Overview

What Is It?
Teenage girls encounter many physical, emotional and personal changes, which are sometimes confusing, but all normal parts of growing up into women.

Puberty – How Your Body Changes
Your body is changing; your moods may be unpredictable and sometimes hard to explain. Don't worry. These changes are normal. Our guide to teen health is designed to help you understand the common physical and emotional changes you are going through, and deal responsibly with new personal and social situations you may encounter. These changes are called puberty.

Puberty lasts for several years and marks the life stage when your body is changing from a child to an adult. Hormones help trigger and guide this process. Hormones are natural chemicals in your body that produce gradual physical changes during this time and may also cause emotional changes that can sometimes seem uncontrollable. These changes are common during puberty, and they happen to everyone. Although it may seem that these changes and feelings are out of your control, don't worry—you're still you, just the "growing up" version.

Common Physical Changes in Girls
Girls going through puberty often notice physical changes, such as larger breasts, hair growth in new places, acne and changes in the shape of your hips, waste, bottom and thighs. Below are some of the common physical changes you may experience.

Menstrual Periods & PMS
Menstruation is a turning point in your development from a child to a teenager. It's important to remember that this is natural and something that makes being a woman special.
Learn more: Menstrual Periods & PMS

Larger Breasts
One of the first changes you will notice are your breasts growing, usually between the ages of eight and 12. Once your breasts start growing, you will most likely want to buy a bra.
Learn more: Selecting a Bra

Hair Growth
Hair will start to grow under your arms, on your legs and on your pubic area. Shaving your underarms and legs is a personal choice, but talk about it with one of your parents first.
Learn more: Shaving

Acne
This aggravating condition may be mild (blackheads and whiteheads), moderate (larger inflamed-looking blemishes) or severe (large cysts or nodules). Acne is caused by a build-up of oil, microorganisms and dead skin cells in the hair follicles under the skin.
Learn more: Acne

Common Social and Emotional Issues
Today's young women face many emotional and social challenges during puberty. Below are some of the common tough issues you may find, and tips for handling them.

Self Esteem & Peer Pressure
The foundation for positive self-esteem is built at an early age and is influenced by relationships between you and your family. Your feelings about yourself will change as you grow.
Learn More: Self Esteem & Peer Pressure

Dating
Preparing to date stars with finding the right person, and making responsible choices in your relationship.
Learn More: Dating

Sex & Sexually Transmitted Diseases
When to engage or not engage in sexual relations is one of the most important decisions a person can make. From getting pregnant to becoming infected with an STD, make sure you understand the risks.
Learn More: Sex and STDs

Mental Health & Abuse
Overall health means more than simply being in shape and eating properly. Mental health, which includes your thoughts and feelings, is just as important as physical health.
Learn More: Mental Health

Eating Disorders
With a more prevalent preoccupation with appearance and weight in today's society, girls may be at risk to develop eating disorders.
Learn More: Eating Disorders

Substance Abuse
During your teenage years, it is a good idea to take some risks, like trying new activities or sports. However, some risk-taking behaviors, such as drinking alcohol, smoking and using drugs have negative effects.
Learn More: Substance Abuse

Visiting Your Doctor
Before the onset of puberty, discuss your questions and concerns with your health care professional. It is also a time for you to gather printed material on a variety of health issues, including your menstrual cycle, contraception and sexually transmitted diseases (STDs).

Facts to Know

1. Puberty lasts for several years. It is the stage of your life when your body is changing from the body of a child to the body of an adult. Hormones, which are natural chemicals in your body, orchestrate these alterations in your body.
2. During puberty, one breast might grow larger than the other. Once your breasts start growing, the differences will most likely be slight. And your breasts will even out before they are finished developing. Even if they don't, no need to worry—many women's breasts don't match each other exactly.
3. It might take a while, perhaps even a year, for your periods to become regular. During the first year, your cycle (from the start of one period to the start of the next) may be as short as three weeks or as long as six weeks. Even after your period becomes regular, exercise, stress or a change in diet could throw it off track. If you are sexually active and skip a period, talk to your health care professional immediately—you could be pregnant.
4. An estimated 3.2 million cases of sexually transmitted diseases (STDs) occur among teenage girls every year; this translates to one in four teenage girls.
5. Suicide is the fourth leading cause of death for persons between 10 and 14 years of age and the third leading cause of death for those aged 15 to 24 years. Actions or talk of suicide are cries for help.
6. Today, an increasing number of teenagers express dissatisfaction with their bodies Media portrayals of idealized body images that are unrealistic for most people are partially to blame for the increase in teenagers' dissatisfaction with their bodies. And this idealized body image among young women—and increasingly for young men, as well—is leading to an increase in the number of teenagers with eating disorders. Eating disorders are not just a preoccupation with food, dieting and weight, however; they are serious mental disorders that can have serious consequences. Two common eating disorders are bulimia and anorexia nervosa.
7. About 53 percent of all teenage school girls are not having sex, according to a 2002 study by the U.S. Centers for Disease Control and Prevention (CDC).
8. You are most likely to get an STD during your teen and young adult years—more than two-thirds of all STDs occur in people younger than 25.
9. According to the National Institute on Drug Abuse, in 2007, 39 percent of eighth-graders, 62 percent of 10th-graders, and 72 percent of 12th-graders reported having tried alcohol. It is the drug most often used by 12- to 17-year-olds.
10. The Harvard College Alcohol Study found a sharp rise (from 5.3 percent in 1993 to 11.9 percent in 2001) in frequent binge drinking was noted among women attending all-women's colleges, and a lesser, but still significant, increase of the same behavior for women in coeducational schools.

Questions to Ask

Review the following Questions to Ask about teen health so you're prepared to discuss this important health issue with your health care professional.

1. What is going to happen during puberty?
2. I get horrible cramps with my period. Is there anything I can do?
3. One of my breasts is larger than the other. What is going on? Will they stay this way?
4. What are sexually transmitted diseases (STDs) and how do I know if I have one?
5. I am thinking of becoming sexually active, and I want to know the safest form of birth control.
6. Will you tell my parents what we talk about?
7. How can I tell if I am pregnant?
8. What is the best way for me to get rid of my acne?
9. My friend tells me she sometimes thinks about killing herself. Is there anything I can do to help her?
10. My boyfriend is pressuring me to have sex with him. What should I do?

Key Q&A

Period & PMS

Menstruation: An Important Milestone

The most significant change during puberty for many girls is their first period. Menstruation is a turning point in your development from a child to a teenager. Among other things, it means you are capable of becoming pregnant. Your first period can be unexpected. You might be surprised to find that you have some bleeding from your vagina. Many young women might feel frightened by the sight of this bleeding or embarrassed if it causes a stain on their underwear or clothing. It's important to remember that this is natural and something that makes being a woman special. You can avoid embarrassing situations by talking to your mom or another adult (dads know about these things, too!) about being prepared for your period.

When Will You Get Your First Period?
Your first period is likely to occur between the ages of nine and 16. It usually lasts for three to seven days and then stops until the next period begins—usually about 21 to 28 days after your period started. This timeframe—from the first day you begin to bleed until the first day of your NEXT menstrual period—is called your "menstrual cycle."

How Does the Menstrual Cycle Work?

During your menstrual cycle, one of your two ovaries releases one microscopic egg, called an ovum. (Your ovaries are reproductive organs approximately one and a half inches long and located in your lower abdomen, one on each side of your uterus; ovaries also release hormones that help to control your menstrual cycle.) The egg's release from the ovary is called "ovulation," and it usually happens in the middle of your cycle—around day 12 to 14 in a 28-day cycle. Ovulation can be irregular, though, when you first start having your period.

The egg then moves through one of the two fallopian tubes (the two tubes attached to the top of the uterus that lead to the ovaries). At the same time, body tissues and blood cells are beginning to line the walls of your uterus, forming a thin layer of material that will eventually be shed as your period. The amazing thing is, you won't feel any of this happening.

If you were to have sexual intercourse at this time (around the time of ovulation), and sperm from a male partner would fertilize your egg on its way to the uterus, you would become pregnant. The egg would attach to the lining of the uterus and a fetus would grow inside of you. However, if sperm does not fertilize the egg, your body does not need this lining to support the fertilized egg. So, hormones trigger a different process, and this lining gently falls away from the walls of your uterus and is released from your body through your vagina. This is often called the menstrual flow or period.

Picking the Right Feminine Hygiene Product
To avoid staining your clothes, you will need to use sanitary pads, panty liners or tampons during your period. Sanitary pads and panty liners fit inside your underwear and are kept in place with an adhesive strip on the back of the pad. There are a variety of pads available with various thicknesses, lengths and absorbencies. Don't worry—you will find one that fits your body and absorbs your menstrual flow well. Panty liners can be used at the beginning or end of your period when your flow is lighter.

Tampons are inserted into the vagina to absorb menstrual flow. Make sure you read the manufacturer's directions for putting a tampon into your vagina correctly. Both pads and tampons should be changed every four to eight hours, more often if needed. The number of days a period lasts and the amount of menstrual flow is different for every woman. On heavier flow days, it is not uncommon to soak more than six pads or tampons. But if you find yourself needing to change your pad or tampon more often than once every hour, you should talk to your parent, school nurse or health care professional.

It might take a while—perhaps a year or longer—for your periods to become regular. During the first year, you may have your period as often as once every two or three weeks or as infrequently as once every few months. Your periods may be heavy or light, and blood flow may change from month to month. Even after your period becomes regular, exercise, stress or a change in diet may throw it off track. Don't feel discouraged—over time you will learn more about your body and your menstrual cycle and be better prepared to deal with your period. If you anticipate your period approaching, you may want to wear a panty liner for extra protection, just in case. After starting your period, if you go for three to six months without having a period, you need to discuss this with a parent, doctor or nurse.

How to Stay Prepared During Your Period
Here are some things you might want to consider keeping with you:

• Two pads, liners and/or tampons, depending on your preference, in case your period begins unexpectedly.
• A medication, such as ibuprofen, to relieve cramps and other period-related symptoms. It's important to make sure that you don't have any allergies to ibuprofen before taking it, and you should talk with your parent and/or health care professional about how much you can take for your menstrual discomfort. Check with your school about the rules for carrying medication; you may need to leave your medication with the school nurse.

How Your Period Makes You Feel
You may feel uncomfortable for the few days leading up to your period. Your uterus may contract, causing cramps around your pelvic area (below your belly button). You may also feel bloated or "puffy." Breast tenderness and swelling, headaches, moodiness, back and leg aches, acne breakouts and nausea are also common symptoms for many young women before and during their periods. These symptoms usually stop or become less severe a day or two after your period starts. If any of these or other symptoms are too much for you to deal with, discuss them with a parent and/or your health care professional. Many symptoms can be relieved by lifestyle changes, such as altering eating habits or exercising or with medications.
If, however, you have any of the following symptoms or if there is a possibility that you may be pregnant, talk with a parent and/or call your health care professional immediately:

• severe pain
• heavy bleeding (for example, soaking a pad or tampon every hour)
• bleeding that lasts more than eight days
• bleeding between periods
• skipping a period for six months or longer

Premenstrual Syndrome
Premenstrual syndrome (PMS) describes a group of symptoms you may experience seven to 10 days before your period begins. These symptoms go away when your period begins or shortly after. PMS can include emotional symptoms, such as crying or crankiness, and physical symptoms such as bloating, breast tenderness or headaches. If you have PMS, you're not alone. While about 75 percent of girls and women who menstruate experience some type of menstrual-cycle discomfort, two to 10 percent of them experience symptoms severe enough to disrupt their normal activities—a condition known as premenstrual dysphoric disorder.

What are the Signs of PMS?

• Bloating and weight gain. Do your jeans feel tighter as your period approaches?
• Tension, anxiety or crying spells. Do you find yourself overreacting to stress or setbacks? Do you have a "short fuse" just before your period?
• Depression. Do you feel sad for no reason? Feeling sad or blue for a day or two can be normal, but feeling down for a longer time may be one symptom of clinical depression, a serious, but common mental health condition experienced by many teens, as well as adults. Depression causes other symptoms, too, such as feeling tired or sleeping all of the time, or not being able to sleep at all; overeating or not eating enough; and feeling no joy in activities you used to enjoy. Usually, when a person is depressed, she may experience several symptoms. If you are experiencing any one or more of these symptoms, don't wait or hesitate to speak with your parents and/or a health care professional.
• Breast tenderness. Do your breasts hurt when touched? Does your bra feel uncomfortably tight?
• Food cravings. Do you crave chocolate, potato chips or other foods (particularly salty or sweet foods)?
• Joint or muscle pain. Do you wake up feeling achy even though you haven't strained anything?
• Nausea or vomiting. Does your stomach feel upset, even though you're not eating anything unusual?
• Headache. Do you have a pattern of headaches in the premenstrual period?
• Trouble with concentration. Is it harder to study or pay attention in class?
• Fatigue. Do you feel tired early in the day? Do you feel exhausted when you get home?

How Can You Avoid PMS?

Eat right
It may take a couple of months for some effects to kick in, but you'll be surprised at the difference the following steps may make:

• Eat more frequently, but make your portions smaller.
• Consume 1,300 milligrams a day of calcium, whether through diet or a supplement. (Talk to a health care professional or your parents to make sure you don't take too much.)
• Consume 240 to 360 milligrams per day of magnesium, whether through diet or a supplement. (Talk to a health care professional or your parents to make sure you don't take too much.)
• Eat a lot of fruits, vegetables and whole grains.
• Cut back on salt, salty foods and refined sugar, especially during the seven to 10 days before your period begins.
• Cut out the caffeine, which can worsen irritability and breast tenderness.
• Drink low-fat milk and eat low-fat yogurt, cheese and other calcium rich foods.

Many researchers find that the standard Food Pyramid originally designed by the U.S. Department of Agriculture (USDA) falls short of being realistic and healthy for many people for a variety of reasons. The USDA revised the Food Pyramid most recently in April 2005 and some modifications have been made. Be sure to talk to your health care professional about what dietary approach would work best for you and your lifestyle.

Exercise
You need to get aerobic exercise for at least 30 minutes most days a week to boost your health and well-being. (Brisk walking, jogging, and bike riding are all forms of aerobic exercise.) Exercise can reduce feelings of fatigue, depression and moodiness.

Lower your stress levels
First, be sure to get adequate sleep. Most teens do not get the eight to nine hours or more of sleep they need to feel their best. You'll be surprised by how many symptoms you can reduce when you get enough sleep. Second, no matter how busy you are with school, after-school activities or a job, be sure to take time to do something fun for yourself—see a movie, hang out with friends or read a book.
A third strategy many teens find helpful is relaxation. Muscle relaxation or deep-breathing exercises can reduce anxiety and improve sleep. Try breathing deeply, using your lower abdomen, not your chest. Hold a deep lung full of air for five seconds, and then release it slowly. Repeat several times.
Yoga and meditation are popular (and effective) ways to relax and de-stress. There are several approaches to both of these disciplines. Check one out to see if it might work for you—consider going with a friend to a community center or gym that offers yoga and meditation and making it a regular practice.

Record your symptoms
Keep a notebook of your symptoms—what they are, when they occur and for how long, when they go away and any factors you think make them worse or better. What you learn from your record keeping, such as a pattern to your symptoms and things that relieve them, may help you manage your symptoms or will give your health care professional some clues about effective treatments.

Talk to your health care professional
If do-it-yourself strategies aren't working, describe your symptoms to your health care professional or a school nurse or pharmacist. If symptoms are severe or interfere with your ability to do schoolwork or the activities you want to do, you need to take action. There are treatments that can make a dramatic difference in PMS symptoms: antidepressants, birth control pills or injections (these products minimize hormone fluctuations) and pain medications such as ibuprofen (e.g., Advil) or naproxen sodium (e.g., Aleve), which can reduce cramping and breast pain.

Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that affects about two to 10 percent of girls and women who menstruate. In severe cases, PMDD can interfere with school activities and relationships.

Symptoms, which usually set in just before your period, include:

• Severe mood swings, depression, irritability and anxiety. Do you experience uncontrollable crying spells, anger or depression so intense you can't function? Emotional symptoms are the ones most likely to lead your health care professional to diagnose you with PMDD.
• Sleep disturbance. Do you experience insomnia (inability to sleep) or need excessive sleep just before your period?
• Difficulty concentrating. Is it impossible or nearly impossible for you to study or pay attention in class?
• Breast tenderness and bloating. Do your clothes feel too tight? Do your breasts ache?

If you think you may have PMDD, try lifestyle modifications recommended for PMS and talk to a health care professional. Many of the emotional symptoms appear to be associated with low levels of a brain chemical called serotonin. Medication can increase the amount of serotonin in the brain, thereby minimizing PMDD.

Selecting a Bra

When your breasts begin to jiggle, feel sensitive when you run or feel heavy, it's time for you to consider a bra. The best advice for choosing a bra is to get one that fits and is made of comfortable fabric. A bra is right next to your skin all day long, so if it's a little scratchy or tight when you try it on in the store, it will drive you crazy by the end of the school day.

The measurements will give you some guidance, but in the real world bras marked the same size vary considerably, so you may have to try on several sizes and styles to determine which is best; the fit should be smooth and not too tight. Do not buy a bra that puckers or squeezes your breasts, leaving bulges of flesh poking out around the sides. For women with larger breast, supportive straps can help prevent back pain. A saleswoman can help you find a bra that fits.

How Are Bra Sizes Determined?

Determine Your Bra Size
Use a tape measure to measure around your chest just under your breasts. If the number is even, add four inches to get your chest size. If you measure 28, for example, add four and look for bras in size 32. If the number you measure is odd, add five to get your size. So if you're 29 inches, you'll look for bras in size 34. Bras typically come in chest sizes ranging from 28 to 44, with larger sizes available at specialty stores and through catalogs.

Determine Your Cup Size
Cup sizes (or the size of your breasts) range from AAA (very small breasts) to EE (very large breasts). Measure around your chest, this time lining up the tape with your nipples. If the measurement is the same as the first one you took, your cup size is AA or AAA. If it's one inch larger, your size is A; two inches larger, size B; three inches, size C; four inches, D; five or more, DD or EE.

Shaving

If you've started shaving, here are some important tips to help prevent nips and cuts, and give you the best shave possible.

• Do shave in the direction of hair growth.
• Do change the blade or switch to a new razor often. A dull razor can cut the skin or cause a rash.
• Do be careful when shaving hair in sensitive areas such as the bikini line—shaving without proper lubrication or with a dull razor can cause a rash.
• Do not shave facial hair; shaving your face will leave stubble and can make hair grow back dark and thick.
• Do shave at the end of the day when your skin is less puffy.
• Do use water and shaving cream or soap because it will help you get a close shave without nicks.

Other Hair Removal Options
(always talk to an adult before trying a new hair removal option):

• Tweezing is an option for isolated hairs. But keep in mind that tweezing can harm hair follicles and make hairs even more stubborn.
• Waxing is a longer-term, somewhat painful option for removal of hair across wide areas, such as legs or hair around the bikini line. Some people have their underarm hair or facial hair waxed. The procedure can leave skin temporarily red and irritated, however.
• Chemical hair removers, such as Nair, are also effective for large areas of the body, but they can leave a rash. Be sure to follow label instructions and use a product made for the area you plan to use it on. Remember to apply a moisturizer to reduce irritation.
• Electrolysis uses electricity to destroy the hair follicle and prevent hair from regrowing. The technique, which can be painful, is used primarily for facial hair.
• Laser hair removal, effective for fair-skinned individuals with dark, coarse hair, is an increasingly popular, expensive option. It is less painful than electrolysis and may offer permanent hair removal.

Acne

MYTH: Chocolate and oily foods cause acne.

FACT: There is no evidence that these foods cause acne. But you should avoid overindulging in chocolate and oily foods because they are typically high in calories and saturated fats and don't provide much nutrition.

MYTH: Repeated face washing will get rid of acne.
FACT: If you have oily skin or acne, you should wash your face no more than twice a day. Over-washing can dry out the skin, prompting the oil glands to work harder.

What you can do about acne:

• Wash your face in the morning and at night, and after you work out. You may want to try a cosmetic face mask (usually a combination of moisturizers and other products that help remove dead and dry skin) once a week or a daily benzoyl peroxide product. Benzoyl peroxide comes in strengths ranging from 2.5 percent to 10 percent. You should start out with a low strength once a day and use a stronger product if needed.
• Keep your hair off your face and don't squeeze or pick at your pimples. Wash your hands before touching your face.
• Experiment with makeup products; ask a parent, friend or sales clerk for help choosing the right product and guidance in putting it on. Some makeup products are oil free and may be a better choice if you have acne. While makeup usually can't make a pimple invisible, it can minimize the blemish and give your skin a smoother overall tone.
• Breakouts are loosely associated with stress, so take note of what's going on when your skin erupts. You may find your acne is associated with your period, a challenging test at school or other stress. If you see such a pattern, you may be able to lessen the problem through stress reduction techniques, such as yoga, breathing exercises or just doing something fun.
• Talk to your health care professional or dermatologist if your acne seems worse than average or if it's especially bothersome to you. A variety of prescription treatments are available to combat acne.

Self Esteem & Peer Pressure

The Importance of Self-Esteem

Self-esteem is the way you think about yourself and what you expect of yourself. The foundation for positive self-esteem is built at an early age and is influenced by relationships between you and your family. Your feelings about yourself will change as you grow. Praise and criticism from parents, friendships at school and attitudes from teachers will continue to affect you from preschool through high school. Persistent criticism, teasing and failures can make you feel worthless. Praise, support and finding something you are good at can help you develop confidence in yourself.

That confidence, or lack of it, may affect decisions made during puberty. All kinds of peer pressure and outside influences can guide you as a teenager and affect your decision-making process. The depth of your self-esteem also affects those decisions, whether it's about playing one sport over another, who to hang out with, which electives to take in school or other situations such as smoking, drinking or deciding to have sex. (See under Resources, "Boosting Your Self-Esteem.")

Boosting Your Self-Esteem
As your body changes, you may feel unattractive, awkward or even ugly. But believe it or not, you can change the way you feel about yourself—and the way other people perceive you—just by changing the way you think. First of all, if you are worried that your weight, height or anything else is unhealthy, talk to your health care professional. If everything is OK physically, you can begin dealing with the image problem.

First of all, accept the fact that there are many things that make you a unique person—your eye color, skin shade, height, facial shape—that cannot be changed. And note, as you watch television and movies, or people, that attractive people come in all colors, shapes and sizes, and that many girls and women who are not supermodels are, in fact, loved and adored for who they are.

If you do want to make a change, such as losing weight, don't set unrealistic goals ("I want to be a size five," or "I want to lose 50 pounds in three months"). Instead, set realistic goals you know you can achieve, such as exercising for at least 30 minutes most days of the week and eating healthfully. The pounds will come off, and you'll enjoy a feeling of success each time you meet your goal. Consider talking with your health care professional for more information about healthy weight loss.

• Next, when your inner voice starts putting you down, counter those comments with positive or neutral ones.
• Replace "I'm fat" with "I exercise and eat right."
• Replace "I bombed that test; I'm just stupid" with "I'm smart and I can do better. I'll ask for help if I don't understand something next time."
• Make a habit of complimenting yourself: "I'm good at math...I'm really funny sometimes...My hair looks just right today." Don't worry that you'll become conceited. Because we all have a habit of focusing on the negative, these thoughts tend to just balance things out a bit.
• At the end of the day, think about three things that were good about the day. Maybe you heard an old favorite song on the radio, polished off a good book under the shade or knew the right answer in class. It's a rare day that doesn't supply us with something that makes us happy—the hard part is being aware of that something.

Dating

Deciding Who to Date

As if puberty isn't confusing enough, this is also the time most teenagers start dating. School dances and parties are dating opportunities, although most of these activities do not require a date. Rather, some girls choose to go to these types of events with another girl or a group of friends. And while some girls are romantically interested in boys, some are romantically interested in girls, and some are romantically interested in both. Sexual orientation is defined by whether you fall in love with, are attracted to, or engage in behaviors with someone of the same sex or someone of the opposite sex. If your sexual orientation is not toward the opposite sex, you may feel sad, worried or different. Talking to a health care professional about these issues may help you feel better or get you the support you might need.

If you are asked on a date, ask yourself these questions to help make sure it's something you want to do and that you'll be safe and have fun:

• Do you trust the person?
• Do you have common friends and/or interests?
• Do you feel pressure from this person in any way at all, to become sexually intimate or to do something you feel is wrong?

If this person is someone you decide you would like to spend time with, starting a relationship and friendship could be exciting. This person could become someone special in your life—someone you can trust and depend on. You could be the same to him or her. Through your relationship, you could teach each other about respect, honesty, communication and loyalty.

When Dating Becomes Intimate
If you date one person for a while, you might feel pressured to become sexually intimate. Friends will be curious and question you whether you've "done it." Your parents might start talking to you about making the right choices about sex, and your partner may start letting you know that he or she would like to have a sexually intimate relationship. But just because you have been dating the same person for a while does not mean you have to have sex, especially if you're not ready.

Besides the possible physical outcomes—such as getting pregnant or becoming infected with an STD—there are emotional factors connected to sex. You could feel regret, anger, shame or guilt afterward. Most parents, health care professionals and others will advise you to wait until you are an adult to have sex. You'll be far more able to handle the personal and health responsibilities that go along with having sex.

Consider these issues before you have sex:

• If you don't want to get pregnant, are you prepared to use contraception?
• What if you became pregnant? What would you do?
• What if you contracted HIV and developed AIDS? Are you ready to deal with a heavy-duty sickness and possibly the end of your life?
• What if you contracted another STD and got sick or and passed it on to another person? How would you feel?
• What if you had sex with someone before you were really ready and it turned out to be an unhappy experience?
• Can you consider saying "no" to your partner if you're not ready to have sex and not feel pressured by friends who ask you about your sexual experiences?

Your parents, a health care professional or any adult in whom you can confide can help you to think through these issues before you find yourself in a situation where you might feel pressured to have sex before you're really ready.

Sex & STDs

Are you ready for sex?

Deciding when to engage or not engage in sexual relations is one of the most important decisions a person, of any age, can make. Some girls you know may already be sexually active. About 53 percent of all teenage school girls are not having sex, according to a 2002 study by the U.S. Centers for Disease Control and Prevention (CDC). It is a decision that could affect the rest of your life. Take it seriously and know the risks, from getting pregnant to becoming infected with a sexually transmitted infection or disease, not to mention other emotional and physical risks that can come into play when teenagers have sex.

If you are sexually active, the best way to prevent getting an STD is by using a latex condom. This is true for oral, vaginal and anal sex. Lesbian couples who practice oral sex can use a dental dam to prevent getting an STD. The use of latex condoms during vaginal sex also prevents pregnancy. You can also use additional forms of birth control to prevent getting pregnant. Another word for birth control is "contraception." No method of contraception, however, is 100 percent safe. The only foolproof way to keep from getting pregnant or to avoid getting an STD is not to have sex.

Sexually Transmitted Diseases (STDs)
STDs are spread by sexual intercourse or genital contact. You can contract an STD from having oral, vaginal and/or anal sex with an infected partner. The CDC reports that 3.2 million teenage girls have at least one sexually transmitted disease, which translates to one in four girls. You may have heard about some STDs, such as HIV/AIDS, chlamydia, gonorrhea and herpes. But there are many other STDs you should be aware of as well.

You are most likely to get an STD during your teen and young adult years—more than two-thirds of all STDs occur in people younger than 25. Because STDs often cause no symptoms (especially in girls and women), health care professionals recommend that sexually active girls and women routinely be tested or screened for STDs. If you are too embarrassed to talk to your health care professional, discuss the issue with a school nurse or call your local health department, Planned Parenthood or the U.S. Centers for Disease Control and Prevention's STD hotline. There are many places in your local area where you can get free and confidential STD counseling and testing.

Types of STDs

• HIV/AIDS
• human papillomavirus (HPV)
• herpes
• chlamydia
• gonorrhea
• trichomoniasis
• hepatitis B
• syphilis

Treating STDs
Treating some STDs requires taking antibiotics. But other STDs are not treatable, and the health consequences of an untreated STD can be severe. Unfortunately, two of the most common STDs—human papillomavirus (HPV) and herpes—are viral diseases that can't be cured. Lack of treatment may result in more serious consequences, including permanent damage to your reproductive organs, which could make getting pregnant when you are older difficult. Some STDs can also cause problems during pregnancy or delivery. (See under Resources, "STD Symptom Checklist.")

And for HPV, now there is something you can use to protect yourself against HPV/cervical cancer in addition to regular pap tests and practicing safe sex: an HPV vaccine. The FDA recently approved the vaccine—called Gardasil—for women ages nine to 26 after clinical trials showed the vaccine is safe and helps prevent HPV strains 16 and 18, which cause 70 percent of cervical cancers and a lot of cervical dysplastic lesions (precancer). Gardasil, given in three injections over six months, also helps prevent HPV strains 6 and 11, which cause about 90 percent of genital wart cases. Although Gardasil prevents the bulk of HPV strains, it doesn't protect against all of them, so the FDA recommends that you have your Pap test regularly. Furthermore, the vaccine does not work if you are already infected with one of these HPV types. It has to be given before infection, and the best time is before you start having sex. Talk to your health care professional about Gardasil if you are sexually active or considering having sex.

You may feel awkward and embarrassed about asking questions about sex, but if you are sexually active or even considering having sex, not knowing how to prevent STDs and pregnancy is dangerous. Get the facts from someone who knows, whether it's a parent, brother, sister, health care professional or teacher.

Unprotected Sex and Other Risk Factors
Having unprotected sex and/or multiple sex partners places you at higher risk for STDs. Many STDs have no symptoms when you are first infected, so you may have an infection without knowing it. If you are sexually active, be sure to have regular checkups that include STD screenings; that way if you have an infection, it can be detected and treated (if possible) at its earliest stages. More than 61 percent of teens who are sexually active say they used a condom the last time they had sex, according to a 2007 CDC survey.

When used correctly, male latex condoms and female condoms used during sexual intercourse can help reduce your risk of getting many STDs, including HIV (the virus that causes AIDS); male and female latex condoms don't prevent all STDs transmitted by skin-to-skin contact, however.

STD Symptom Checklist

• Burning sensation when urinating.
• Vaginal discharge. Occasional discharge—clear or white, thin, with no smell—is normal, but you may have an STD or vaginal infection if you experience discharge that doesn't seem normal for your body—for example, large amounts of discharge, or discharge that has an unusual color (yellow, yellowish-green) or odor, is bloody, or is persistent.
• Pain or discomfort during sex
• An unusual, "fishy" vaginal odor after sex
• Vaginal irritation, soreness or itching
• Pain in your lower abdomen (the area below your belly button where you may feel menstrual cramps)
• Warts, lesions or bumps in or around the vagina, vulva, anus or on the thigh
• Bleeding during sex or between periods or increased menstrual cramping
• A skin rash
• Note: Girls and women frequently do not experience symptoms from STDs. If you are sexually active, you should talk to a health care professional about being screened. (Call your local health department or Planned Parenthood, if you are uncomfortable with your regular health care professional). If a sexual partner has any symptoms, get tested immediately. For boys and men, the most frequent symptoms of STDs are penile irritation or pain, pus or discharge from the penis or sores or warts on the penis. Men with STDs only occasionally experience pain or burning sensation when urinating. As in women, a lot of STDs are without symptoms in men.

Mental Health & Abuse

Mental Health

Overall health means more than simply being in shape and eating properly. Mental health, which includes your thoughts and feelings, is just as important as physical health. During your teenage years, various things may make you sad or get you down—for example, if someone makes fun of your clothes or if you don't do well on a test for which you thought you were prepared. But if you are constantly feeling down or upset about something, you could be depressed. Depression is a mental illness, but it is treatable once it is accurately diagnosed. Many teenagers experience depression.

Depression & Suicidal Feelings
Depression, if untreated, may cause you to feel like hurting or killing yourself. Suicidal feelings are a very real problem that should be taken seriously. Suicide is the fourth leading cause of death for adolescents between 10 and 14 years of age and the third leading cause of death for those 15 to 24 years old. A 2007 CDC Youth Behavior Risk survey showed 18.7 percent of girls and 10.3 percent of boys had thought about committing suicide and nearly seven percent had tried. If you are thinking about suicide, talk to someone—there are lots of ways to help teens feel better when they are depressed and/or suicidal.

How Do You Know if You May Be Depressed?
If you answered "yes" to several of the following questions, talk to someone about getting help. This person could be a teacher, a coach, your parent, an older sibling or someone else you trust, but talk with someone. Take a few minutes to make a list of people you can call.

• Do you cry more now than you used to?
• Do you think your life is hopeless or meaningless?
• Do you have a hard time sleeping? Are you either sleeping too much or having difficulty falling asleep at night?
• Do you spend more time alone than you used to?
• Do you ever think of hurting yourself?
• Do you often feel worn out?
• Have you felt unusually irritable lately?
• Have you gained or lost weight in the last month or two?
• How is your appetite? Are you overeating or undereating?

Tendencies of Suicidal Thoughts
The following is a list of behaviors that a person who is suicidal might show.

• Has the person become withdrawn from friends and/or family or undergone a dramatic personality change?
• Does the person have trouble concentrating, or does the person always seem bored?
• Does the person often act rebellious?
• Is the person having a hard time coping with a major life event, such as divorce of parents, death of a sibling or being pregnant?
• Is the person abusing drugs or alcohol or both?
• Is the person giving away prized personal possessions?
• Does the person write poems or notes about death?
• Does the person talk or even joke about suicide?

If this person is you, your friend or family member, reach out for help and do not keep quiet. Suicide is preventable, but you must act quickly. If you are an adolescent yourself, it is important to involve an adult first. Consider these steps:
Get help from a professional immediately. Don't wait or hesitate. Call this suicide crisis hotline number (toll-free nationwide): 1-800-SUICIDE (1-800-784-2433) for guidance or 911 to speak with your local emergency services.

• Ask the person directly if she is thinking of committing suicide. Sometimes just saying the word helps the person feel understood and feel like her or his cries for help have been heard. Actions or talk of suicide are cries for help. Most teenagers are looking for acceptance, understanding, attention and love.
• Reassure the person that you care about him or her and want to help. Never agree to keep his or her thoughts about suicide a secret. If another person shares with you that he or she wants to die or kill him or herself, tell an adult.
• Get rid of or lock up all guns, pills and medications, sharp tools including saws, knives, razors and scissors, and ropes and belts.

Abuse
When the word "abuse" is used in conjunction with teenagers, drug or alcohol abuse is often what comes to mind. But there are several kinds of abuse, many of which do not involve a decision made by the adolescent. There is also physical, sexual, verbal and psychological or emotional abuse.

• Physical abuse is hitting, slapping, beating, cutting, burning or some other type of physically harmful assault.
• Sexual abuse is unwanted or coercive sexual contact; it also can involve someone being forced to watch sex acts or to look at or take part in pornography.
• Psychological or emotional abuse is regular or persistent threats, screaming, humiliation or emotional mistreatment. Bullying is a form of psychological abuse.
• Neglect such as a parent not providing adequate food, clothing and shelter, or exposing a child to environments where unsafe behaviors occur, is also abusive.

Anyone—rich or poor—can be a victim of abuse. And the abuse can come from many sources—a parent, an older sibling, a teacher, a coach or school administrator, a boyfriend or girlfriend, a neighbor, a peer, a boss or anyone. If you or someone you know is a victim of abuse, call the National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453) for help.

Eating Disorders

These days, many teenage girls express dissatisfaction with their bodies. According to Anorexia Nervosa and Related Eating Disorders, Inc., one in 100 teenage girls between the ages of 10 and 20 have anorexia. And according to the CDC's 2007 Youth Risk Behavior survey, more than 53 percent of female students surveyed had eaten less food to lose weight in the past 30 days, 7.5 percent of girls reported taking diet pills and 6.4 percent reported vomiting or taking laxatives to lose weight. And the obsession with weight starts early—the National Eating Disorders Association (NEDA) reports that 42 percent of first- to third-grade girls want to be thinner, and 82 percent of 10-year-olds are afraid of getting fat. Many teenage girls strive to look like fashion models, but the NEDA reports that most fashion models are thinner than 98 percent of the population.

This preoccupation with appearance and weight can become extreme and develop into an eating disorder. An eating disorder is a serious mental illness during which a person takes drastic measures to control his or her weight. Although the popular press paints eating disorders as affecting only girls, they can also affect boys, with the same devastating consequences.

Bulimia
Bulimia is a disorder in which a person eats larger amount of food than he or she normally would in an uncontrolled manner, and then does something such as force him or herself to vomit, use laxatives, or exercise excessively, to prevent weight gain. This is often referred to as "bingeing and purging." A person with bulimia is typically of average weight or overweight. This illness can be very dangerous, especially if the teen forces vomiting regularly—this can disrupt normal blood chemistry and can cause problems with vital organs such as the heart.

Anorexia nervosa
A young person with anorexia nervosa has a distorted body image and sees him or herself differently than the rest of the world does (often at a much larger size than he or she really is) and has an intense fear of gaining weight. This person usually diets severely and loses a large amount of weight. The person often denies that there is a problem or that she or he is too thin. Females with anorexia who lose a significant amount of weight often stop menstruating.
Other eating disorders include binge eating disorder (bingeing without purging), which is strongly linked to obesity. Additionally, obesity is affecting young people at alarmingly increasing rates and, along with smoking, is a leading contributor to serious health problems such as heart disease and diabetes among adults.

How to Tell If You or a Friend Has an Eating Disorder
Teenage girls and college-age women—and increasingly teenage boys and young men—are especially prone to developing eating disorders, mental illnesses characterized by a dangerous obsession with losing weight or staying thin. Teens with eating disorders may starve themselves (anorexia nervosa), or they may binge on food and then throw up or exercise excessively or take laxatives to purge themselves of the food (bulimia). How can you tell if a diet has progressed to something dangerous?

Anorexia nervosa
Teens with anorexia nervosa starve themselves because they have a distorted body image and believe that they are overweight even when they aren't. They have an irrational fear of becoming fat and are obsessed with food and weight control.

These behaviors and emotional symptoms suggest anorexia nervosa:

• Loss of a significant amount of weight
• Continuing to diet and "feeling fat" even after reaching a goal weight, or becoming visibly thin
• Irrational fear of gaining weight
• Obsession with food, calories, fat content and nutrition
• Weighing oneself once a day or more
• Refusal to discuss a diet with others
• Cooking for others but not eating
• Compulsive exercising
• Lying about eating
• Hyperactivity
• Depression and anxiety
• Eating large amounts of food and getting rid of it by throwing up, fasting, taking laxatives or exercising excessively. This is called bingeing and purging.

Physical symptoms:

• Hair loss
• Loss of monthly menstrual period
• Cold hands and feet
• Weakness and exhaustion
• Trouble concentrating
• Constipation
• Growth of body hair on arms, legs and other body parts
• Irregular heartbeats
• Dry skin and brittle nails

Bulimia nervosa
Bulimia nervosa is characterized by binge eating—the frequent consumption of large amounts of food in a short period of time. A person with bulimia often feels ashamed and/or guilty after binging and as a result "purges" by making himself or herself vomit, using laxatives or other medication to control weight, exercising excessively or fasting. A person with bulimia usually has a normal or a somewhat above normal weight.Behaviors and emotional symptoms:

• Binge eating, or eating uncontrollably and/or secretively
• Purging by dieting, fasting, exercise, vomiting or using laxatives or diuretics
• Using the bathroom frequently after meals
• Obsession with weight
• Depression
• Mood swings
• Feelings of being out of control

Other symptoms

• Swollen glands in the neck and face
• Heartburn
• Bloating
• Irregular periods
• Dental problems
• Constipation
• Indigestion
• Sore throat
• Vomiting blood
• Weakness and exhaustion
• Bloodshot eyes

Binge eating
People with binge eating disorders also compulsively overeat. However, they do not regularly purge and are often overweight. Some people may overeat throughout the day rather than binging sporadically.
Behaviors and symptoms:

• Binge eating episodes
• Eating when not hungry
• Frequent dieting
• Uncontrollable eating
• Awareness that eating patterns aren't normal
• Feelings of shame, depression or antisocial behavior
• Obesity
• Weight fluctuations

Substance Abuse

During your teenage years, it is a good idea to take some risks, like trying new activities or sports. Going away to camp or to school in a different place from where your family lives can be exciting; it's an adventure. Usually those risks pay off. You may make new friends, develop new talents, expand your interests and increase your self-confidence. You become more independent with every challenge you successfully tackle.

However, some risk-taking behaviors, such as drinking alcohol, smoking, using drugs, driving too fast or using a weapon, usually have negative effects. According to the CDC's Youth Behavior Risk survey, about half of teens report having ever tried smoking. The same survey reported that about 20 percent of teenage girls and 25 percent of teenage boys report having consumed alcohol before the age of 13; 7.8 percent of teens report using hallucinogenic drugs; more than 10 percent report using inhalants; 18 percent reported carrying a weapon sometime in the 30 days leading up to the survey; and 29 percent reported getting in the car with someone who had been drinking.

Smoking
There are multiple health problems associated with regular tobacco use including stained yellow teeth and bad breath, breathing difficulties and the increased risk of developing lung cancer. There are dozens of online programs designed especially for teens who want to quit.
How to Tell if You or Someone You Know is Addicted to Smoking?
You have no intention of becoming a "smoker"; it's just for fun, right? Well, you'd be surprised at how an addiction to nicotine, the ingredient in cigarettes that gives a stimulating effect, can creep up on you.

Ask yourself these questions:

1. Do you smoke every day, or almost every day?
2. If you don't smoke for a day, do you feel a craving for a cigarette?
3. Did you start out by smoking with your friends, but now smoke alone?
4. Are you gradually smoking more and more cigarettes?
5. Are you spending more money than you'd like on cigarettes?
6. Do you ever feel like you "need" a cigarette?
7. Do you feel anxious if you run out of cigarettes?
8. Have you tried to quit smoking and faile?
9. Do you ever find yourself lighting up a cigarette almost unconsciously, without really thinking about it?
10. Have you ever been surprised at how fast you went through a pack of cigarettes?
11. Do you need to have a cigarette first thing in the morning?

If you answered yes to any of these questions, you are may already be addicted to nicotine. Talk to a health care professional about strategies for quitting. But whether you're addicted or not, you should try to quit.

Alcohol
Many people first try alcohol during their teenage years. The CDC reports that 75 percent of teenagers report having tried alcohol. Alcohol is the number one drug problem among adolescents even though it is illegal for persons under 21 to purchase or drink it. Alcohol is associated with all the leading causes of death among teenagers, including traffic accidents, homicides and suicides, and may be a factor in unprotected sex resulting in unplanned pregnancies, STDs and AIDS. In addition, many young people die from alcohol poisoning. And surprisingly enough, alcohol use is just as prevalent among female teenagers as it is among male teenagers; in fact, according to the CDC Youth Risk Behavior survey, more female 12th-grade students (85.2 percent) reported drinking alcohol at some point in their lifetimes than male 12th-grade students (80.2 percent). (See the Resources, "Alcohol Poisoning" for symptoms of alcohol poisoning.)

Binge Drinking
Binge drinking (consumption of five or more drinks for a male or four or more drinks for a female on a single occasion within the past two weeks) is a major problem on our college campuses. Binge drinking causes most of the alcohol-associated harm occurring on campuses and in students' lives. A major, eight-year study (the 2001 Harvard School of Public Health College Alcohol Study) involving the drinking habits of thousands of college students revealed that, in 2001, approximately two in five (44.4 percent) college students engaged in binge drinking, a rate almost identical to rates reported in the previous eight years. Among the underage students, half of those surveyed reported obtaining alcohol easily from other students as their primary source. Since 1993, the use of fake identification cards to obtain alcohol illegally has declined. In addition, a sharp rise (from 5.3 percent in 1993 to 11.9 percent in 2001) in frequent binge drinking was noted among women attending all-women's colleges, and a lesser, but still significant, increase of the same behavior was reported for women in coeducational schools.

How to Know if You or Someone You Know has an Alcohol Problem
Although it is illegal to drink if you're under 21, many teens do it anyway, and some do so in excess. The following are warning signs of a problem with alcohol:

• Getting drunk on a regular basis
• Getting drunk even when striving not to
• Lying about drinking
• Believing that alcohol is necessary to have fun
• Drinking because of problems or to relax
• Drinking because of anger
• Drinking alone
• Trying to stop drinking and failing
• Having frequent hangovers
• Feeling run-down, depressed or even suicidal
• Having "blackouts"—forgetting what you did while drinking
• Having problems at school or work or getting in trouble with the law
• Drinking in the morning
• Gulping drinks
• Thinking it's cool to be able to hold your liquor
• Drinking then driving
• Going to school intoxicated

Alcohol Poisoning
Below is a list of critical signs of alcohol poisoning. If you notice any of the following symptoms in a friend after he or she has consumed alcohol, get help immediately.

• Person seems to be acting strangely or seems unusually sleepy and you can't wake him or her up
• Vomiting while sleeping
• Seizures
• Slow breathing
• Irregular breathing
• Hypothermia (low body temperature), bluish skin color or paleness

What to do if you suspect that someone may have ingested a fatal dose of alcohol:

• Call 911 or the emergency number IMMEDIATELY.
• Tell emergency medical technicians the symptoms and, if you know, how much alcohol the victim drank. Prompt action may save the life of a friend or your own.

• Stay with the person.
• Keep the person from choking on vomit.

Alcohol Support Groups
Alcoholics Anonymous (AA) and other agencies offer support groups nationwide designed especially for teens with drinking problems. At AA, help from peers with similar problems is available on a confidential, free basis. Look in the phone book under Alcoholics Anonymous for chapters in your area or visit the organization on the Web at www.aa.org. You can also talk to your health care professional confidentially about accessing professional mental health services to deal with a drinking problem.

Drug Use
In 2007, 38.1 percent of all high school students reported having used marijuana, the most commonly used illicit drug, one or more times in their lifetimes. And 19.7 percent reported using it in the previous month. Recent data from the National Institute on Drug Abuse shows that drug use among teens has declined. Between 2001 and 2007, reported use of illicit drugs has fallen 32 percent among eighth-graders, nearly 25 percent among 10th-graders, and 13 percent among 12th-graders. Since 2001, fewer teens report having used marijuana in the past year as well—use has fallen by 33 percent among eighth-graders, 25 percent among 10th-graders, and 14 percent among 12th-graders. Use of methamphetamines, cocaine and alcohol is also down. But, there has been a recent increase in the abuse of certain prescription drugs, heroine, hallucinogens and Ecstasy among teenagers,

Ask for Support
No matter how good your intentions may be, you may at some time find yourself in a situation where you need the support of your parents or a trusted adult. It's important to open the doors of communication with your parents before you ever find yourself in a dangerous situation. Ask your parents or a reliable trusted adult for a "no-questions-asked" or a "free-ride" policy, meaning, if you find yourself in a difficult situation, you can call your parents and get a free ride with no questions asked until the next day. That way, your parents can trust you to use your best judgment in strange and difficult situations, and you can be comfortable knowing that if you make a mistake, you won't be ridiculed by your parents for it.
The process of putting down thoughts on paper can clarify expectations on both sides.

An organization called Students Against Destructive Decisions (SADD; Web site is www.sadd.org) promotes its Contract For Life for just this purpose. You can use this as the basis of your own agreement. <a href="https://www.sadd.org/contract.htm#cfl" target=blank>(See Contract For Life — A Foundation for Trust and Caring)</a>

Reproductive Health Appointments

Before the onset of puberty, all preteens should have an exam, according to the Adolescent Wellness and Reproductive Education Foundation. This visit is an opportunity to discuss your questions and concerns with your health care professional. It is also a time for you to gather printed material on a variety of health issues, including your menstrual cycle, contraception and sexually transmitted diseases (STDs). A gynecological (pelvic) examination is usually not a part of this visit. You should be tested for STDs if you have had sex within the past three years, and you should be screened for chlamydia and gonorrhea infections every 12 months.

What to Expect During Your First Reproductive Health Appointment?

Pelvic Exam
According to the American Cancer Society, women should have a pelvic exam about three years after they become sexually active or by the age of 21 if they have never been sexually active. A woman may need to have a pelvic exam before that if she has any health problems with her vagina, uterus or ovaries. And these days, many health care professionals recommend that young women be seen before their first sexual experiences. This way, they can provide young female patients with information about abstinence, contraception and STDs before they become sexually active.

Health care professionals realize that most young women are nervous and/or embarrassed during their first pelvic exams; your health care professional will most likely talk to you about what to expect before the exam. You will probably be asked to undress. If you are asked to undress, don't worry; you will be given a disposable robe or cover-up to wear, and only those parts of your body being examined will be exposed. Some young women prefer to have their mothers or another person with whom they feel comfortable accompany them on the first few visits. You can decide whether that person comes into the exam room or not.

Breast Exam
Your annual visit may also include a breast exam. If so, your health care professional will examine both of your breasts for any unusual lumps and other abnormalities such as redness, pain or discharge. He or she will do this both by sight and by touch. You may feel embarrassed during this exam. Try to keep in mind, however, these types of examinations are critical for your health and are part of learning to take good care of yourself as you grow older. Your health care professional can also teach you how to do regular breast self-exams so you can monitor your own body and become aware of any concerning changes.

What Questions Should You Ask Your Gynecologist?
The discussions you have with all of your health care professionals are confidential. Some of the topics you may discuss with your health care professional include menstrual problems and general women's health issues including mental health, sexual activity or sexual problems, contraception, preventing and screening for sexually transmitted diseases (STDs) and pregnancy.

To get the most out of your first OB/GYN appointment, make a list of questions that address any concerns you have about your periods, sexually transmitted diseases, breast health (including soreness) and birth control. Questions may include:

1. What can I do to be more comfortable during this exam?
2. How long will the exam take?
3. How will my privacy be protected? Will you share information about this exam with my parents?
4. What tests should I take based on my health and sexual history?
5. Am I developing normally? Is there anything I should be concerned about?
6. I feel fine, but could I still have a sexually transmitted infection or disease or vaginal infection? What tests can you do to find out?
7. What can I do about my PMS symptoms? Would birth control pills or an antidepressant help?
8. What are my birth control options? How do I decide which is best for me?
9. How can I tell my parents about my decision to use birth control?
10. If I have sex and then want emergency contraception, what should I do? Can I get a prescription now?
11. What are some precautions I should take to protect myself from STDs and unwanted pregnancy?
12. What should I do if I think I'm pregnant?
13. What are some things I should do to improve my health?

Resources & Hotlines

When you have a problem too big to handle and you don't feel comfortable sharing it with adults you know, you can call on outside help. These agencies provide free information and confidential, caring support over the phone with no long-distance charges. When you need a lifeline, these are the people to call.

U.S. Centers for Disease Control and Prevention
National STD Hotline
1-800-232-4636 (toll-free)
1-800-243-7889 (TTY/TDD STI/AIDS hotline for the hearing impaired; toll-free)
www.cdc.gov/std/

Covenant House Nineline
1-800-999-9999
1-800-999-9915 (TTY/TDD for the hearing impaired; toll-free)
www.covenanthouse.org/

Planned Parenthood
1-877-4ME-2ASK (toll-free; Monday-Friday, 9 a.m.-6 p.m. PST)
www.teenwire.org
(Links to clinics are listed at Web site.)

Suicide Awareness Voices of Education (SAVE)
1-800-273-TALK (1-800-273-8255; toll-free)
www.save.org

Mental Health America Help Desk
1-800-273-TALK (1-800-273-8255; toll-free)
TTY Line: 1-800-433-5959 (toll-free)
www.mentalhealthamerica.net/contact-us

Depression Test
1-800-969-NMHA (1-800-969-6642; toll-free)
www.psycom.net/depression-test/

American Psychiatric Association
1-888-35-PSYCH (1-888-35-77924; toll-free)
www.psych.org

National Clearinghouse for Alcohol and Drug Information
1-800-729-6686 (toll-free)
TDD Line: (800) 487-4889
https://www.samhsa.gov/

Organizations to contact for useful information about teen health:

American Academy of Pediatrics
847-434-4000
www.aap.org

Planned Parenthood Federation of America
1-800-230-PLAN (toll-free)
www.plannedparenthood.org

Students Against Destructive Decisions (SADD)
1-877-SADD-INC (toll-free)
www.sadd.org

Consumer Healthcare Products Association
202-429-9260
www.chpa-info.org

Drug Free America Foundation, Inc.
727-828-0211
www.dfaf.org

National Institute on Drug Abuse
301-443-1124
www.nida.nih.gov

Campaign for Tobacco-Free Kids
202-296-5469
www.tobaccofreekids.org

JoinTogether
(A program of Boston University School of Public Health; advancing effective alcohol and drug policy, prevention, and treatment)
617-437-1500
www.jointogether.org

The Partnership for a Drug-Free America
212-922-1560
www.drugfree.org

Lifestyle Tips

1. Depression and Teenage Girls
   Girls are twice as likely as boys to be depressed and nearly twice as likely as boys to consider suicide. But signs of depression in teens are often not obvious. So be on the lookout for:
   • sadness that lasts for longer than two weeks
   • persistent tearfulness, crying
   • hopelessness
   • decreased interest in activities that were once enjoyable
   • persistent boredom
   • social isolation
   • guilt and low self esteem
   • increased irritability
   • difficulty with relationships
   • frequent complaints, headaches and stomachaches
   • thoughts or expressions of suicide or self-destructive behavior.
   If your daughter has one or more of these symptoms and you suspect she might be depressed, talk to a health care professional as soon as possible.
2. Nutrition and Adolescent Girls
   Girls grow faster during adolescence than at any other time except for infancy. That requires a mountain of vitamins and minerals best found in food, totaling an average of 1,800 to 2,200 calories a day, depending on your activity level. But all too often teenage girls don't eat a balanced diet and don't get the nutrients they need. For instance, they often don't get enough calcium, which can lead to osteoporosis, or iron, which can lead to anemia. Refocus your teen's diet to include at least one and a half to two cups of fruit, two and a half cups of vegetables, and three cups of milk a day. Keep nutritional snacks on hand, such as cut up fruit, pretzels, cheese sticks, individual yogurts and butter-free popcorn. Don't bring soft drinks into the house. Set a good example by eating nutritiously yourself at home and while dining out.
3. Exercise and Adolescent Girls
   Lifelong exercise habits are formed in adolescence, so it's important for parents to encourage their teens to be active. That means some form of activity every day, with more vigorous activity (resulting in a sustained increased heart rate) at least 30 minutes a day most days per week, more if she needs to lose weight. Whether it's on organized teams or through individual sports or exercise programs, the main message should be to get out and move. For instance, parents should encourage their daughters' interest in challenging activities, such as rock climbing, cycling, skiing or snowboarding. Try to make exercise a family affair. Go for a bike ride or hit the trails together. Give your teenager a pedometer and challenge her to collect at least 11,000 to 12,000 steps a day (the amount recommended for adolescents). Once she hits that figure, challenge her to more.
4. Tattoos and Body Piercings
   If you hear that your daughter is considering body art, make sure she understands the potential risks: infections, scar tissue and draining wounds for piercings, allergic reactions, and life-threatening diseases such as hepatitis and HIV/AIDS from instruments used for tattoos. Even the trendy temporary henna tattoos can result in months of pain and discomfort and a lifelong allergy to a common chemical found in the dyes. Tongue piercing can cause swelling that closes off the airway; choking risks from loose jewelry; uncontrollable bleeding and nerve damage; or chipped or cracked teeth. If you do this, make sure the procedure is performed with sterile equipment by a certified professional whose shop is clean, much like a medical facility.
5. Adolescent Girls and the Sun
   Remind your teen about the basics of protecting her skin from the sun. If she's going to be in the sun, she should slather on at least two tablespoons of sunscreen at least every two hours, more often if she's swimming or sweating. Encourage her to cover up with a wide-brimmed hat and sunglasses with ultraviolet (UV) light protection. And if she's prone to freckles, sunburns easily or has light-colored hair or eyes, urge her to keep sun exposure at a minimum and have a health care professional examine her skin regularly. Between visits, she should examine her own skin for any moles that have changed size or shape.
6. Menstrual Complaints in Teenaged Girls
   Your daughter isn't just trying to get out of gym class&mdash;it's common for teenage girls to have unusually severe cramps and heavy periods. Don't just write an excuse note, however. Take her to see a medical professional. If there's nothing medically wrong, your health care professional or nurse practitioner can prescribe ibuprofen for the pain, or even oral contraceptives to help with cramping and heavy blood flow. Although girls generally begin menstruating between ages nine and 13, if they're not menstruating by 16, see a health care professional. Also check with him or her if your daughter has very heavy periods. Heavy bleeding could result in anemia or indicate a clotting disorder such as VonWillebrand's disease.

Organizations and Support

For information and support on Teen Health, please see the recommended organizations, books and Spanish-language resources listed below.

American Academy of Child and Adolescent Psychiatry (AACAP)
Website: https://www.aacap.org
Address: 3615 Wisconsin Ave., NW
Washington, DC 20016
Phone: 202-966-7300

American Academy of Pediatrics
Website: https://www.aap.org
Address: 141 Northwest Point Boulevard
Elk Grove Village, IL 60007
Phone: 847-434-4000
Email: kidsdocs@aap.org

American School Health Association
Website: https://www.ashaweb.org
Address: 7263 State Route 43
P.O. Box 708
Kent, OH 44240
Phone: 330-678-1601
Email: asha@ashaweb.org

Association of Maternal and Child Health Programs
Website: https://www.amchp.org
Address: 2030 M Street, NW, Suite 350
Washington, DC 20036
Phone: 202-775-0436

Campaign for Tobacco-Free Kids
Website: https://www.tobaccofreekids.org
Address: 1400 Eye Street, Suite 1200
Washington, DC 20005
Phone: 202-296-5469

Federation of Families for Children's Mental Health
Website: https://www.ffcmh.org
Address: 9605 Medical Center Drive, Suite 280
Rockville, MD 20850
Phone: 240-403-1901
Email: ffcmh@ffcmh.org

Girls, Inc.
Website: https://www.girlsinc.org
Address: 120 Wall Street
New York, NY 10005
Phone: 212-509-2000

Join Together
Website: https://www.drugfree.org/join-together
Address: 715 Albany Street, 580-3rd Floor
Boston, MA 02118
Phone: 617-437-1500
Email: info@jointogether.org

National Adolescent Health Information Center
Website: https://nahic.ucsf.edu
Address: 3333 California Street, Suite 245
San Francisco, CA 94118
Phone: 415-502-4856
Email: nahic@ucsf.edu

National Institute of Child Health and Human Development
Website: https://www.nichd.nih.gov
Address: National Institutes of Health
P.O. Box 3006
Rockville, MD 20847
Hotline: 1-800-370-2943

National Institute on Drug Abuse
Website: https://www.nida.nih.gov
Address: 6001 Executive Boulevard, Room 5213
Bethesda, MD 20892-9561
Phone: 301-443-1124
Email: information@nida.nih.gov

National Maternal and Child Health Clearinghouse
Website: https://mchb.hrsa.gov/
Address: HRSA Information Center
P.O. Box 2910
Merrifield, VA 22116
Hotline: 1-888-ASK-HRSA (1-888-275-4772)
Phone: TTY/TTD: 1-877-4TY-HRSA (1-877-489-4772)
Email: ask@hrsa.gov

National Maternal and Child Oral Health Resource Center
Website: https://www.mchoralhealth.org
Address: 2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
Phone: 202-784-9771
Email: OHRCinfo@georgetown.edu

Partnership for a Drug-Free America
Website: https://www.drugfree.org
Address: 405 Lexington Avenue, Suite 1601
New York, NY 10174
Phone: 212-922-1560

Planned Parenthood Federation of America
Website: https://www.plannedparenthood.org
Address: 434 West 33rd Street
New York, NY 10001
Hotline: 1-800-230-PLAN (1-800-230-7526)
Phone: 212-541-7800

President's Council on Physical Fitness and Sports
Website: https://www.fitness.gov
Address: Department W
200 Independence Ave., SW, Room 738-H
Washington, DC 20201
Phone: 202-690-9000
Email: fitness@hhs.gov

Sexuality Information and Education Council of the United States (SIECUS)
Website: https://www.siecus.org
Address: 90 John Street, Suite 704
New York, NY 10038
Phone: 212-819-9770

Students Against Destructive Decisions (SADD)
Website: https://www.sadd.org
Address: 255 Main Street
Marlborough, MA 01752
Hotline: 1-877-SADD-INC (1-877-723-3462)
Email: info@sadd.org

Young Women's Christian Association (YWCA)
Website: https://www.ywca.org
Address: 1015 18th Street, NW, Suite 1100
Washington, DC 20036
Phone: 202-467-0801
Email: info@ywca.org

Books

Between Mother and Daughter: A Teenager and Her Mom Share the Secrets of a Strong Relationship
by Amanda Ford

The Care & Keeping of You: The Body Book for Girls
by Valorie Schaefer and Norm Bendell

Changing Bodies, Changing Lives: Expanded Third Edition: A Book for Teens on Sex and Relationships
by Ruth Bell

Life Lists for Teens: Tips, Steps, Hints, and How-Tos for Growing Up, Getting Along, Learning, and Having Fun
by Pamela Espeland

Preventing Childhood Eating Problems: A Practical, Positive Approach to Raising Kids Free of Food and Weight Conflicts
by Jane Hirschmann and Lela Zaphiropoulos

Put Yourself in Their Shoes: Understanding Teenagers with Attention Deficit Disorder
by Harvey C. Parker

Reviving Ophelia: Saving the Selves of Adolescent Girls
by Mary Pipher and Ruth Ross

Sex, Boys & You: Be Your Own Best Girlfriend
by Joni Arredia

The Teenage Body Book
by Kathy McCoy, Ph.D and Charles Wibbelsman

The Underground Guide to Teenage Sexuality, 2nd Edition
by Michael J. Basso

Unmasking Sexual Con Games
by Kathleen M. McGee and Laura J. Buddenberg

Vegetables Rock! A Complete Guide for Teenage Vegetarians
by Stephanie Pierson

What are My Rights?: 95 Questions and Answers About Teens and the Law
by Thomas A. Jacobs

What's Going on Down There? Answers to Questions Boys Find Hard to Ask
by Karen Gravelle, Nick Castro, Chava Castro, and Robert Leighton

When Nothing Matters Anymore: A Survival Guide to Depressed Teens
by Bev Cobain

Spanish-language resources

Medline Plus: Teen Health
Website: https://www.nlm.nih.gov/medlineplus/spanish/teenhealth.html
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

The Nemours Foundation: Teen Health - Body Image and Self-Esteem
Website: https://kidshealth.org/teen/en_espanol/mente/body_image_esp.html
Email: https://secure02.kidshealth.org/teen/kh_misc/send_...