Who Will Tell?

Mother of a 9 yr 10 mth girl walked in, panic writ on her face;  “Doctor saab” she stuttered in Marathi “Shivani started her periods just now and she is crying bitterly; she is very scared. What to do?” I made her relax and asked, “did you not prepare her for this?” “No” she said “we had thought when she is 10, we will take her to a doctor for explaining.”

Indian girls are attaining Menarche at a much earlier age (9.5 to 11 yr) than a decade before. Most parents go through the dilemma, who is to tell the girl about ‘this’? Readers here may wonder what am I talking about? Please think of mothers who are semi-literate to illiterate and their girls studying in English schools – mothers get unnerved and never prepare them for menarche.

A similar case related to puberty had come to me few years ago where a boy of 12 suddenly had gone quiet; kind of went in a shell – not talking to family/ friends; not going out; no playing; reduced appetite etc. On repeated enquiries, he admitted he had watched a pornographic film and was terribly disturbed by what he saw; clearly no one had imparted any sex education or prepared him for changes of puberty.

The changes of adolescence entail modifications in a child’s previous self-concept. It is seen, time and again, that managing body changes, menarche and a feeling of sexuality are three chores that turn difficult without proper information and parents are not always geared to impart the same; some schools do have a built in process but most don’t and those are the children that need it most.

Menarche is just one of the manifestations of Puberty, which is a period of change while attaining biological maturity. Parents need to prepare children for dramatic physical changes of puberty, like the adolescent growth spurt and the development of secondary sexual characteristics. More attention is paid towards girls’ as the need to prepare them for first menstruation is felt necessary. Not much attention is paid to the boys’ need to be prepared for sexual thoughts and fantasies.

When to start?

It is best to start sharing information when a daughter is about eight years of age. Some may feel this is too early, but between the ages of eight and ten, her body has already begun to mature; viz breast development and an increase in body hair (appear approximately 2 year before menarche). Some girls may experience a growth spurt (Shivani had both these 1½ year before menarche but her mother did not think it necessary to start talking to her).

How to start talking?

It is shown that 2/3rd of girls have not been spoken about menstruation when they attain menarche. Most mothers feel awkward about it. Such mothers should start by asking

• Has any information been shared in the class about menstruation?
• Any of your friends have got menstruation?
• What do you know about it?

These three questions will tell you what the girl already knows and set the stage for further discussion where the mother should impart such practical aspects like how often a period occurs? How long it lasts? How much blood is lost? What are the steps of self-care during a cycle? etc.

Mothers who feel awkward about it may start the conversation with, “when I was your age, my close friend started her cycles 6 months before I did and your granny helped me understand it and overcome the fears” or “Someday soon you will experience something, which is very normal and that happens to all girls”

Such mature education is not a one-time discussion but is a continuing process; from menstruation it can graduate to sex education and so on and so forth. A mother has to inculcate mature and responsible thinking in the daughter so that she can face all kinds of peer-pressure and distractions.

What I offer?

Many mothers are confident that I can talk to their daughter without any embarrassment; such girls I explain in front of the mother. For others, we have an e-mail support (no charges are levied) for answering any sensitive/ intimate query and the girl is assured of the confidentiality.

Dr Chander Asrani, father to three daughters and grand father to one, is a post-graduate in Family Medicine. He has over 35 years in clinical practice, launched www.growingwell.com in 2000 and since then has been writing on various subjects. Know more about him at about.me/drasrani.