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Table of Contents
Table of Contents
Introduction | 11
Chapter 1 “Oops … I Had an Accident" | 17
Understanding Menstruation
Chapter 2 “But I’m Not Sick. Do I Really Need to See a Doctor?" | 39
Routine Female Health Care
Chapter 3 “How Do I Know If I’ve Got It?" | 61
Sexually Transmitted Diseases
Chapter 4 “I Wanna Know" | 107
Sexuality and Relationships
Chapter 5 “Mom, I Need to Tell You Something" | 83
Birth Control
Chapter 6 “I’m So Fat!" | 133
Body Image, Eating Disorders and Psychological Health
Chapter 7 “Am I Becoming the Person I Want to Be?" | 157
Nurturing Your Passions and Gifts
Final Thoughts | 165
Notes | 167
Glossary | 169
Annotated Bibliography | 171
Index | 175
About the Authors | 183
Ordering Information | 184
Excerpts
Glossary
A brief guide to unusual terms, medical terms, or common terms used by teens.
Amenorrhea is the absence of your menstrual cycle. Primary amenorrhea means you have never had a period; secondary amenorrhea means you have previously had at least one cycle.
Bacterial Vaginosis is a common vaginal infection caused by an imbalance of normal bacterial growth in the vagina.
Candidiasis is another word for yeast infection caused by an overgrowth of Candida; a common form of vaginal infection.
Chlamydia is a sexually transmitted infection that, if untreated, can cause scarring in tubes and ovaries leading to infertility.
Corpus Luteum is what is left behind in the ovary after ovulation, and it produces progesterone.
Dysmenorrhea refers to menstrual cramps, painful periods.
Endometriosis is a condition where tissue from the lining of the uterus gets misplaced anywhere in the pelvis outside of the uterus including the ovaries and fallopian tubes; a common source of pelvic pain.
Endometrium is the lining of the uterus.
Estrogen is a female hormone produced by the ovaries that causes the lining of the uterus to thicken up most prominent during the beginning of your cycle.
Follicle is a small fluid filled sac that forms in the ovaries that can produce an egg.
Gonorrhea is a sexually transmitted infection that can cause infertility, pelvic inflammatory disease and arthritis if untreated.
Hormones are substances produced by the body that travel through the bloodstream to control certain organs. Estrogen and progesterone are examples of female hormones.
Hirsutism is excessive hair growth on the face chest or abdomen in women, often due to overproduction of testosterone.
Human Papilloma Virus (HPV) is a very common viral infection spread through sexual contact. It is the common virus associated with abnormal Pap tests and cervical cancer.
Mastodynia means painful breasts.
Pap test is a test that looks at cells from the uterine cervix, useful in detecting cervical cancer.
Chapters
Introduction
Teens today, more than ever, face a myriad of issues involving sex and sexuality, self-esteem and body image. They need education; they need guidance; they need support to make the right decisions at the right time.
In our profession as women’s health care providers, we’ve found that teens experience greater success through these difficult years when they have open communication with their mothers.
But we’ve also found that’s not quite as simple as it sounds.
As women’s health care providers we understand that daughters are commonly reluctant to approach their mothers for advice, for fear of punishment or lecture, or simply because they are embarrassed of the issue itself. They instead turn to their friends or the mass media, or avoid the issues all together, creating greater problems for themselves in the future.
And as mothers ourselves, we also understand that many of us are embarrassed to admit that despite our best intentions, we hesitate to engage our daughters in health-related dialogue. We either feel shy, inadequate, and poorly informed, or we have been so looking forward to such interactions with our daughters—anticipating with cherished thoughts how our conversations will go, only to discover that our teenage daughters are disinterested, busy, or outright offended.
So where are teen girls getting the little information they do have about health and sex? And what is it that they are concluding about health and sex and their bodies from these information sources? Adolescent girls learn about sex primarily from their conversations with their mothers, interactions with their peers, participation in school programs, and exposure to mass media, yet not necessarily in that order. All contribute to the knowledge our children receive about sex and their bodies; all are potential sources of conversation with our daughters.
Mothers. As mothers, from the time that our children are born, we make sure that they are clean, fed and clothed. We take them to the pediatrician regularly. We teach them everything, from how to ride a bike to how to use appropriate manners. We provide our children with love, protection and guidance. We tend to breeze through most of these tasks, and when we stumble occasionally, we turn to our own mothers for help.
As our children become more inquisitive and their lives become more complicated, these tasks can become far more challenging. Most of us find it uncomfortable when our daughters ask us questions about sex and their bodies. We often have difficulty teaching our daughters about sex because of our own discomfort and/or our own lack of knowledge. This uneasiness with the subject is often a reflection of the way that we were taught about sex by our own mothers, years earlier.
My mother had only two significant conversations with me about my body and sex, which were probably two more conversations than she had with her own mother. Our first conversation was about menstruation, and we had it just before I actually started getting my periods. Oversimplified and incomplete, the information that she provided was probably all she felt was needed to handle my first episode of bleeding.
Our second conversation, when I was 13 years old, was about human reproduction. My mother read me a book, which had been recommended by her gynecologist, entitled “How to Talk to 6-8 Year Olds." Like other mothers, she was uncomfortable about teaching me what I needed to know about sex and my body. Also, like other mothers, her knowledge about sexuality and related health issues may have been limited. Our conversations were a beginning but they did not provide me with all the information that I would need as a teen.
Peers. Adolescent girls exert a huge influence on each other. This is a time in a girl’s life when she desperately wants to “fit in." Peers help each other “figure it all out." Teen girls can also be a fabulous resource for inaccurate information.
Young girls also get a lot of inaccurate information from their boyfriends — whom they want to please — about the risks of sexual activity. For example, a common myth believed by boys is that girls can’t get pregnant “the first time."
Never underestimate the influence girls have on each other regarding the issue of body image. It’s been noted, for instance, that eating disorders can “run in packs." Girls teach each other how to “do it" and encourage each other to stay skinny. The concern to “be popular" or “fit in" is far more important than taking care of their bodies. They find out what it means to be popular and to fit in, first and foremost from their buddies.
School Programs. Our public schools are another primary source of sex education for girls. In 1996, the federal government enacted legislation limiting federal funding for sex education programs in public school to those programs with an “abstinence only" curriculum. Those programs focus on sex after marriage, ignore pre-marital sex, and do not mention birth control and safe sex practices. As parents, abstinence until marriage sounds like a great idea for our daughters. Unfortunately, as a public policy, it has not proven particularly effective.
A recent public health study not only confirms that teen girls generally are not abstaining from sexual intercourse, but demonstrates that 75% of females have had premarital sex by the age of 20. Further, by not emphasizing the need for safe sex practices if a girl decides not to abstain, school-based programs fail to show our girls how to protect their health. Fewer than 10% of sexually active teenagers are using condoms when having sex. Consequently, adolescents have the highest prevalence of sexually transmitted diseases.
Teenagers are surging with natural hormonal urges, yet they are not being taught in school how to deal with them. This is like putting hungry children in a room with all kinds of food. Most of them would take the junk food instead of the healthier alternatives unless we have taught them how to make better choices.
Mass media. The fourth, and perhaps the most influential source of information about sex is the mass media. From magazines to television to the Internet to radio—from every source you can think of—the message is the same. Each source screams “SEX" at adolescents. Prime time network television shows an average of eight sexual incidents per hour. Almost half of adolescents report learning about sex, pregnancy, and birth control from television, movies and magazines. Movies and television are powerful educators, often portraying reckless and unsafe behavior by teens in a glamorous or romantic light. Sex, as portrayed by the media, frequently involves quick hook-ups and immediate gratification.
Even in the absence of frank references to sex, magazines and other media targeting adolescent girls emphasize “ideal" body images and suggestive behaviors to attract boys sexually. As a result, girls are encouraged to have unhealthy diets and engage in practices with sex as the ultimate goal. For instance, look at any teen oriented fashion magazine; all of the models are unrealistically thin and the articles range from “how to kiss better" to “how to get him to notice you."
Health care providers often see young women after problems occur— problems that might have been avoided if the adolescents had received adequate education, or if they had found opportunities to engage a trusted, meaningful person with their questions. When we mothers fall short in educating our girls about health, sex, and self-esteem we miss out on our opportunities to prevent potential problems. We cannot count on the schools, our daughters’ peers or the mass media to provide our adolescent daughters with the information that they need to protect themselves.
The goal of this book is to empower mothers and daughters with accurate and comprehensive knowledge so that they can have the open, relaxed, and informative conversations about sex and female health that every young woman needs and deserves. Mothers have the chance to directly shape their daughters’ thought processes regarding their bodies, life choices, health and well being. The book also highlights the mother-daughter connection in helping girls to explore their passions and to focus their energies on self discovery.
For you mothers, table talk is a way of comfortably inviting your daughter into your beliefs and thoughts, and learning from her as well. For you daughters, table talk is a way of comfortably inviting your mother into your beliefs and thoughts, and learning from her as well. This book is designed for both moms and daughters alike. The information is meant to be shared. It is deliberately meant to spark conversations. Getting started with table talk can happen almost any place or time, just as this book describes.
Young girls deserve accurate information presented in a relaxed way by people whom they trust. They deserve straightforward answers to their questions. Moms deserve a chance to have engaging conversations with their daughters about life-critical issues.
Table Talk
Setting the Table. Here are great mother-daughter ideas for “settings" to have table talk conversations:
• Ride with just the two of you in the car listening to music. The lyrics can often spur great conversations.
• Take a walk—a wandering walk—together, and let the conversation go where it may.
• Pick your daughter up from school and suggest a drink at a coffee house. Most coffee houses have comfortable seating and generally are quiet at this time of day.
• Go to a knitting shop and learn to knit together. Many such shops often have quiet, cozy areas in which to work. Furthermore, knitting can be a productive conversation-enhancing hobby.
• Read a book together, followed by discussion sessions. Let the book’s content be your conversation starters.
• Make plans to get up early and have a quiet breakfast before the rest of the family wakes up.
• Go to yoga class together and get a smoothie afterwards. Yoga puts everyone in a good mood.
• Dance together. Enroll in a tap class, then have dinner afterwards.
• Plant an herb garden and cook one meal per week together.
• Have a “spa day" at home. Buy a facial mask and give each other “manis" and “pedis." Serve sparkling apple cider to make it seem really special.
• One afternoon find a place in your town that has high tea. If unable to find a place with high tea, make scones, put on classical music and have a tea party.
• On a sunny day make a picnic lunch and go to a local park.
• Find a pottery painting place and do some artwork.
• Try working out together. It can make exercising more fun!
Getting started with table talk can happen almost any place or any time. Putting the facts on the table and learning from one another may be the best gift a mother can give her daughter to protect her future health.
My favorite way to talk to my daughter at night is when she gets on her treadmill at her school gym and I get on mine at home. We put our phones on speaker and talk to each other as we walk. It’s like being on a walk together even when we are miles apart. It also makes exercise more fun, and I am connected with her throughout my dreams at night.
Terms of Conditions
References
Bartell, Susan. (2006) Dr. Susan's Girls-Only Weight Loss Guide: The Easy, Fun Way to Look and Feel Good! Williston Park, NY: Parent Positive.
Blackstone, Margaret and Guest, Elissa Haden. (2006) Girl Stuff: A Survival Guide to Growing Up. New York: Harcourt.
Boteach, Shmuley. (2006) 10 Conversations You Need to Have with Your Children. New York, NY: HarperCollins.
Canfield, Jack and Victor-Hansen, Mark. (2007) Life Lessons for Busy Moms: Essential Ingredients to Organize and Balance Your World. Deerfield Beach, FL: Health Communications, Inc.
Canfield, Jack; Victor-Hansen, Mark; Hansen, Patty; and Dunlap, Irene. (2005) Chicken Soup for the Girl's Soul: Real Stories by Real Girls About Real Stuff. Deerfield Beach, FL: Health Communications, Inc.
Clifford-Poston, Andrea. (2005) Tweens: Understanding Your 8-12 Year Old. Oxford, England: Oneworld Publications.
Cline, Foster W. and Fay, Jim. (2006) Parenting Teens With Love And Logic: Preparing Adolescents for Responsible Adulthood. Deerfield Beach, FL: Pinon Press.
Cohen-Sandler, Roni. (2005) Stressed-out Girls: Helping Them Thrive in the Age of Pressure. New York, NY: Penguin.
Elium, Jeanne and Elium, Don. (2003) Raising a Daughter: Parents and the Awakening of a Healthy Woman. Berkeley, CA: Ten Speed Press.
Eyre, Linda and Eyre, Richard. (1999) How to Talk to Your Child About Sex: It's Best to Start Early, but It's Never Too Late. New York, NY: Martin’s Press.
Devillers, Julia. (2002) GirlWise: How to Be Confident, Capable, Cool, and in Control. New York, NY: Three Rivers Press.
Domitrz, Michael. (2003) May I Kiss You? A Candid Look at Dating, Communication, Respect, & Sexual Assault Awareness. Greenfield, WI. Awareness Publications.
Drill, Esther and McDonald, Heather. (1999) Deal with It! A Whole New Approach to Your Body, Brain, and Life as a gURL.
Fleming, Don. (1993) How to Stop the Battle with Your Teenager: A Practical Guide to Solving Everyday Problems. New York, NY: Fireside.
Gabriel, H. Paul, M.D., and Wool ,Robert. (1995) Anticipating Adolescence: How to Cope With Your Child's Emotional Upheaval and Forge a New Relationship Together. New York: Henry Holt and Company.
Ginsburg, K.R. and Jablow, Martha. (2002) But I'm Almost 13!: Raising a Responsible Adolescent. Chicago, IL: Contemporary Press.
Jackson, Nisha. (2006). Surviving the Teenage Hormone Takeover: A Guide for Moms. New York, NY: Thomas Nelson.
Madaras, Lynda and Madaras, Area. (2000) My Body, My Self for Girls (What's Happening to My Body?). New York, NY: Newmarket Press.
Marshner, Connie. (1988) Decent Exposure: How to Teach Your Children About Sex. Nashville, TN: Wolgemuth & Hyatt Pub.
McCarthy, Moira. (2008) The Everything Guide to Raising Adolescent Girls: An Essential Guide to Bringing Up Happy, Healthy Girls in Today's World. Avon, MA: Adams Media. Part of the Adams Media
McMahon, Tom. (2003) Teen Tips: A Practical Survival Guide For Parents With Kids 11-19. New York, NY: Pocket.
Meeker, Meg. (2007) Your Kids at Risk: How Teen Sex Threatens Our Sons and Daughters. Washington, DC: Regency Publishing.
Northrup, Christiane. (2005). Mother -Daughter Wisdom: Understanding the Crucial Link Between Mothers, Daughters, and Health. New York, NY: Bantam Dell. Dr. Northrup
Richardson, Justin and Schuster, Mark. (2003) Everything You Never Wanted Your Kids to Know About Sex (But Were Afraid They'd Ask): The Secrets to Surviving Your Child's Sexual Development from Birth to the Teens. New York, NY: Three Rivers Press.
Riera, Michael. (2003) Staying Connected To Your Teenager: How To Keep Them Talking To You And How To Hear What They're Really Saying. Cambridge, MA: Da Capo Press.
Schafer, Ayson. (2006) Breaking the Good Mom Myth: Every Mom's Modern Guide to Getting Past Perfection, Regaining Sanity, and Raising Great Kids. Somerset, NJ: John Wiley & Sons.
Shalit, Wendy. (2007) Girls Gone Mild: Young Women Reclaim Self-Respect and Find It's Not Bad to Be Good. New York, NY: Random House.
Shearin Karres, Erika V. (2004) Mean Chicks, Cliques, And Dirty Tricks: A Real Girl's Guide to Getting Through the Day with Smarts and Style. Avon, MA: Adams Media Corporation / F+W Publications.
Snyderman, Nancy and Streep, Peg. (2002) Girl in the Mirror: Mothers and Daughters in the Years of Adolescence. New York, NY: Hyperion.
Van Munching, Philip. (2005) Boys Will Put You on a Pedestal (So They Can Look Up Your Skirt): A Dad's Advice for Daughters. New York, NY: Simon & Schuster.
Wiseman, Rosalind. (2003) Queen Bees and Wannabes: Helping Your Daughter Survive Cliques, Gossip, Boyfriends, and Other Realities of Adolescence. London, England: Piatkus Books.
Organizations, Web Sites, and Hot Lines
Digene HPVTest
We love Digene Corporations’s web site because it gives straight-forward, factual information about HPV as well as treatment.
Centers for Disease Control and Prevention (Department of Health and Human Resources)
This is an excellent web site to obtain facts concerning sexually transmitted infections.
CDC Sexually Transmitted Diseases Hot Line
800-227-8922
National Eating Disorder Association
800-931-2237
Families Are Talking (part of The Family Project of the Sexuality Information and Education Council of the United States [SIECUS])
This project began in 2000 to empower parents and caregivers to communicate with their children about sexuality-related issues. We send families to this site because it tackles most of the problems families bring to therapy. It addresses boundary issues, issues with friends, how to start a family budget. It also is a parent-friendly source: very direct and easy to access.
American Social Health Association (ASHA)
ASHA runs the www.iwannaknow.org web sites, which is one of the best sites for teens to read about sexuality and relationships. It has reliable, up-to-date information on birth control and also addresses relationship problems that are common for the teenage population.
Planned Parenthood Federation of America (PPFA)
An award-winning sexual health web site for teens, teenwire.com offers bilingual (English/Spanish) information on sexuality as well as healthy living for teens. It provides in-depth reference articles as well as links to other sites to explore. It is wonderful because of its ethnic diversity.
Something Fishy
We believe this is one of the best sites for eating disorders. We use it in the Weight Management Center. It is not focused on food but rather on the compulsions as well as addictions that manifest as eating disorder. This site is helpful for parents, teens, as well as professionals.
BodyPositive®
This is an excellent site to be used in conjunction with family meetings or “date nights" with your teenage daughter. It has meditations, mindful eating activities, exercises, as well as articles about accepting your body. It leaves you feeling empowered which is why it is one of our favorite sites.
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