Transcription:

Melanie Cole (Host): Although puberty refers to the physical changes when the body becomes sexually mature and ready to reproduce, there are also a lot of emotional changes with teens that go along at the same time, and how is a parent to talk to their teens about their sexual and reproductive health? My guest today is Dr. Melisa Holmes. She’s a nationally recognized advocate for adolescent health and an obstetrician-gynecologist with Greenville Health System. Welcome to the show, Dr. Holmes. Let’s start with what are some of those changes. As a tween become a teen and we start noticing changes, smelling changes in our teens, what is going on in their bodies?

Dr. Melisa Holmes (Guest): As children become adolescent, they start with a lot of different changes. For girls it starts younger today than it used to, especially with breast development. Breast development starts typically as young as 7 or 8 years old now, but it used to be closer to 10 or 11. And then, after that all of the puberty changes start to happen, they start to grow hair, they become malodorous, they get their body odor, they get taller, they start their periods, and they continue to develop curves as their body changes. They also have some brain changes going on at the same time. And so, those can make their mood feel bigger—hormones don’t cause moods, but they do make them feel bigger sometimes. And so, they’re learning to adjust to all of those changes.

Melanie: When is the first time that you would like to see a girl come to her obstetrician and start to get some information, or do they get that from their pediatrician?

Dr. Holmes: It really depends on the physician. Some pediatricians will continue to follow children up through college and they make that transition to adolescence very well with the family. But, for some kids they feel like the pediatrician is so much a part of their family that they would like somebody else to talk to. So, OBGYNs are trained to start seeing children at the age of 13 to 15 to begin talking about their reproductive health and sexuality and things like that. But, again, it just depends on the provider and their comfort level having these conversations with girls and boys.

Melanie: Speaking of conversations, it’s time at that time for parents to have those conversations with their children about sexual health and reproduction. How do you tell parents to start that conversation? What are the words you use?

Dr. Holmes: The easiest way for parents to start those conversations is to start when their children are super young. So, if they start teaching their young children proper names for body parts, what’s appropriate touching, what’s not appropriate touching, they talk to them preemptively about puberty before the changes happen, and then, if the parents can be the first ones to talk to their children about reproduction and sex before they hear it from their friends on the playground, that’s the ideal way to start those conversations. Unfortunately, a lot of parents wait until they panic, they see the body changes, they hear something, they react to a question their child has or something they’ve seen them looking up on the internet. And when that happens, our secret for all parents is to tell them, number one, don’t freak out, because if they freak out over any of these conversations, their children are never going to come to them again with their questions or concerns. So, parents can just stay calm, be matter of fact, but also be honest. That’s the best way to start a great dialogue because there’s no one talk that fixes everything, it’s multiple dialogues and conversations that have to happen throughout the preteen and teen years.

Melanie: What about when parents say, “But if I discuss these things with them it’s like giving them a license to become sexually active”?

Dr. Holmes: There has been a lot of research on that exact issue and it’s proven that talking to them actually prepares them to handle things better and to make better decisions. What we know about the adolescent brain and how it functions is that teenagers don’t have that prefrontal cortex developed, which means they don’t think fast on their feet. It doesn’t mean they don’t think well, it just means they can’t make these decisions quickly. So, when they’re faced with something challenging, peer pressure, a sexually, emotionally charged situation, if they haven’t thought about it before they get there, they will act impulsively. But, if they’ve heard about it beforehand, they’ve thought about how they might respond, they understand their family values, then they’re more likely to act in a way that’s in line with their family values and what their goals are for themselves. So, talking to them about it ahead of time does not set them up to experiment. It sets them up to be better prepared, to act in accordance with the way they’re taught.

Melanie: The teenage brain is absolutely fascinating to study. It certainly is. And, that includes driving around that same time. It kind of gives that reaction. Now, also, we’re hearing a lot in the media about HPV and the vaccine, and I’m sure a lot of parents have questions about this vaccine, the efficacy, the safety of it, and why we’re giving it to our teens so early.

Dr. Holmes: One of the primary questions we get is, “Why do I have to give it to them so early?” The CDC actually came out last week with new recommendations that if the vaccine is given before the age of 15, there are only two shots required, instead of the three which about have been required since it was started. And that’s because data is showing us that the younger children get the vaccine, the more robust immune response they have. And so, the vaccine actually works betters when it’s given at a younger age. It’s not because we think kids are going to start having sex at 13. It’s because it just works better. So, it’s recommended that boys and girls receive the vaccine at 11 to 12, along with their other recommended vaccinations. It should just be part of one of those routine vaccines that they get. A lot of parents are also concerned about the HPV vaccine because they feel that it’s new or hasn’t been studied enough. There have been tens of millions of vaccines injected worldwide with this HPV vaccine, and there has been monitoring in place looking for problems and we just can’t identify anything related to the vaccine that’s really harmful. The biggest side effects are fainting or soreness at the site, and that’s really from the needle, not the vaccine. So, we do know it’s safe. And, most importantly, we’re seeing really important results coming from it showing how effective it is in preventing not only cancers but also abnormal pap smears and genital warts. If you’ve ever had an abnormal pap smear, and a lot of women out there have, they know what it’s like to go through a polypscopy and biopsies and sometimes having pieces of your cervix removed or frozen. If we can prevent even that, that’s huge. But being able to prevent cancer in addition, it’s a very important public health issue and we have a treatment for it. We have a prevention. So, it’s very important.

Melanie: And it does also help with parents to open up that discussion if a child asks about this vaccine. Another thing that children go through at this time is body image because it’s so important, as their bodies are changing. Some of them are not sure they like what they see, so what do you tell parents, and specifically parents of young girls about these changing body images?

Dr. Holmes: Body image and self-worth are huge. When we talk about sexuality, so much of sexual behaviors and risk-taking behaviors are influenced by a child’s body image and self-worth. So, there are a lot of things that we know can help and other things we that can hurt. One thing is parents really should not discus weight with their children. They really should discuss healthy nutrition and exercise that’s good for their health, not because it’s going to help them lose weight or look a certain way. We want children to be healthy and if the focus stays on that, we’re doing a much better job. It’s also important to help children recognize that what they see in the media is not real. Everybody knows about photoshopping now and the way images are altered. So, helping girls--girls and boys, too. Even the male bodies are altered in the pictures that they show on the internet and in commercials and things like that. So, helping them recognize that what they see is not real and not even attainable can help normalize the real bodies they see around them. We tell kids that normal is what you see in the school cafeteria, not what you’re seeing on Instagram and the internet and things like that. So, I think those are two things that parents can do help their children with body image. And then, self-worth is another piece that’s very important. That just requires helping kids recognize that they’re good enough. They’re already worthy of love and being respected. That’s not something that they have to change the way they look to be loved. Those are tips that we talk about with parents.

Melanie: Such great advice. In the last few minutes, wrap it up for us because the teenage years are when those lifelong health habits start to develop and parents can help guide their children through those tumultuous teenage years and all of those body image and body changing times. So, give your best advice on what do you tell parents and teens every day and why they should come to Greenville Health System for their care.

Dr. Holmes: Teens need an adult in their life to be a mentor, to be someone who loves them unconditionally, and to be someone who can be honest with them. And, if a teen has an adult that serves that, and most of the time that’s a parent, they will have a healthier, better approach to life in the way they handle risk-taking, the way they handle their health. Modeling healthy behaviors is one of the best things we can do for our adolescents and bringing them in for their yearly checkup with their physician, even as teenagers is important, because sometimes their physician or nurse practitioner will have conversations that the parents haven’t even thought about. Teens also have the right to confidential care, so if parents are worried about what’s being said at the exam at their visit, they can rest assured that, as healthcare providers, we’re really here to focus on their teen’s health, to help them make decisions that are in line with staying safe and healthy. We’re not sharing secrets or trying to keep their parents out of the loop. We’re really just trying to provide the very best care that we can.

Melanie: Thank you so much for being with us today, Dr. Holmes. You’re listening to Inside Health with Greenville Health System, and for more information you can go to www.ghs.org. That’s www.ghs.org. This is Melanie Cole. Thanks so much for listening.