Showing posts with label adolescence. Show all posts
Showing posts with label adolescence. Show all posts

Wednesday, September 3, 2008

Girl Bonding 101: Moving Beyond Netter



I am in a state of slow, silent, ever-evolving panic.

I just looked over at my 10-year-old daughter (soon to be 11), and for a second I saw a young woman sitting in the armchair. Or at least, a young pre-woman. Ack.

She has shot up several inches and a couple of shoe sizes this year. I feel like she goes up one Tanner stage every week or so. Her face has gradually acquired subtle, more mature angles, and let’s not even talk about the rest…

She builds sand castles at the beach and sleeps with her teddy bear. But she also notices attractive young actors or singers, and her comprehension of the nuances of flirtation is accelerating at an alarming rate. She is bubbly and all smiles and hugs one moment, irate and scowling the next, at the slightest provocation. She can still enjoy Sponge Bob, but she can also start to discuss American politics and social issues. I am amazed and thrilled and in awe and totally distressed.

I want to tell her pituitary axis: whoa! Slow down! Childhood’s short enough! But it’s useless.

It’s time to have THE TALK.

No, not that talk. We had that talk when she was eight, because the kids at school were already disseminating all sorts of sketchy information about reproduction and childbirth. I told her I was okay with her discussing reproduction and childbirth but I wanted her to have the right information – and who better than her doctor-mom to provide it, right?

Now, I am sure there are lots of people out there who can describe the “right way” and “wrong way” to handle sex education. I myself got “educated” in a bit of an unusual way. I was in a book store when I was five and saw a book entitled Where Babies Come From, or something like that, illustrated with some cartoon-like illustrations. I had been reading for about a year. I picked up the book, learned the facts of life, and, bored out of my mind, put the book back on the shelf. My mom was a little surprised, I think, when, after she expressed doubt that I actually knew about intercourse, I explained the process to her fairly accurately. It was only later that the more abstract concepts came within reach.

When my daughter asked me where babies come from, I said, “Cells, of course. Remember how I told you all our bodies are made of little, tiny things called cells? Babies start out as little clumps of cells inside their mothers and grow bigger and bigger with time. The parts of the body develop as our cells make more cells.”

That explanation satisfied her for a while, but then the inevitable came: “How do the cells get inside the mommy? And is it true that mommies push the baby out through where they pee?” That was the part the kids at school were talking about.

That was the part that made me thankful I'd hung on to my Netter Atlas of Anatomy from medical school. I sat my daughter down between my husband and me and we explained the relevant mechanics of reproduction step by step. I explained a little bit about menstrual cycles. I drew simple diagrams of female internal organs and used Netter as a supplement. Last but not least, my husband and I both expressed our personal values regarding the place of sexuality in the context of human relationships. As our daughter listened I felt proud, because she seemed to be listening so thoughtfully.

Lately, though, now that she’s a little older, she has acquired a kind of embarrassed reluctance to discuss “woman stuff.” When she was eight we could almost sense a certain pride in her at being entrusted with these more “adult” concepts. Today, however, she’d really rather not talk about them. But I feel I have to get us talking about them, not only to reinforce the idea that it’s okay for us to talk and for her to have questions, but also to make sure she doesn’t feel anxious or uncertain or ill-informed. Sometimes it seems like it's almost easier to get patients to open up about personal things.

I wanted to have the talk about menarche. I think it’s imminent at this point. But how to create a level of comfort about the subject? And to make sure we’re prepared, together, before the moment arrives? I want her to feel good about growing up, to celebrate each milestone instead of dreading or being unpleasantly surprised by it.

The other night an opportunity arose. I don’t quite remember how. But the subject came up, and I asked her if she had any questions about periods.

No,” she answered emphatically, casting her eyes down. I could almost hear her mortified mental voice asking me, Please don’t give me an awkward, long-winded lecture; please don’t start looking for “ins;” and please, whatever you do, don’t ask me if I’m sure about not having any questions.
“Are you sure?” I asked, stupidly. So predictable.

Then I started to babble. I told her she could always come to me if she felt unsure or worried about something. I told her it wasn’t at all scary to get a period if you knew what to expect. I told her I would go with her to the drug store when the time came to look at the options in terms of supplies.

Then it happened. I got my “in.”

“Actually, that’s the part I wasn’t sure about,” she said, looking up again.

“What’s that, honey?”

“The supplies part. I don’t exactly understand how they work.”

Relief! She had given me a concrete way to nurture and support her! Hallelujah! I launched into an enthused discussion - not, I hoped, an awkward, long-winded lecture - about the pros and cons of various types of supplies, demystifying the “anatomy” and mechanics of each with appropriate exhibits. I explained what I liked and didn’t like about each option.

Sometimes, whether it’s a patient or a beloved child, it can be so tough to talk about so-called “sensitive” issues. And somehow it can be much easier to be direct with total strangers. “Are you sexually active?” we ask during a comprehensive medical history. “With one partner or more than one? Male or female?” I can do all that "doctor stuff" without batting an eyelash, but somehow when it comes to the mother-stuff of making sure my daughter’s emotionally okay, or figuring out if I’m asking too much or too little, saying too much or too little, I feel much less certain that I’m doing an adequate job. There’s no Netter Atlas of Parenting, after all.

I guess I just have to take my cues from her.

Photo: reusable menstrual pad with Kokopelli motif from Wikipedia article on the history of sanitary napkins
Link of interest, for the historically inclined: Museum of Menstruation

Friday, July 18, 2008

Bees and Birds

“Douche bag!” My tween son hurls at his brother in the car on the way to a picnic.

“What was that?” I counter.

“Douche bag.” He returns sheepishly.

“Do you know what a douche bag is?”

“No, not really.” Will replies.

“Well let me tell you.”

And so continues our snippets of car talk. One would think that talking about sex and sexual matters would come easily for a pediatrician. Conversations about sexual matters and children are a daily occurrence in my practice. Yet a different element exists when I am trying to convey information about sex to my own children.

Trends in our family would suggest that there are some universal truths about sex education. The first is that the topics my children seen to have the most questions about aren’t covered widely in any book I know about. We’ve covered the basics – mostly in the car – about where babies come from and the real words for male and female anatomy. Sometimes it is all I can do to stay on the road. Then there are these other topics like defining a douche bag or masturbation. One time after an Oprah episode my eldest wanted to know what a pedophile was. Okay, where do I begin?

The second universal truth is that I am my sons’ go to girl for information. I am the token female in our family and it is my job to educate them about the female gender. Yeah, right. My job has globalized into ISM specialist or Information about Sexual Matters specialist. As I strive to keep these lines of communication open and honest, I am having epiphanies of understanding for all the parents who struggle with these topics. At one point I had aspirations of writing a coaching guide for mothers of boys to tackle some of these topics. I bought as many books about puberty and boys as I could find on Amazon.com. If I educated myself, I might be able to educate others, right? As the project sits stagnant on my bookshelf, the books have provided practical punctuation for Will’s sexual education and fodder for more conversations to come.

Lastly the universe has decided that we will have these conversations whenever and wherever. Car, movie theater, restaurants. No place is excluded. As a new parent, I assumed that “the talk” would take place in the privacy of our home. When my boys ask questions, they seem out of context because 90% take place out of our house. The silver lining to this truth is that the conversations are usually short – literally snippets – and ongoing. This is a key concept I try to share with families in my practice. The talk really should be an ongoing thread woven into daily life. Break off small pieces to feed your kids on a regular basis. It is less overwhelming that way.

“Sorry about the language, Mom.” Will say at the end of the picnic.

“I’m just try to teach you before someone else does.”

“I know.”

“I don’t want you to be embarrassed by a teacher or someone else’s parent. You need to know the real meaning of the words you use.”

“Thanks, Mom.” Will kisses my cheek. Mission accomplished (for today).