have been developed to replace the removed tissue and restore speech of near normal quality; for example, insertion of a prosthetic device through a tracheoesophageal puncture has shown a promising rate of success in test patients.

 

HOM�OPATHIC TREATMENT FOR FEMALE DISORDERS AT PUBERTY

* The girl often weeps while stating her symptoms. She is usually of good nature. ----- Puls.

* Menstrual trouble from wetting the feet just before menses. ----- Puls.

* Delayed first menstruation. ----- Puls.

* Diarrh�a during or after menses. ----- Puls.

* Menses unduly delayed and do not start at proper age. ----- Puls.

* In chlorosis she desires strange foods and also a craving to eat strange articles, such as hair, dirt or sand. ----- Alum.

* Melancholia. Suffering from the effects of disappointed affection. ----- Ant-c.

* Menses suppressed with cerebral and head symptoms, especially in young girls. There is more or less �dema. ----- Apis

* Dysmenorrh�a of young girls. ----- Aquilegia

* Epileptic conditions and convulsive diseases of girls at puberty. ----- Artem-v.

* Palpitation of heart in young girls. High blood pressure. ----- Aur.

* Mamm� turgid (swollen) with milk in the unimpregnated girls at puberty. ----- Asaf.

* Disposition to pimples at puberty. ----- Aster.

* Foul breath in girls at puberty. Ulceration of gums. ----- Aur.

* Persons subject to quinsy. Muscular atrophy. ----- Bar-c.

* Frequent bleeding of nose when menses should appear. ----- Bry.

* Menses too early, too profuse, too long. ----- Calc.

* Backache and leucorrh�a. ----- Ova Tosta

* Goitre of puberty. ----- Calc-i.

* Headache of school girls. ----- Calc-p.

* Burning desire for marriage. ----- Caust.

* Rapid atrophy of breasts. Women with very large breasts and tumour in the mammary gland with sharp pain through it. ----- Chim-u.

* Facial blemishes in young women. ----- Cimi.

* Acne in an�mic girls at puberty. ----- Cycl.

* Large abdomen in girls at puberty with constipation. Mamm� swollen and hard. Nipple sore, cracked and blistered. Decided aversion to coitus. ----- Graph.

* Tired backachy females. Pruritus vulv�. Breasts swollen, nipple painful and tender. ----- Helon.

* Delayed menses in young girls, with chest symptoms or ascites. Difficult first menses. Tendency to tuberculosis. ----- Kali-c.

* Prostration. Weak and tired. Especially adapted to the young. Extreme lassitude and depression. Headache of students, and those worn out by fatigue. Breath offensive, fetid. ----- Kali-p.

* Constipation from puberty. Amenorrh�a with non-development of breast, a girl reaches age of 15 to 18 without starting of menses. ----- Lyc.

* Mamm� full of milk at menses in place of menses. ----- Merc-s.

* Breasts too small and without milk. ----- Nux-m.

* Sexual desire completely destroyed in female. ----- Onos.

* Violent sexual excitement in women. ----- Ferula Glauca

* Effective in masturbation and excessively aroused sexual impulses. ----- Orig.

* Epistaxis of tall slim girls. ----- Phos.

* Delayed puberty with defective development of breasts. ----- Pituitary

* Masturbation before the age of puberty and its bad effects. ----- Plat.

* Undeveloped mammary glands. Breasts shrunk due to menses or some other diseases of uterus. ----- Sabal-s.

* Menses retarded, suppressed. Functional amenorrh�a of young girls with backache. ----- Senecio.

* Prolapse of uterus and vagina. Vagina painful, especially on coition. ----- Sep.

* Dwells on sexual matters. ----- Staph.

* Large abdomen in girls at puberty. Burning in vagina. ----- Sulph.

* Frigidity of female. Aids the establishment of normal menstrual flow in young girls. ----- Turnera

* Neuralgic dysmenorrh�a, with neuralgic headache. Mental depression. ----- Xanth.

* Delayed puberty. ----- Zinc.

 

NOTE :

Any information given above is not intended to be taken as a replacement for medical advice. Therefore, it is very important that the patients should avoid self-treatment and rather consult the most abled and qualified classical hom�opath and take the treatment under his proper guidance and advice.

 

Reference:

MS Encarta Encyclop�dia.

 

 

Copyright � Dr. Sayeed Ahmad 2004