Rectopen: Gynecology

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Showing posts with label Gynecology. Show all posts
Showing posts with label Gynecology. Show all posts
Infertility
June 01, 2021
What is Infertility?
Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples.

Symptoms :
The main symptom of infertility is not getting pregnant. There may be no other obvious symptoms. Sometimes, a woman with infertility may have irregular or absent menstrual periods. In some cases, a man with infertility may have some signs of hormonal problems, such as changes in hair growth or sexual function.

Most couples eventually conceive, with or without treatment.

When to see a doctor :
A woman probably doesn't need to see a doctor about infertility unless she has been trying regularly to get pregnant for at least one year. Women should talk with a doctor earlier, however, if they:

• Are age 35 or older and have been trying to conceive for six months or longer
• Are over age 40
• Have irregular or absent periods
• Have very painful periods
• Have known fertility problems
• Have been diagnosed with endometriosis or pelvic inflammatory disease
• Have had multiple miscarriages
• Have undergone treatment for cancer

Men should talk to a doctor if they have:
• A low sperm count or other problems with sperm
• A history of testicular, prostate or sexual problems
• Undergone treatment for cancer
• Small testicles or swelling in the scrotum
• Others in family with infertility problems

Causes :
All of the steps during ovulation and fertilization need to happen correctly in order to get pregnant. Sometimes the issues that cause infertility in couples are present at birth, and sometimes they develop later in life. Infertility causes can affect one or both partners. In general:

• In about one-third of cases, there is an issue with the man
• In about one-third of cases, there is an issue with the woman
• In the remaining cases, there are issues with both the man and the woman, or no cause can be found

Causes of male infertility :
• Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.

• Problems with the delivery of sperm due to sexual problems like premature ejaculation; certain genetic diseases like cystic fibrosis; structural problems like blockage in the testicle, damage or injury to the reproductive organs.

• Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure and depression also can affect fertility. Frequent exposure to heat, can raise body temperature and may affect sperm production.

• Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

Male Infertility
Male Infertility

Causes of female infertility :
• Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — also may interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include too much exercise, eating disorders or tumors.

• Uterine or cervical abnormalities, including abnormalities with the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may cause infertility by blocking the fallopian tubes or stopping a fertilized egg from implanting in the uterus.

• Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.

• Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes.

• Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, and radiation or chemotherapy treatment.

• Pelvic adhesions, bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.

• Cancer and its treatment. Certain cancers — particularly reproductive cancers — often impair female fertility. Both radiation and chemotherapy may affect fertility.

Female Infertility
Female Infertility

Risk factors:
Many of the risk factors for both male and female infertility are the same. They include:

• Age: Women's fertility gradually declines with age, especially in the mid-30s, and it drops rapidly after age 37. Infertility in older women is likely due to the lower number and quality of eggs, and can also be due to health problems that affect fertility. Men over age 40 may be less fertile than younger men.

• Tobacco use: Smoking tobacco or marijuana by either partner may reduce the likelihood of pregnancy. Smoking also reduces the possible effectiveness of fertility treatment. Miscarriages are more frequent in
women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.

• Being overweight: Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. For men, sperm count also may be affected by being overweight.

• Being underweight: Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and those who follow a very low-calorie or restrictive diet.

• Exercise issues: A lack of exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.

• Alcohol use: For women, there's no safe level of alcohol use during conception or pregnancy. Alcohol use may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.

Prevention:
Men: Although most types of infertility aren't preventable in men, these strategies may help:
  • Avoiding drug and tobacco use and drinking too much alcohol, which may contribute to male infertility.
  • Avoiding high temperatures found in hot tubs and hot baths, as they can temporarily affect sperm production and motility.
  • Avoiding exposure to industrial or environmental toxins, which can affect sperm production.
  • Limiting medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don't stop taking prescription medications without medical advice.
  • Exercising moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.

Women: For women, a number of strategies may increase the chances of becoming pregnant:
  • Quit smoking. Tobacco has many negative effects on fertility.
  • Avoiding alcohol and street drugs. These substances may impair the ability to conceive and have a healthy pregnancy.
  • Limiting caffeine. Women trying to get pregnant may want to limit caffeine intake
  • Exercising moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
  • Avoiding weight extremes. Being overweight or underweight can affect your hormone production and cause infertility.

Diagnosis:
Tests for men
• Semen analysis
• Hormone testing
• Genetic testing
• Testicular biopsy
• Imaging
• Other specialty testing

Fertility Tests
Fertility Tests

Tests for women:
Fertility for women relies on the ovaries releasing healthy eggs. The reproductive tract must allow an egg to pass into the fallopian tubes and join with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the lining. Tests for female infertility try to find out if any of these processes are impaired. A patient may have a general physical exam, including a regular gynecological exam. Specific fertility tests may include:

  • Ovulation testing
  • Hysterosalpingography
  • Ovarian reserve testing
  • Other hormone testing. Other hormone tests check levels of ovulatory hormones, as well as pituitary hormones that control reproductive processes.
  • Imaging tests.

Uterine Cancer
June 01, 2021
Cancer of the Uterus
(Uterine Cancer or Endometrial Cancer)

What is Endometrial cancer:
Endometrial cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ where fetal development occurs.

Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is sometimes called uterine cancer. Other types of cancer can form in the uterus, including uterine sarcoma, but they are much less common than endometrial cancer. Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer.

Types of womb cancer :
• Most womb cancers begin in the cells that make up the lining of the womb (the endometrium). This is why cancer of the womb is often called endometrial cancer.

• In rare cases, womb cancer can start in the muscle wall of the womb. This type of cancer is called uterine sarcoma and may be treated in a different way.

Symptoms :
Signs and symptoms of endometrial cancer may include:
• Vaginal bleeding after menopause
• Bleeding between periods
• Pelvic pain

Uterine Cancer
Uterine Cancer

Why does womb cancer happen?
  • It's not clear exactly what causes womb cancer, but certain things can increase your risk of developing it.
  • One of the main risk factors for womb cancer is higher levels of a hormone called oestrogen in your body.
  • A number of things can cause your oestrogen levels to be high, including obesity. There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen.

Risk factors :
Factors that increase the risk of endometrial cancer include:

• Changes in the balance of female hormones in the body : The ovaries make two main female hormones — estrogen and progesterone. Fluctuations in the balance of these hormones cause changes in the endometrium. A disease or condition that increases the amount of estrogen, but not the level of progesterone, in the body can increase the risk of endometrial cancer. Examples include irregular ovulation patterns, which might happen in polycystic ovary syndrome, obesity and diabetes. Taking hormones after menopause that contain estrogen but not progesterone increases the risk of endometrial cancer. A rare type of ovarian tumor that secretes estrogen also can increase the risk of endometrial cancer.

• More years of menstruation : Starting menstruation at an early age, before age 12 or beginning menopause later increases the risk of endometrial cancer. The more periods, the more exposure endometrium has to estrogen.

• Never having been pregnant : If one has never been pregnant, she has a higher risk of endometrial cancer than someone who has had at least one pregnancy.

• Older age : As one gets older, the risk of endometrial cancer increases. Endometrial cancer occurs most often after menopause.

• Obesity : Being obese increases the risk of endometrial cancer. This may occur because excess body fat alters body's balance of hormones.

• Hormone therap for breast cancer : Taking the hormone therapy drug tamoxifen for breast cancer can increase the risk of developing endometrial cancer.

• An inherited colon cancer syndrome : Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC), is a syndrome that increases the risk of colon cancer and other cancers, including endometrial cancer. Lynch syndrome is caused by a gene mutation passed from parents to children.

Prevention :
To reduce the risk of endometrial cancer one should:

• Talk to the doctor about the risks of hormone therapy after menopause. Talk to the doctor about the risks and benefits if the patient is considering hormone replacement therapy to help control menopause symptoms. Unless a patient’s undergone a hysterectomy, replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking a combination of estrogen and progestin can reduce this risk.

• Consider taking birth control pills. Using oral contraceptives for at least one year may reduce endometrial cancer risk. The risk reduction is thought to last for several years after stopping taking oral contraceptives.

• Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight.

Diagnosis :
Tests that examine the endometrium are used to detect (find) and diagnose endometrial cancer. Those tests are:

• Endometrial biopsy
• Dilatation and curettage
• Hysteroscopy
• Transvaginal ultrasound exam
• Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.


Uterine fibroids
May 13, 2021
What Are Uterine Fibroids?

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer. Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight. Many women have uterine fibroids sometime during their lives.

Diagram of Uterine Fibroids:


Symptoms:
Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids. In women who have symptoms, the most common signs and symptoms of uterine fibroids include:
  • Heavy menstrual bleeding
  • Menstrual periods lasting more than a week
  • Pelvic pressure or pain
  • Frequent urination
  • Difficulty emptying the bladder
  • Constipation
  • Backache or leg pains
  • Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die

Classification:
Fibroids are generally classified by their location :
  1. Intramural fibroids - grow within the muscular uterine wall.
  2. Submucosal fibroids - bulge into the uterine cavity.
  3. Subserosal fibroids - project to the outside of the uterus.

When to see a doctor:
A patient should see a doctor if she has :
  1. Pelvic pain that doesn't go away
  2. Overly heavy, prolonged or painful periods
  3. Spotting or bleeding between periods
  4. Difficulty emptying your bladder
  5. Unexplained low red blood cell count (anemia)
Patient should seek prompt medical care if she has severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

Causes:
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors:

1. Genetic changes : Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.

2. Hormones : Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

3. Other growth factors : Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth

4. Extracellular matrix (ECM). ECM is the material that makes cells stick together, like mortar between bricks. ECM is increased in fibroids and makes them fibrous. ECM also stores growth factors and causes biologic changes in the cells themselves.

Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

Complications:
Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as a drop in red blood cells (anemia), which causes fatigue, from heavy blood loss. Rarely, a transfusion is needed due to blood loss.

Pregnancy and fibroids:
Fibroids usually don't interfere with getting pregnant. However, it's possible that fibroids — especially submucosal fibroids — could cause infertility or pregnancy loss. Fibroids may also raise the risk of certain pregnancy complications, such as : placental abruption, fetal growth restriction and preterm delivery

Diagnosis:
Uterine fibroids are frequently found incidentally during a routine pelvic exam. The doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids. If a patient has symptoms of uterine fibroids, the doctor may order these tests:

1. Ultrasound : If confirmation is needed, the doctor may order an ultrasound. It uses sound waves to get a picture of the uterus to confirm the diagnosis and to map and measure fibroids. A doctor or technician moves the ultrasound device (transducer) over the abdomen (transabdominal) or places it inside the vagina (transvaginal) to get images of the uterus.

2. Lab tests : The tests might include a complete blood count (CBC) to determine if the patient has anemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.

If traditional ultrasound doesn't provide enough information, your doctor may order other imaging studies, such as : Magnetic resonance imaging (MRI), Hysterosonography, Hysterosalpingography ,Hysteroscopy.

Prevention:
Although researchers continue to study the causes of fibroid tumors, little scientific evidence is available on how to prevent them. Preventing uterine fibroids may not be possible, but only a small percentage of these tumors require treatment. But, by making healthy lifestyle choices, such as maintaining a normal weight and eating fruits and vegetables, it may be possible to decrease fibroid risk. Also, some research suggests that using hormonal contraceptives may be associated with a lower risk of fibroids.

Uterine Prolapse
May 13, 2021
What is uterine prolapse?

A uterine prolapse is when the uterus descends toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus.
In some cases, the uterus can protrude from the vaginal opening. Complications can sometimes result, including ulceration of exposed tissue and prolapse of other pelvic organs such as the bladder or the rectum. Among women aged 55 years and above, it is one of the most common reasons for undergoing a hysterectomy.

Diagram of uterine prolapse :


Stages of Uterine Prolapse :

The uterus, also known as the womb, is held above the vagina by the pelvic floor
muscles and ligaments. Uterine prolapse can be categorized as incomplete or
complete :
  • Incomplete uterine prolapse: The uterus is partially displaced into the vagina but does not protrude.
  • Complete uterine prolapse: A portion of the uterus protrudes from the vaginal opening.
The condition is graded by its severity, determined by how far the uterus has descended:
  • 1st grade: descended to the upper vagina
  • 2nd grade: descended to the introitus
  • 3rd grade: cervix has descended outside the introitus
  • 4th grade: cervix and uterus have both descended outside the introitus
More severe cases may need surgery, but in the early stages, exercises may help.

Symptoms:
Symptoms vary depending on how severe the prolapse is. Typical symptoms include :
  1. Pelvic heaviness or pulling
  2. Vaginal bleeding or an increase in vaginal discharge
  3. Difficulties with sexual intercourse
  4. Urinary leakage, retention or bladder infections
  5. Bowel movement difficulties, such as constipation
  6. Lower back pain
  7. Uterine protrusion from the vaginal opening
  8. Sensations of sitting on a ball or that something is falling out of the vagina
  9. Weak vaginal tissue
In mild cases, there may be no symptoms. Symptoms that appear only sometimes often become worse toward the end of the day.

Causes :
Pelvic floor muscles can become weak for a number of reasons :
  1. Pregnancy
  2. Factors related to delivery, including trauma, delivering a large baby, or having a vaginal delivery
  3. Getting older, especially after menopause, when levels of circulating estrogen drop
  4. Frequent heavy lifting
  5. Straining during bowel movements
  6. Chronic coughing
  7. A history of pelvic surgery
  8. Genetic factors leading to weakened connective tissue
Diagnosis :

A doctor will ask about symptoms and perform a physical examination. While examining the pelvis, the provider will evaluate for organ placement and vaginal tone. An ultrasound or MRI may help assess the severity of the prolapse.

Remedy :
Mild uterine prolapse can be treated with Kegel exercises (Kegel exercises are simple clench-and-release exercises that make the muscles of pelvic floor stronger), weight management and avoidance of heavy lifting, preventing and treating constipation.

Treatment :
Prolapse up to the third degree may spontaneously resolve. More severe cases may require medical treatment.

Options include :

Vaginal pessary : This is a vaginal device that supports the uterus and keeps it in position. It is important to follow the instructions on care, removal, and insertion of the pessary. In cases of severe prolapse, a pessary can cause irritation, ulceration, and sexual problems. Discuss with your provider if this treatment is right for you.

Surgery : Surgical repair of a prolapsed uterus can be performed through the vagina or abdomen. It involves skin grafting, or using donor tissue or other material to provide uterine suspension. A hysterectomy may be recommended. If future pregnancies are intended, surgery may not be recommended, due to the risks of undoing the effects of surgical repair.
Menstruation
May 13, 2021
What is menstruation?

Menstruation is the elimination of the thickened lining of the uterus (endometrium) from the body through the vagina. Menstrual fluid contains blood, cells from the lining of the uterus (endometrial cells) and mucus. The average length of a period is between three days and one week.

Diagram of menstrual cycle

Diagram of menstrual cycle
Diagram of menstrual cycle

Phases of menstruation:

Follicular phase
The follicular phase starts on the first day of menstruation and ends with ovulation. Prompted by the hypothalamus, the pituitary gland releases follicle stimulating hormone (FSH). This hormone stimulates the ovary to produce around five to 20 follicles (tiny nodules or cysts), which bead on the surface. Each follicle houses an immature egg. Usually, only one follicle will mature into an egg, while the others die. This can occur around day 10 of a 28-day cycle. The growth of the follicles stimulates the lining of the uterus to thicken in preparation for possible pregnancy.

Ovulation:
Ovulation is the release of a mature egg from the surface of the ovary. This usually occurs mid-cycle, around two weeks or so before menstruation starts. During the follicular phase, the developing follicle causes a rise in the level of estrogen. The
hypothalamus in the brain recognizes these rising levels and releases a chemical called gonadotrophin-releasing hormone (GnRH). This hormone prompts the pituitary gland to produce raised levels of luteinizing hormone (LH) and FSH. Within two days, ovulation is triggered by the high levels of LH. The egg is funnelled into the fallopian tube and toward the uterus by waves of small, hair-like projections. The life span of the typical egg is only around 24 hours. Unless it meets a sperm during this time, it will die.

Luteal phase:
During ovulation, the egg bursts from its follicle, but the ruptured follicle stays on the surface of the ovary. For the next two weeks or so, the follicle transforms into a structure known as the corpus luteum. This structure starts releasing progesterone, along with small amounts of estrogen. This combination of hormones maintains the thickened lining of the uterus, waiting for a fertilized egg to stick (implant).If a fertilized egg implants in the lining of the uterus, it produces the hormones that are necessary to maintain the corpus luteum. This includes human chorionic gonadotrophin (HCG), the hormone that is detected in a urine test for pregnancy. The corpus luteum keeps producing the raised levels of progesterone that are needed to maintain the thickened lining of the uterus. If pregnancy does not occur, the corpus luteum withers and dies, usually around day 22 in a 28-day cycle. The drop in progesterone levels causes the lining of the uterus to fall away. This is known as menstruation. The cycle then repeats.

Common menstrual problems:

Premenstrual syndrome (PMS) – hormonal events before a period can trigger a range of side effects in women at risk, including fluid retention, headaches, fatigue and irritability. Treatment options include exercise and dietary changes Dysmenorrhea – or painful periods. It is thought that the uterus is prompted by certain hormones to squeeze harder than necessary to dislodge its lining. Treatment options include pain-relieving medication and the oral contraceptive
pill.

Heavy menstrual bleeding (previously known as menorrhagia) – if left untreated, this can cause anaemia. Treatment options include oral contraceptives and a hormonal intrauterine device (IUD) to regulate the flow. Amenorrhea – or absence of menstrual periods. This is considered abnormal, except during pre-puberty, pregnancy, lactation and post menopause. Possible causes include low or high body weight and excessive exercise.

Cryptomenorrhea – is a condition where menstruation occurs but is not visible due to an obstruction of the outflow tract. Specifically the endometrium is shed, but a congenital obstruction in the vagina or on part of the hymen retains the menstrual flow. A patient with cryptomenorrhea will appear to have amenorrhea but will experience cyclic menstrual pain. The condition is surgically correctable.

Polymenorrhea – is a term used to describe a menstrual cycle that is shorter than 21 days. A normal menstrual cycle is between 24 and 38 days long. Polymenorrhea is just one form of abnormal uterine bleeding.

Oligomenorrhea – is a condition in which you have infrequent menstrual periods. It occurs in women of childbearing age. Some variation in menstruation is normal, but a woman who regularly goes more than 35 days without menstruating may
be diagnosed with oligomenorrhea.

Menorrhagia – is the medical term for menstrual bleeding lasting for longer than 7 days. It is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Menorrhagia can lead to anemia if not treated.

Metropathia – abnormal, excessive, often continuous, uterine bleeding due to persistence of the follicular phase of the menstrual cycle.

DUB (dysfunctional urinal bleeding) – is a condition that causes vaginal bleeding to occur outside of the regular menstrual cycle. Abnormal uterine bleeding or dysfunctional uterine bleeding is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy

Puberty
May 12, 2021
What is puberty?
Puberty is when a child's body begins to develop and change as they become an adult. Puberty is the time in life when a boy or girl becomes sexually mature. It is a process that usually happens between ages 10 and 14 for girls and ages 12 and 16 for boys. It causes physical changes, and affects boys and girls differently.

বয়ঃসন্ধি (ইংরেজি: Puberty) একটি সুনির্দিষ্ট প্রক্রিয়া যার মাধ্যমে একটি শিশুর শরীর একজন প্রাপ্তবয়স্ক মানুষের শরীরে রূপান্তরিত হয় এবং প্রজননের সক্ষমতা লাভ করে। মস্তিষ্ক থেকে গোনাডে (ডিম্বাশয় ও শুক্রাশয়) হরমোন সংকেত যাবার মাধ্যমে এটির সূচনা ঘটে।

Stages of puberty:
The average age for girls to begin puberty is 11, while for boys the average age is 12.But it's different for everyone, so don't worry if your child reaches puberty before or after their friends. It's completely normal for puberty to begin at any point from the ages of 8 to 14. The process can take up to 4 years.

Late or early puberty:
Children who begin puberty either very early (before the age of 8) or very late (after 14) should see a doctor just to make sure they're in good health.


Signs of puberty:

First signs of puberty in girls
  1. The first sign of puberty in girls is usually that their breasts begin to develop.
  2. It's normal for breast buds to sometimes be very tender or for one breast to start to develop several months before the other one.
  3. Pubic hair also starts to grow, and some girls may notice more hair on their legs and arms.

Later signs of puberty in girls
After a year or so of puberty beginning, and for the next couple of years:
  1. Girls' breasts continue to grow and become fuller.
  2. Around 2 years after beginning puberty, girls usually have their first period.
  3. Pubic hair becomes coarser and curlier.
  4. Underarm hair begins to grow – some girls also have hair in other parts of their body, such as their top lip, and this is completely normal.
  5. Girls start to sweat more.
  6. Girls often get acne – a skin condition that shows up as different types of spots, including whiteheads, blackheads and pus-filled spots called pustules.
  7. Girls have a white vaginal discharge.
  8. Girls go through a growth spurt – from the time their periods start, girls grow 5 to 7.5cm (2 to 3 inches) annually over the next year or two, then reach their adult height.
  9. Most girls gain weight (which is normal) as their body shape changes – girls develop more body fat along their upper arms, thighs and upper back; their hips grow rounder and their waist gets narrower.

First signs of puberty in boys
  1. The first sign of puberty in boys is usually that their testicles get bigger and the scrotum begins to thin and redden.
  2. Pubic hair also starts to appear at the base of the penis.

Later signs of puberty in boys
After a year or so of puberty starting, and for the next couple of years:
  1. The penis and testicles grow and the scrotum gradually becomes darker (read more about penis health).
  2. Pubic hair becomes thicker and curlier.
  3. Underarm hair starts to grow.
  4. Boys start to sweat more.
  5. Breasts can swell slightly temporarily – this is normal and not the same as "man-boobs“.
  6. Boys may have "wet dreams" (involuntary ejaculations of semen as they sleep).
  7. Their voice "breaks" and gets permanently deeper – for a while, a boy might find his voice goes very deep one minute and very high the next.
  8. Boys often develop acne – a skin condition that shows up as different types of spots, including whiteheads, blackheads and pus-filled spots called pustules.
  9. Boys go through a growth spurt and become taller by an average of 7 to 8cms, or around 3 inches a year, and more muscular.

Mental health in puberty
Puberty can be a difficult time for children. They're coping with changes in their body, and possibly acne or body odor as well, at a time when they feel self-conscious. Puberty can also be an exciting time, as children develop new emotions and feelings. But the "emotional rollercoaster" they're on can have psychological and emotional effects, such as:
  • Unexplained mood swings
  • Low self-esteem
  • Aggression
  • Depression
Why do these emotions occur?

The physical changes that occur during puberty give rise to a variety of social and emotional changes. First, the ongoing physical maturation process directly affects body and brain to alter children's needs, interests, and moods. Then, as children start to look and act differently, an array of social influences further accelerate the social and emotional changes children experience. The physical changes associated with puberty become the basis for new emotional experiences. For example, it is common for parents to note their children become more moody and irritable during this period of their lives. This moodiness is commonly attributed to the sudden and fluctuating hormonal levels, or "raging hormones". It is certainly true that sex hormones are powerful chemical agents that can affect mood. During puberty, the body is adjusting to these fluctuating hormone levels and this fluctuation does create mood swings. However, there are several other physical causes accounting for increased moodiness apart from fluctuating hormones.

Lack of Sleep

There are both physical and social reasons for why sleep deficits may occur during puberty. The body's sleep-wake cycle is dependent upon a "circadian rhythm" which in turn, is influenced by hormones. During puberty, a natural shift occurs in a teen's circadian rhythm that causes them to feel more fully alert later at night. Unfortunately, they must still rise early for school and other activities. As a result, they get less sleep than they require. This lack of sleep can increase irritability and decrease concentration ability, and contribute to children suddenly finding it difficult to complete tasks that were once simple. This new struggle only adds to their frustration and moodiness.

Adolescent Brains Are Still Maturing

A second factor that complicates adolescent moodiness is that their brains are still physical maturing: Children's brains are not fully developed until they are in their early 20’s. This incomplete brain development is responsible for much of the cognitive and emotional immaturity that can so easily frustrate parents. Cognitive immaturity refers to youths' still-developing thinking skills which are not yet as
sophisticated and reliable as those characteristic of adults. Cognitively immature people lack good judgment. Immature thinking result in a youths' having difficulty thinking things through so as to anticipate the consequences of their actions and make informed decisions or choices based upon those anticipated consequences. As a result, youth easily appear as impulsive, hasty, and even selfish. The brain's incomplete physical development is also in large part responsible for youthful emotional immaturity.

Youth have more difficulty than mature adults in regulating their emotions and putting events in proper perspective. Emotion regulation is an important ability because it enables people to consciously control (within limits) how strongly they will feel emotions like anger, joy or fear. Such control helps people limit the emotional highs and lows that are commonly called "mood swings." To make things worse, during periods of high emotional arousal, the brain's thinking capacity is temporarily further diminished.

What can parents do?

Parents need to know about children's still-immature brain structure, sleep alterations and changing hormones and the emotional and cognitive immaturity that results from this still developing state so that they can regard their children's behavior in proper perspective. Though adolescent children may become moody and make poor choices, they are not doing this purely out of spite, but rather because they cannot be substantially otherwise at this point in their development. Despite their resistance, parents need to continue to provide their adolescent children with clear behavior guidelines and set and enforce age-appropriate behavior limits. Through doing so parents provide children with the proper mixture of safety and freedom they require to enable and enhance their further growth. Children need enough room to express their individuality and to practice (and sometimes fail) independent decision-making AND they need to be protected from the consequences of their worst decisions in order for them to thrive.

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