Pubertal Health and Hygiene For Adolescent Girls:
A Basic Guide
When Valarmathi had attained puberty, relatives were told and a lot of fuss was made at home but her mother, grandmother or aunts did not explain in detail what the bleeding was all about, how long it would last or about some concerns she has with regard to bodily changes. When Valarmathi became a mother herself, she decided that she would approach the her daughter’s pubertal transformationin an open, positive and supportive manner. So, when Parvati, Valarmathi’s daughter, was9 years old, Valarmathi started to read up on how best to approach the topic of puberty with her daughter. She was aware that her daughter’s classmates and friends would soon attain puberty. Furthermore, there is a lot of information being shared on the Internet and social media, andValarmathi wanted to make sure that her daughter received the right, age-appropriate information. She also wanted to impart adequate support and guidance to her daughter.
If you have a daughter and wish to prepareher forpuberty, we present a basic guide for you. In this article, we present the basics of what puberty is, the associated physical changes, health and hygiene practices and menstrual concerns. When a girl attains puberty, she is at a crucial point in her life and would need physical and mental support. Correct, adequate information, and an empathetic approachon the parents’ part will help the girl develop healthy habits and boost her confidence and self-esteem.
The Science Behind the Transition
Puberty is a process that usually happens between the ages of 9 and 14 for girls but can vary, depending on individual health and genetic factors. The early signs of puberty typically begin to show after 8 years, andthe girl will start seeing physical and emotional changes in her body. All this is triggered by the hypothalamus, which islocated at the bottom of our brain. It begins to release the gonadotropin-releasing hormone (GnRH) which travels to the pituitary gland and stimulates itto release hormones – this signals the body to prepare for upcoming changes.The hormonesinclude follicle-stimulating hormone (FSH) and luteinising hormone (LH) for the development and maturation of eggs in the ovaries.Several thousand eggs are stored in each ovary on the left and the right.One egg is released every month from each ovary into the fallopian tube once puberty is attained. During that time, the lining of the uterus undergoes changes under hormonal influence. If fertilisation takes place, the lining will be used for the baby’s growth. If fertilisation doesnot take place,the lining of the uterus is shed through the vaginaas ‘periods’. Usually, the sheddingoccurs every 28 days, but it differs from person to person.
Phases of Puberty
Early Phase: This is the first phase of puberty, and occurs between the ages of 6 and 8.During this time, the adrenal glands (on the top of each kidney) produce adrenal androgens (sex hormones) that signal the brain for behaviour changes. This is followed by changes in the breasts, growth of pubic and underarm hair, acne breakout and increased body odour.
Late Phase: The most significant milestone in a girl’s life is the first period,which occurs between the ages of 10 and 16 (approximately two years after the formation of ‘breast buds’). Though puberty is generally considered to be complete at this stage, changes (including fat and muscle patterning) continue through adolescence.
The occurrence of pubertal changes should be gently explained to your daughter. More importantly, it is essential that you assure her there is nothing “wrong” with these changes, and that there is no cause for alarm or shame. Talk openly and reassure her with adequate information to relieve her of any shame and/or stigma.
As a guide, we have shared below the primary physical and mental changes that occur during puberty and necessary steps you may take.
Breasts: The formation of small lumps of tissue under the nipples called ‘breast buds’ (one of the first signs of puberty).The development of ‘breast buds’ is a great opportunity to talk to your daughter about body changes that are yet to come. The right and left breasts may grow at different speeds and may vary in shape for different individuals. When breasts begin to grow, they may feel sensitive and your daughter may complain of itchy or tender breasts. She may also complain of swelling, pain and soreness of breasts during menstruation. All this is normal and occurs due to cyclical hormonal changes, and usually improves with time. Once a girl’s breasts start to grow, it might help to get her a training bra to protect and support her breasts, especially when she exercises and plays sports.
Body Hair: One of the most obvious signs of puberty is the growth of soft, sparse body hair in differentparts of the body, such as under the arms, external genitals, legs and upper thighs. The hair will later become longer, coarse and curly.Growth of body hair can appear both before and after breast development. Though shaving, waxing or use of hair removal creams for removing body hair is considered a social norm, the practice has been reported to have no health benefits. Therefore, it is a entirely personal choice. However, it is important that you guide your daughter about safe hair removal practices, so as to prevent both allergies andinjuries.
Height and Weight: The pubertal growth spurt may beginat the age of 9 or 10 for girls but it varies considerably across individuals, as it is regulated by hormonal factors, genetics, environment and nutrition. Although hormones (estrogen and androgen) play a crucial role in pubertal growth, a person’s height is also influenced by the pituitary gland, insulin and thyroid hormones. Your daughter may feel a bit clumsy and awkward as her arms and legs may grow faster than the rest of the body – this is a normal development, as the first bones that grow are those that are farther from the centre of the body. Assure her that the rest of the body will catch upsoon. Your daughter may also notice an increase in weight, especially around her waist and hips. During this stage, teenagers need good calcium support. Hence, it is important for them to consume calcium-rich foods such as milk, dairy products, soy products, oranges, peas, almonds and broccoli. Calcium supplements may be taken if necessary (as advised by your doctor or paediatrician).
Body Odour: Body odour, which signals the start of puberty, can start as early as 7 years for girls. Our human body has two types of sweat glands – eccrine glands and apocrine glands. The eccrine glands start working as soonas we were born. At the onset of puberty, the apocrine sweat glands, which are located in the armpits, breasts and genital–anal area become over-active and produce an oily secretion in addition to sweat. When sweat mixes with the natural bacteria on your skin, it gives off a stronger body odour.If your daughter is alarmed or seems self-conscious, gently assure her that they are all due to hormonal changes – which is a normal, healthy development.Many teenagers tend to use perfumes and sprays to cover up body odour. Though it may help, the most effective way to get rid of body odour is to bathe with soap and water. The use of soap will help kill bacteria and wash off the sweat. Therefore, advise your child to bathe every day and to wear freshly washed cotton underwear, socks and other items of clothing. If your daughter follows a rigorous sports or exercise routine, advise her to shower and change her clothes after each session, as sweat-soaked clothes can harbour bacteria and cause body odour (and skin infections, too). Besides this, advise your daughter to drink plenty of water, follow a healthy diet and to limit her intake of spicy foods, garlic and red meat.
Vaginal Discharge: This is a thin, clear, transparent or white-coloured fluid that your child may notice in the lining of her underwear even before her first period, or in between menstrual cycles. This is perfectly normal, and occurs as the hormones in the glands of the vagina and cervix (neck of the womb) work to keep the vagina moisturised and healthy. Vaginal discharge also helps to protect the area from damage or infection. The discharge usually gives off a slight odour and does not cause itching or burning. Vaginal discharge also varies across individuals. If your daughter feels uncomfortable, she can choose to wear a panty-liner.Advise her to wash her genitals from front to back to prevent the entry of germs into the vagina. Also, tell her to avoid using heavily scented soaps and body washes, as theymay irritate the tender skin or dry up the vagina, thereby increasing the risk of infection. If your daughter notices a change in the colour or smell of the vaginal discharge, you should consult your doctor.
Social and Emotional Changes:Social and emotional changes are part of your child’s journey to adulthood. Recent research suggests that pubertal hormones directly influence brain activity and contribute to cognitive skills, social behaviours and mood changes, and that girls are more prone to social anxiety and panic disorders (when compared to boys) during theirpubertal transition.As your child goes through puberty, you may notice that her mood is unpredictable. She may give vent to strong feelings and intense emotions, and become extremely sensitive and self-conscious. You may also notice that your child wants to spend more time with her peers and less time with you and family members. During this time, you have a big role to play in helping your child develop healthy emotional and social skills.Remain calm and friendly, and help her find safe and healthy ways to cope with these changes. If she seems hesitant to open up to family members, you can encourage her to speak to acounsellor or doctor.
Sleep Patterns:As your daughter reaches puberty, she may start sleeping for longer hours in the mornings and stay awake later at night. This change occurs as the body’s biological clock of sleep-wake cycle is reset in a teenager, due to their brain making the ‘sleep hormone’ (melatonin) later at night than in younger children and adults. As a parent, it is extremely important to guide pre-teens and adolescents to follow a regular sleeping pattern as deep sleep is crucial for the menstrual process of signalling the LH surge (luteinising hormone), which is essential for ovulation (release of egg). Moreover, children today spend a lot of time facing blue spectrum light from TVs, computer screens or personal device screens. This affects the human biological clock negatively and causes sleep deprivation. Insufficient sleep may cause impairments in emotion, behaviour and academic performance, and lead to a higher risk of obesity.Speak to your daughter about the importance of regular sleep patterns, help her formand maintain a routine bedtime, and try to avoid using electronic devices for an hour before bedtime. Also, make sure that her room or sleep area is calm, cool and dark.
Menstrual Concerns: As soon as you see the signs of puberty, talk to your daughter and make her feel comfortable so that she does not feelshocked or embarrassed at the sight of bleeding when her first period shows up. At every step, it is important to remind your daughter that menstruation is a natural process that every woman goes through. Explain to her that it is perfectly normal if the first few periods are heavy, light or irregular. Also, the colour of menstrual blood may be light red, brown or even black. Assure her that, in course of time, once her body’s hormonal harmony is set, her periods will follow a regular pattern.She can keep a pouch with a couple of sanitary pads and clean underwear in her bag or near her at all times, so that she is prepared for unexpected periods as well.
Hygiene During Periods: The topic of menstruation is still clouded by socio-cultural restrictions and taboos, and many adolescent girls remain ignorant of healthy and hygienic practices they should follow during their menstrual cycles. Recent research has shown that women who follow good menstrual hygiene are less vulnerable to reproductive tract infections. So, it is essential that you educate your daughter about the available feminine hygiene products (like sanitary napkins, tampons and menstrual cups) that are available and guide her to choose and use whatever works best for her.
When your daughter’s menstrual cycle starts, make sure she takes a shower twice a day with warm water. Ask her to gently pat the vaginal area with a dry towelafter the shower. It is better to avoid using vaginal washing liquids and / or loofahsand body brushes, as they may irritate or injure the gentle skin around the private parts and lead to thespread of infection.
Premenstrual Syndrome (PMS):Premenstrual Syndrome or PMS refers to a group of physical and psychological symptoms that can occur a week or two before periods. Studies show that over 90% of women experience some form of PMS, including mood swings, tiredness, food cravings, headaches, sore muscles and joints, sore breasts, abdominal pain, bloating and acne breakouts. A healthy and balanced diet, exercise and sufficient rest can help to ease the symptoms. However, if your child suffers from severe cramps and PMS symptoms that extend beyond her periods, you should consult a doctor.
Eating Right: A healthy, balanced diet that includes all required nutrients is essential. Eating plenty of fresh fruits and vegetables is advised. Also, it would be better to avoid excessive caffeine, very salty foods and foods with a high content of refined sugar, especially a few days before the start of periods.We have several traditional Indian recipes formulated to help keep the woman’s body healthy and strong during her periods. For example, consumption of sesame seed balls made with jaggery (elluurundai) during the menstrual cycleis recommended. This is because the nutritional content of sesame seeds include vitamins, minerals, natural oils and organic compounds that consist of calcium, iron, magnesium, phosphorus, manganese, copper, zinc, fibre, thiamine, Vitamin B6, folate and tryptophan, which can ease the menstrual cramps and provide essential nutrients to the body.
Black gram can be included in your diet (before your periods) and fenugreek porridge (after your periods) to reduce cramps, strengthen the uterus and regularise hormones. These foodsarerich in phytoestrogens, iron and calcium, which can help ease PMS and promote good health. You can also include banana flower, ridge gourd, pineapple and dwarf copperleaf spinach (ponnankannikeerai)in your diet to regulate your menstrual cycles, reduce body weight and meet the body’s iron and calcium requirements.
We hope this little guide has been helpful. Remember, every girl is unique and may differ in terms of her pubertal growth. If you are uncertain about any specific developments and/or notice any drastic differences in your daughter, please reach out to our doctors for help and guidance.
Contact us or book an appointment now. Call us on+91 72 999 111 07 or mail us at info@bloomhealthcare.in
Dr. Kavitha Gautham is a leading figure in the field of obstetrics and gynecology, and reproductive medicine, with a distinguished career marked by excellence and compassion. She holds an MBBS from Annamalai University, an MS in Obstetrics and Gynecology from Sri Ramachandra Medical College & Research Deemed University, and a Diploma in Reproductive Medicine from University Schleswing-Holstein, Germany. As the Founder & Director of Bloom Fertility Centre & Bloom Birthing Centre and Medical Director of Bloom Fertility & Healthcare, Dr. Kavitha spearheads initiatives aimed at providing personalized and holistic care to patients.
With several years of expertise in gynaecological laparoscopy surgery, she has performed (approx.) 10,000 deliveries, 10,000 hystero-laparoscopy surgeries, and more than 5,000 IVF cycles to date. She is a Life Member of the European Society of Reproductive Medicine & Indian Society of Reproductive Medicine, All India Congress of Obstetrics & Gynaecology, Obstetric and Gynaecological Society of Southern India, Federation of Obstetric and Gynaecological Societies of India, and the Indian Medical Association. She is a Fellow from the Indian College of Obstetrics & Gynaecology and International Medical Science Academy, and FIMSA.
Dr. Kavitha has been the recipient of several awards, including the prestigious J.L. Javeri Award (AICOG, 2005), Excellence in Healthcare – Infertility & IVF Treatments award (The Chennai City ICON Awards, 2019), WONDER FOGSIAN award (FOGSI, 2019). Additionally, she was the first doctor in South India to successfully conduct a water birth in a VBAC case.
Dr. Kavitha has also presented research papers at prestigious conferences including ISAR and IMSACON and has been published in esteemed journals such as the ‘Journal of Clinical Diagnostic Research’. Her commitment to public service is evident through initiatives such as conducting health camps in collaboration with organizations like the SMILE Foundation and raising awareness about reproductive health through appearances on radio and TV shows.
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Dr. Kavitha Gautham holds an MBBS from Annamalai University, an MS in Obstetrics and Gynecology from Sri Ramachandra Medical College & Research Deemed University, and a Diploma in Reproductive Medicine from University Schleswing-Holstein, Germany.
As the Founder & Director of Bloom Fertility Centre & Bloom Birthing Centre and Medical Director of Bloom Fertility & Healthcare, Dr. Kavitha spearheads initiatives aimed at providing personalized and holistic care to patients.
With several years of expertise in gynaecological laparoscopy surgery, she has performed (approx.) 10,000 deliveries, 10,000 hystero-laparoscopy surgeries, and more than 5,000 IVF cycles to date. She is a Life Member of the European Society of Reproductive Medicine & Indian Society of Reproductive Medicine, All India Congress of Obstetrics & Gynaecology, Obstetric and Gynaecological Society of Southern India, Federation of Obstetric and Gynaecological Societies of India, and the Indian Medical Association. She is a Fellow from the Indian College of Obstetrics & Gynaecology and International Medical Science Academy, and FIMSA.
Dr. Kavitha has been the recipient of several awards, including the prestigious J.L. Javeri Award (AICOG, 2005), Excellence in Healthcare – Infertility & IVF Treatments award (The Chennai City ICON Awards, 2019), WONDER FOGSIAN award (FOGSI, 2019).
Dr. Kavitha has also presented research papers at prestigious conferences including ISAR and IMSACON and has been published in esteemed journals such as the ‘Journal of Clinical Diagnostic Research’.
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Dr. Revathi is an Obstetrician and Gynecologist with a rich academic background and extensive clinical experience. She holds an MS in Obstetrics and Gynecology from Sree Balaji Medical College and Hospital, and has pursued specialised training in diagnostic ultrasound imaging from Selvi School of Sonology and reproductive medicine from Institute of Reproductive Medicine and Women’s Health, MMM Hospital. With a passion for research, Dr. Revathi has contributed significantly to scientific literature with publications in prestigious journals and presentations at national conferences. She actively engages in community health initiatives, participating in rural health camps in Chengalpattu and providing free gynecological services in Karaikudi. Her expertise extends to surgical techniques, obstetric emergencies, and patient counseling. Dr. Revathi is also a life member of FOGSI and ISAR.
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Dr. Sayed Asarudeen is a skilled pediatrician with expertise in mechanical ventilation, central line insertion, chest tube insertion, and parental nutrition. With fluency in English, Tamil, Bengali, and Hindi, he ensures effective communication with diverse patient populations. Having served as a Senior Resident at NICY, Department of Pediatrics, District Hospital, Kolkata, Dr. Sayed gained invaluable experience in neonatology. He furthered his expertise through a Post-Doctoral Fellowship in Neonatology at Rainbow Children Hospital, Chennai, and National Neonatal Forum (NNF).
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Dr. Harun Kumar is a skilled orthopedic surgeon who holds an MBBS from SRM Medical College, an MD Ortho from PSG Institute of Medical Science, and a DNB in Orthopaedic Surgery from BIRRD. With membership in the Indian Medical Association and Tamil Nadu Medical Council registration, Dr. Arun maintains high professional standards. Having served as a Junior Resident at MAPIMS and currently as a Senior Resident at ACS Medical College, he possesses expertise in trauma cases, hip joint fractures, amputations, and closed nailing procedures.
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Dr. Swarna Ganesan is an AYUSH physician, with a Bachelors of Naturopathy and Yogic sciences from Dr. MGR Medical University, Tamil Nadu. She is a registered holistic health practitioner for naturopathy and yoga under CCRYN (central council of research in naturopathy and yoga), Ministry of AYUSH, Government of India. Dr. Swarna completed her fellowship in clinical research under the National Institute of Naturopathy), Pune, and worked as Research Officer, Principal Investigator for 14 research projects corresponding to yoga and normal delivery practices, PCOD and other women health issues. She has published research papers in competent medical journals and presented her work in over 25 national and international conferences. Dr. Swarna is also a trained labour doula under CAPPA, and is well known for her commitment to helping mothers have a safe and positive birthing experience.
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Dr. Paul Rafson Jani is a dedicated Anaesthetist and Intensivist. Throughout his medical career, he has focused tirelessly on critical care procedures such as intubation, extubation, central and peripheral venous cannulation, tracheostomy, intercostal tube insertion, and ultrasound-guided regional blocks, Dr. Paul ensures comprehensive care for patients in critical conditions. His work history reflects a hands-on approach to patient management, from recording medical histories to administering specialised treatments and creating individualised treatment plans. Dr. Paul excels in team collaboration, research, and training, ensuring the highest standards of care. With certifications in ACLS and BLS, he is dedicated to maintaining excellence in patient care and emergency response.
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Dr. Vinu Bharathi Loganathan brings with her extensive experience from renowned institutions like Apollo First Med Hospitals and Karthik Hospitals, with a focus on diverse emergency cases. Dr. Loganathan excels in triage, assessment, and evidence-based treatment delivery. Her proficiency extends to procedural sedation, ICU management, and spearheading departments. Dr. Vinu Bharathi has been certified by the Royal College of Emergency Medicine (U.K.) and holds a Diploma in Emergency Medicine. She actively contributes to medical education, conducting workshops and training sessions, and has trained over a hundred paramedics in ACLS and BLS. With certifications in ACLS, BLS, and PALS and fluency in English and Tamil, Dr. Vinu Bharathi embodies flexibility, positivity, and strong judgment, ensuring optimal patient care.
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Dr. Kavitha Gautham holds an MBBS from Annamalai University, an MS in Obstetrics and Gynecology from Sri Ramachandra Medical College & Research Deemed University, and a Diploma in Reproductive Medicine from University Schleswing-Holstein, Germany.
With several years of expertise in gynaecological laparoscopy surgery, she has performed (approx.) 10,000 deliveries, 10,000 hystero-laparoscopy surgeries, and more than 5,000 IVF cycles to date. She is a Life Member of the European Society of Reproductive Medicine & Indian Society of Reproductive Medicine, All India Congress of Obstetrics & Gynaecology, Obstetric and Gynaecological Society of Southern India, Federation of Obstetric and Gynaecological Societies of India, and the Indian Medical Association. She is a Fellow from the Indian College of Obstetrics & Gynaecology and International Medical Science Academy, and FIMSA.
Dr. Kavitha has been the recipient of several awards, including the prestigious J.L. Javeri Award (AICOG, 2005), Excellence in Healthcare – Infertility & IVF Treatments award (The Chennai City ICON Awards, 2019), WONDER FOGSIAN award (FOGSI, 2019).
Dr. Kavitha has also presented research papers at prestigious conferences including ISAR and IMSACON and has been published in esteemed journals such as the ‘Journal of Clinical Diagnostic Research’.
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Dr. Aiswarya Nair is a dedicated and accomplished general medicine practitioner with a passion for improving patient care. She is a gold medalist MD graduate from the Vinayaka Mission’s Kirupananda Variyar Medical College. Prior to this, she earned her MBSS from Rajah Muthiah Medical College Hospital. With a career spanning over a decade, Dr. Aiswarya Nair has held various academic and clinical positions, including that of Assistant Professor of General Medicine at Dr. Somervell Memorial Medical College and Hospital, and currently as Associate Professor at Sri Ramachandra Medical College and Hospital, Chennai. Her research contributions include publications on topics such as ‘Infection in the elderly’ and ‘Severe sepsis-related acute kidney injury’. Driven by a commitment to excellence, Dr. Nair seeks to leverage her expertise as a physician, aiming to enhance patient outcomes and contribute positively to the healthcare community.
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