Op.Dr.Kenan Ertopcu
A shepherd in William Shakespeare’s The Winter’s Tale” If only there were no ages between 10 and 23, or that young people would sleep through the intervening years. Because in the intervening period, there is nothing but impregnating young women, contradicting family elders, stealing and fighting.” says.
Adolescence is defined as the transition period from childhood to adulthood. During this period, adolescence passes into adulthood with physical growth and development, sexual and psycho-social development. The characteristic of this period is that a number of changes that did not exist before occur in the child, both physically and spiritually.
Girls enter puberty about two years earlier than boys.
World Health Organization; He defines the 10-19 age group as adolescence (adolescence), the 20-24 age group as the youth period, and the 10-24 age group as young people. Approximately 20% of the population in Turkey is 20 years old and under. With the population growth rate in our country, it is expected that adolescents will make up 40% of our society in 2025.
The World Health Organization defines reproductive health as: It is not only the absence of disease and disability related to reproductive system functions and processes, but also the completion of reproduction in a state of complete physical, mental and social well-being.
Adolescence is a period in which many psychosocial changes are experienced.
For Freud, adolescence is a reflection of painful psychosexual conflicts, for Erik Erikson it is the most turbulent period of identity crisis in life. We can examine the adolescence period in three different processes;
Early Adolescence (12-14 years): Young people deal with their bodies, they are constantly in front of the mirror. They establish strong friendships with their own kind. They can think of abstract concepts. They worry about the future and therefore show emotional fluctuations. Consistently limiting attitudes of families and teachers towards adolescents will reduce the anxiety of young people. In the pre-adolescent period, the perception of sexual identity, masculinity and femininity has developed. There are myths and information about sexuality from friends, school, and family. In early adolescence, curiosity, sexual fantasies and masturbation begin to take place in their own bodies and those of their peers. Sexual activities are not usually physical.
Middle Adolescence (15-18 years): Pubertal changes and cognitive development are completed. Adolescents can make generalizations, think abstractly, and develop an insight that can be combined with their experiences. He is interested in the opposite sex, tries to establish friendships and get to know them. Dating is common in middle adolescence. There may be relationships with or without coitus (sexual intercourse). They experience separation from the family and efforts to gain independence, and they give more importance to groups of friends. Sports and various social activities are very helpful to adolescents in order to direct the increased impulsive intensity during this period and to find appropriate ways to cope with impulses.
Late Puberty (Above 18): How long it takes varies from person to person. Late puberty can last up to age 24 or many more years! At the end of this period, he will be able to answer the questions of who he is and what he will be. Adolescents have gained the ability to establish close relationships and to choose a job and spouse. Physical, social and legal maturation is completed in late adolescence. Sexual behaviors can turn from being individual to more meaningful and shared relationships. He has the responsibility to assume the adult role in society.
When I was fourteen, my father was so ignorant that I couldn’t bear to have him near me, but by the time I was twenty-one he knew so much that I was amazed how he learned in seven years. Mark Twain
Confused between childhood and adulthood, adolescents and their parents worry about distinguishing between normal and abnormal.
Adolescents tend to gain an independent personality from being dependent on the family during the development process. The adolescent’s efforts to establish an independent identity, possible changes in gender roles and unresolved parent-child conflicts of parents increase the stress of parents in this period.
Adolescent sexuality can be even more threatening to adults with unresolved issues with it. Increased stress can reduce parental self-confidence, causing them to become more inconsiderate, reactive, overly controlling, and rigid. A high level of anxiety can result in a loss of communication. The absence of any rules and discipline of the parents is also dangerous, as in cases where the discipline is too strict, it can result in the adolescent’s excessive and incorrect sexually active behavior. Children of self-consistent parents who can accurately monitor adolescents’ appointments, set reasonable curfew times, rarely show irresponsible sexual behaviors. Since many parents are not comfortable talking about sexuality with their children, their physicians should ensure that the subject is brought up and discussed. A great majority of adolescents are faced with the dangers of risky behaviors during this period of their lives. Adolescents may understand that certain risky behaviors, such as smoking and unprotected sex, will have negative consequences for them, but they tend to value pleasures over costs. Generally, adolescents’ impulsive behaviors start around the age of 10 and continue to decrease throughout life. But the love of excitement peaks around the age of 15. Stimulation seeking can lead to positive behaviors as well as dangerous ones. For example, the motivation to meet more people can lead to a wider circle of friends. This makes the adolescent healthier, happier, safer and more successful.
We might think that changes in the adolescent brain may also explain the reason for their behavior patterns. In the project, where the US National Institutes of Health followed more than 100 young people who grew up in the 1990s, the first and full scans of the adolescent brain were made. These scans have shown that our brains are significantly reorganized between the ages of 12 and 25. The human brain reaches 90% of its full size by the age of 6 years. The brain does not grow much during adolescence, but undergoes extensive restructuring, similar to the network and cable updates of computers. Imaging studies since the 1990s show that physical changes in the brain occur in a slow wave from the back of the brain (areas that manage basic functions such as vision and movement) to the front. It shows that you are progressing towards (areas that allow more complex thinking). As a result, our memory and ability to integrate our decisions with our experiences improve. Compared with adults, adolescents use less of the areas of their brains that control performance, plan, catch mistakes, and avoid distractions. When offered an extra reward, adolescents force these executive regions to work better. The slow developmental curve revealed by these imaging studies may help explain adolescents’ uncontrolled behaviors, such as driving fast or having constant conflicts with their families.
They act like this because their brains are not yet complete!
Gaining the adolescent’s trust is important for treatment. Disruptions in the psychological development process of the adolescent may lead to many mental health problems, especially alcohol and substance addiction.
sexual changes in adolescence; It appears as the maturation of primary sexual characteristics (female and male genitals) and the emergence of secondary sexual characteristics (hair growth in the genital area and armpits, breast development in girls, deepening of the voice in boys, menstruation in girls and sperm production in boys).
in girls at puberty; First the breasts grow, then the genital area and armpit hair increase, and the last menstrual bleeding occurs. The first menstruation can happen at any age between 9 and 16 and usually begins a year after the breasts start growing. The first menses begin before the egg cells are fully matured and before ovulation. Irregularity, prolongation, increase, early or delayed bleeding may occur for 1-2 years after the first menstruation, and even no menstruation may be seen. Menstrual bleeding is not painful. Regular spawning has not yet begun. After a few years, menstrual bleeding and ovulation will be regulated, a slight pain in menstruation, tension in the chest before menstruation and other signs of premenstrual syndrome may appear. When the menstrual bleeding is regulated, the period between two periods will be between 21 and 35 days. It is normal to have different amounts of bleeding lasting between 2-7 days.
There will be an increase in physiological discharge in girls before they enter puberty. If there is no evidence of infection, it is unnecessary to take a culture from the vagina. Genital hygiene is important in adolescence. Underwear should be changed frequently and cotton underwear should be preferred. Reproductive organs should be kept dry and clean. It should be dried well after the bath and toilet, not sitting in a wet swimsuit after the sea or the pool. Cleaning the toilet should be done from front to back.
At puberty, the body acquires the ability to reproduce. Accordingly, if the changes that begin in the body begin before the age of 10, it should bring to mind the possibility of a disease. Young girls who do not menstruate despite completing the age of 16 (although there is growth and hair growth in the breasts), and boys who do not show any signs of puberty until the age of 19 should also be referred to a specialist due to the possibility of the disease. .
Masturbation is the individual’s self-fulfillment of sexual satisfaction. Masturbation is a normal act in every period of life. The comments that it causes a physical or mental illness or habit are not true.
The most common breast problems in girls are benign fibroadenomas and fibrocysts. Breast cancer in adolescence is very rare. The problems that most preoccupy girls in adolescence are breast asymmetry, breast smallness, breast size, excess or absence of nipple and tissue, breast pain, nipple twitching and nipple discharge.
In male adolescents, the most common breast problem is gynecomastia, which is the size of the breast tissue. Breast size, which is temporary due to the effect of reproductive hormones, can be permanent in young people up to 10%, which will continue in adult life. It should be known whether gynecomastia develops due to the drug used or the previous diseases, and it should be treated when necessary to prevent it from being permanent.
Precocious puberty is the most suitable period when vaccines developed against HPV virus types that can mostly cause cervical cancer, as well as genital warts, colon cancer and throat cancer in men and women, and sexually transmitted (condom does not protect fully, it can be transmitted by skin friction) can be administered to girls and boys. period (12-14 years old).
The increase in testosterone (male hormone) levels in girls and boys with puberty is responsible for acne, acne and hair growth. How young people look is the most important issue for them in this period. They are constantly dealing with acne and pimples in front of the mirror. Acne is one of the most common complaints in applying to health institutions. If acne is not treated at an early stage, there is rarely a possibility of scarring. The reason for the increase in hair growth outside the genital area and armpits should also be explained in female adolescents. Generally, only familial (hereditary) factors can cause this, as well as some diseases originating from the ovaries (such as polycystic ovary syndrome) or adrenal glands may present with hair growth.
There will be rapid physical development during adolescence. There is a difference between boys and girls in height and weight gain. Throughout puberty, girls measure 18-23 cm. men are 25-30 cm. elongates.
Structural or familial short stature or height seen in adolescence, some diseases such as thyroid should also be distinguished. Nutritional problems are very common in adolescence. Weakness, obesity, short stature, anemia, other vitamin and mineral deficiencies can be counted among these. Obesity has started to be seen above 10% in young people in recent years. Due to the change in eating habits and rapid weight gain, they can gain 50% of their adult weight in 2-3 years. Girls have one and a half times more fat than boys, and boys have twice as much muscle tissue as girls. Young people need to be supported with diet, exercise and psychologically. If eating disorders are observed along with weight fluctuations, fatigue, menstrual irregularities and various psychological complaints in young people, diseases such as anorexia should also be considered. Gluttony, evening eating syndrome and other eating disorders may also be encountered with mental disorders during this period.
Wishing you healthy days

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