DR. MAHESWARI JAIKUMAR.
•THE AIM OF SEX EDUCATION IS AS FOLLOWS.
•To have first hand knowledge on sex & sexuality.
•To understand about one’s own sex & be comfortable
•To help to handle changes during adolescence.
•To cope with both physical & emotional changes.
•To establish a stable social relationship with
individuals of the same & opposite sex based on mutual
respect & concern for each other.
•Adolescence is a period of transition from childhood
•This period is crucial as these days are formative
•Major physical, psychological & behavioral changes
•This is the period of preparation for undertaking
grater responsibilities including healthy responsible
•The future of the society depends on the quality of
adolescents in the community.
•Health problems of the adolescents are different from
those of children & adults.
•Adolescents are prone to various behavioral &
reproductive health problems.
•Therefore there is a need for proper guidance &
PHYSICAL & PHYSIOLOGICAL
CHANGES IN ADOLESCENTS.
•PUBERTY IN GIRLS.
•MENARCHE & MENSTURATION.
•PUBERTY IN BOYS.
•PSYCHOLOGICAL & BEHAVIOURAL CHANGES.
•NUTRITION & HEALTH NEEDS IN ADOLESCENTS.
•HEALTH PROBLEMS IN ADOLESCENTS.
PUBERTY IN GIRLS.
•In girls physical changes may begin at around 10 yrs, &
may reach their maximum growth by around 14 yrs.
•There after the growth continues at a slower rate till
the age of 18 yrs.
•Secondary sexual characteristics appear – appearance
of hair in the pubic area, growth of breast.
•Other changes include accelerated growth &
development of genital organs – uterus & overies.
•Overies begin to ovulate at around 11-14 yrs once
every 28 – 30 days.
MENARCHE & MENSTURAL CYCLE.
•Menarche is the onset of first menstruations that occurs
in a young girl at around 12 yrs.
•There are variations in the age at which the
•Good nutritional status will lower the age of menarche.
If menstruation has not started by 16 yrs counsel the
girl’s parents to consult the medical officer.
The ovum produced by the overies when unites with the
male sperm, fertilization occurs,--- failing which
•Menstruation occurs once in a month as a regular
•Menstrual cycle is a continuous process.
•It remains as a normal physiological phenomenon
throughout the child bearing age, except during
•Menstruation stops permanently at menopause
approximately between 45-55 yrs.
PUBERTY IN BOYS.
•Puberty in boys appears little later in case of boys.
•It may begin with the change in voice, growth of hair
on chin, under arms, face, chest & pubic region.
•Enlargement of external genitalia starts & sperm
production also starts.
•Occasionally penile erection & involuntary ejaculations
•The changes are normal.
PSYCHOLOGICAL & BEHAVIOURAL CHANGES.
•During the transition phase, there is rapid changes
in the body.
•The adolescent develops anxiety & apprehension.
•Adolescence is a time for exploration, adventure &
discovery of one’s own body & one’s own capability &
•Some times this can lead to confusion &
experimentation with harmful substances like drugs,
alcohols, & be involved in risky behaviour like risky
•Some times expression of sexual urge by adolescents
may lead to anger among adults.
•This may lead to feeling of anger, guilt& shame.
•Adolescents often hesitate to make communicate about
sexual development & other matters related to health.
•Therefore it is imperative that they are given adequate
information about sex education – normal physical,
sexual & psychological changes etc.
•They should be advised & warned about sex
experiments, drug abuse, teenage pregnancy,
& suicides etc.
NUTRITION & HEALTH NEEDS IN
•The nutritional requirement of adolescents is more
due to rapid growth spurt & increase in physical
•Encourage healthy eating habits & life style.
•Good nutrition is important for optimal growth.
•Adolescents need plenty of all nutrients – calcium,
iodine, & iron.
•The increased iron is due to growth spurt & the
onset of menstruation.
Inadequate iron stored in the body is a major cause of
iron deficiency anemia during pregnancy – aggravates the
risk during pregnancy.
In endemic areas increased incidence of iodine deficiency
disorder results in growth retardation, mental retardation
& poor psychomotor development.
Stunted & under nourished girls are more likely to have
complications during pregnancy & give birth to low birth
Therefore the community should be educated on the
importance of god nutrition, health eating habits & good
•Personal hygiene IS THE BASIC COMPONENT FOR
protection of good health.
•Adolescents should take care of personal hygiene as
•Clean hands thoroughly before & after taking food &
after going to toilet.
•Clean teeth & tongue twice daily.
•Must take bath daily.
•Boys should give attention to clean smegma (thick
secretion collected under the fore skin of the penis.)
during bath & after urination.
•Boys & girls should keep the groin clean & dry ----fungal infection leading to itching will develop.
•Girls should use clean clothes or sanitary napkins
during periods. It should be changed frequently & the
part should be kept clean & dry. Adolescent girl may
have itching around the groin following the menstruation
– this is normal
•Some times girls may have vaginal discharge that
stains in such case she should consult the physician
•The vaginal opening & anus are close to the urethral
opening, therefore wash after passing urine.
•Washing after passing stool & urine must be from
front to back & not reverse as there is a chance of
HEALTH PROBLEMS IN ADOLESCENTS.
THE FOLLOWING ARE THE HEALTH PROBLEMS
•Irregular menstrual cycle.
•Unprotected sex& unwanted pregnancy/unplanned
•Risk of pregnancy in adolescents.
•Unprotected sex & sexually transmitted disease.
•Prevention of adolescent pregnancy & STD’s.
IRREGULAR MENSTURAL CYCLE.
•Irregular menstrual cycle is reported among
•Reassure the girl & parent & advice nutritious diet.
•Generally periods get regularized with in 2 yrs of
•If menstruation is not regularized then refer to PHC.
•Under nutrition is a major & common problem among
adolescents in India.
•Undernutrition during childhood & adolescence results
in impaired growth,anemia, iodine deficiency etc.
•Under nutrition among adolescents is found to be the
major cause of LBW in India.
UNPROTECTED SEX / UNWANTED PREGNANCY.
•There is a wide spread ignorance among adolescents
about sexuality & risks associated with unprotected
•Un protected sex may lead to unwanted pregnancy /
unplanned pregnancy ----- need for induced abortion.
•This may lead the girls to seek abortion services from
untrained practitioners & become victims of
•Termination of pregnancy poses greater risk to life.
•Even if pregnancy progresses it may lead to
RISK OF PREGNANCY IN ADOLESCENCE.
•The health of the adolescent is at risk when they are
married at young age.
•This predisposes the girl to complications like early
•The probability of the mother having anemia, retarded
fetal growth, premature birth & complications are high
•Some times these complications may even lead to death.
UNPROTECTED SEX / STD.
•STD is the major consequence of unprotected sex.
•The commonest ones being syphilis, gonorrhea &
•Young adolescents who engage in unprotected sex are
more vulnerable to these sexually transmitted diseases.
•Acquiring STD’s during adolescence results in serious
consequences like infertility, pelvic inflammatory
diseases, ectopic pregnancy etc.
PREVENTION OF ADOLESCERNT
•Adolescent pregnancies are high risk pregnancies.
•Therefore counseling should be done both the
parents & children on the avoidance of early marriage
•This can be achieved through advocacy, counselling,
& by social & legal action.
•Counseling should focus on enabling –decisions on
prevention of pregnancies by adopting abstinence or
use of contraceptives..
Acknowledge client’s feelings.
Provide emotional support.
Refer to counselling as necessary.
Explain diagnostic procedures.
Provide information, privacy.
Assess the nature of pain.
Observe non verbal cues.
Encourage pain reduction technic.– medication,
comfort measure, back rub, use of heat / cold
Monitor vital signs.
Provide quiet environment, calm activities.
Assess for bleeding, pain,vaginal secretions &
Encourage the women to express her feeling.
Explain the recording dates, type of flow, number of
sanitary pads used.
Teach pain relieving technics.
OTHER SYMPTOMS & MANAGEMENT
Irritability, lethargy, fatigue, sleep disturbance,
depression, headache, vertigo, backache, acne,
Encourage verbalization of feelings.
Encourage to plan activities during symptom free
Administer Vit & mineral supplements.
Encourage daily relaxation & exercises.
Provide emotional support.
Assist in coping mechanism.
PROVIDE HEALTH EDUCATION ON THE
FACTORS ALTERING MENSTRUAL CYCLE.: stress,
fatigue, exercise, acute or chronic illness, changes
in climate, working hours , pregnancy.
PERSONAL HYGIENE.: Usage of pads, frequent
change of pads, general & perenial hygiene.
BALANCED DIET & PLENTY OF FLUIDS.
ROLE OF A NURSE.
•ENSURE SAFE & SECURE ENVIRONMENT.
•EDUCATE THE FAMILY MEMBERS & THE
•GIVE CLARIFICATION & CORRECT INFORMATION
TO THE CLIENTS.
•EDUCATE ON HEALTHY LIFE STYLE..