your browser does not support javascript!

Call us:
+91 (044) 4353 0444 / 555 / 666 / 777 / 888

For Appointment with Dr.Priya Kalyani : +91 7550 22 00 15
Mon - Sat, 8 AM - 11 AM & 4 PM - 6 PM

Adolescent Gynecology


Puberty is the process of physical changes through which a child's body into an adult body capable of sexual reproduction to enable fertilization. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a boy.

Changes: Physical changes during adolescence

For girls, you might start to see early physical changes from about 10 or 11 years, but they might start as young as 8 years or as old as 13 years. Physical changes around puberty include:

  • breast development
  • changes in body shape and height
  • growth of pubic and body hair
  • the start of periods (menstruation)
adolescent gynecology

For boys, physical changes usually start around 11 or 12 years, but they might start as young as 9 years or as old as 14 years. Physical changes include:

  • growth of the penis and testes (testicles)
  • changes in body shape and height
  • erections with ejaculation
  • growth of body and facial hair
  • changes to voice

Pubertal Stages:

For girls –

  • P1 - Prepubertal
  • P2 - Early development of subareolar breast bud +/- small amounts of pubic and axillary hair
  • P3 - Increase in size of palpable breast tissue and areolae, increased dark curled pubic/axillary hair
  • P4 - Mature adult breast. Pubic hair extends to upper thigh.
puberty in females

For boys –

  • P1 - Prepubertal, testicular volume less than 2mls
  • P2 - Enlargement of scrotum and penis. Scrotum slightly pigmented. Few long dark pubic hairs
  • P3 - Lenghtening of penis. Further growth of testes and scrotum. Pubic hair darker, coarser and more curled
  • P4 - Penis increases in length and thickness. Increased pigmentation of scrotum. Adult pubic but no spread to medial thighs
  • P5 - Genitalia adult in size and shape. Pubic hair spread to thighs


For girls –

  • First ovulation occurs 6 – 9 mths after menarche
  • Plasma progesterone remains at low levels even if secondary sexual characteristics have appeared
  • Rising progesterone after usually ovulation
  • Plasma testosterone rise during puberty (not as much as in male)

For boys –

  • First signs of puberty
    • Testicular volume of 4mls
    • Slight progressive increase in scrotal folds
    • Slight increase in scrotal pigmentation

Abnormal Puberty:

There are many causes of abnormal puberty. The main aim of assessment is to determine those children with an underlying pathological abnormality from those with constitutional and benign pubertal changes. It is important to recognise abnormal timing and progression of puberty. This may require a combination of clinical assessment, investigations and expert advice.

signs of female puberty


  • Take a full history of previous growth and development.
  • Record the timing and sequence of physical milestones and behavioural changes of puberty.
  • Record full medical and surgical history.
  • If the individual is underweight and has delayed puberty take a nutritional history.
  • Detail any family history of early or delayed puberty and any genetic disease.

Physical examination

  • Plot growth velocity on a growth chart. Has there been a change compared with records?
  • The most important systems to examine are neurological and endocrine.
  • Look for evidence of thyroid or other endocrine dysfunction.
  • Optic fundi, visual fields and sense of smell should be checked to look for a pituitary tumour.
  • The genitalia and body habitus should be examined and the stage of puberty documented.
  • Photographs are useful to document the stage of puberty. However, such clinical photographs need appropriate consent and are best undertaken in hospital medical photography departments.


Investigations should be used selectively and based on a thorough clinical assessment.

  • Blood tests include FSH/LH levels, oestrogen assay, 17-OH progesterone/DHEA assay, testosterone levels, prolactin levels, beta human chorionic gonadotrophin (beta-hCG) and TFTs.
  • Gonadotrophin-releasing hormone (GnRH) stimulation test and other tests of pituitary function.

Menstrual Cycle:

Normal Menstrual Cycle:

A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens. The rise and fall of levels of hormones during the month control the menstrual cycle.

menstruation cycle pictures

Menstrual Hygiene:

You can take the following hygiene measures during menstruation:

  • Take a bath or shower at least once a day.
  • Use clean undergarments and change them regularly.
  • Change pads or tampons regularly.
  • Wash the genital area with plain water (no soap) after each use of toilet and even after urination.
  • Keep the area between the legs dry, otherwise you may experience chafing.
  • It is very important to remember that vagina has its own self-cleaning mechanism and an external cleaning agent like deodorant or soap should not be used inside it.

menstrual hygiene

Menstrual irregularities & disturbances:

Menstrual periods are considered irregular if periods have not started by 15 years of age or 3 years of thelarche, are regular earlier but become markedly irregular, occur more frequently than every 21 days or less frequently than every 45 days, last more than 7 days. Some of the other menstrual health issues include Pre-menstrual syndrome or PMS, Dysmenorrhea (instense menstrual pain & cramps), Amenorrhea (skips a cycle for more than 90 days).

Some of the other issues affecting girls and women’s health are detailed below –

Contraception – It is very important to educate the impact on the girl's health through sexual education. The number of Teen Pregnancies is on a big rise these days.

contraceptive pills images

Obesity & Eating Disorders - Exercise & Diet control for adolescents is a must. Lack of physical activity is resulting in obesity which in turn is connected to several disorders and diseases such as thyroid, diabetes, etc. PCOS also has its roots in adolescence bcoz obesity contributes to abnormal hormonal secretion.

causes of obesity in adolescence

Acne is another pressing concern stemming out of today’s lifestyle and eating habits. More and more girls are facing skin health issues and resorting to skin treatments and make up to cover up the effects of acne. Instead they should increase intake of Vitamin A (red colored fruits & vegetables).

causes of acne on face

Immunization - To know more about vaccines click here -

As parents we need to put special efforts and focus on HPV vaccination for cervical cancer starting at the age of 10 itself.

The key lies in making excellent dishes at home that are healthy and appealing to adolescents. There has to be an increase in the intake of calcium particularly milk in the form of a milkshake, smoothies, etc.. Decrease intake of oil and junk food (everything is fine once in awhile but not on a regular basis).

Bone Mass accumulation during puberty is critical to the development of peak bone mass, which is a major determinant of the risk of developing osteoporosis in later life. Adolescence is a time in life that harbors many risks and changes but also one that presents great opportunities for sustained health and well-being.

Contact Us

Bloom – Centre for Woman & Child Wellness

No. 453/454, R.K. Shanmugam Salai, K.K. Nagar,
Chennai - 600 078