Experiences of puberty development

Sm. Sci. Med. Vol. 19. No. 4. PP. 461465. 1984 Printed in Great Britain

EXPERIENCES

0?77-9536/84$3.00+ 0.00 Pergamon

OF PUBERTY

Press Ltd

DEVELOPMENT

LISBETH SHORE Institute of Social Medicine, University of Copenhagen, 32 Juliane Maries Vej, DK-2100 Copenhagen, Denmark

Abstract-This paper presents some of the findings from a study regarding sex education which I have conducted with 500, 14-16 year-old pupils in a school district in the southern part of Denmark. The specific focus of the paper is on the pupils’ experiences of puberty development; both the physical and psychological transformations undergone and the differences in the experiences of boys and girls. The psycho-social aspects of menstruation and the relative importance of various sources of sex information are also discussed. The findings show that the pupils have a stronger need and desire for sex education which emphasizes the psycho-social dimensions of puberty development than specific technical information. It is therefore suggested that sex education place more emphasis upon these psycho-social dimensions and that this may influence the promotion of more responsible sexual behavior.

INTRODUCTION

PRESENT STUDY-BACKGROUND

The developmental phase of puberty, significantly marked by sexual maturation, can be regarded with special interest from a socio-psychological and sociomedical perspective. Although the period is most prominently characterized by physical changes-the development of primary and secondary sex characters-the process of pubescence also affects the development of new interests and social behavior. Furthermore, the striking indications of sexual maturity, the onset of menstruation, genital and breast development, imbue physical growth with highly personal meanings. Initiation to the biological and social tasks of maturity is undergone during adolescence. In many societies, the transformations of puberty are conventionalized by traditional sanctions and taboos. The initiation rites recorded by anthropologists are witness to the fact that at puberty, a profound reorganization of psychic formation occurs. Some societies provide models on which the adolescent can pattern his/her personal resolution. The designation of new role and status offers the adolescent a self-image which is definite and group-bound, and societal assimilation is promoted [I]. To some extent, an institutionalized initiation similarly occurs, in our schools. The school offers training in specific skills, and provides a fund of knowledge. Indirectly, it provides a framework for adapting to the personality transformations of puberty, by way of peer identification and identification with an adult role model, alternative to the parents. The understanding of biological changes occurring in puberty, offered in the enlarged social sphere of the school, may be a reasonable argument for the importance of an institutionalized initiation processand the importance of providing sex education in schools, specifically geared to the socio-sexual and psychological transformations of puberty. However, sex education does not necessarily fulfill the needs pupils have regarding this initiation process.

In a study conducted with a population of 500, 14-l &year old Danish school pupils, I have surveyed pupils’ reactions to the sex education they have received. Despite increased efforts in sex education aimed at youth and increased accessibility to contraceptive methods, the rate of unwanted pregnancies in the age group 15-19 years has not fallen notably in the past 15 years-so that the yearly rate of pregnancies is 45-50 per 1000 15-19 year olds. Among girls between ages 15-I 7 in 1981, 75% resulted in abortion, and among 18-l 9 year olds, 45% PI. Factors other than technical knowledge may be influential in determining adequate contraceptive practice. It has therefore been the purpose of this study to investigate what attitudes prevail among youth, and what their own priorities and perceived needs are regarding sex education, which then could contribute to defining more goal-oriented and successful teaching efforts. By way of interviews and self-administered questionnaires, pupils have responded to questions concerning their attitudes to sex education, their perceived needs, their knowledge about specific physiological functions and contraceptive methods as well as their experiences with puberty development. The focus of this paper will be on the psycho-social aspects of puberty development, with reference to the study population’s subjective experiences. The aims of sex education as stated by the Ministry of Education in Denmark, is to provide school pupils with such knowledge of sexual matters as to “enable them to take responsibility for their own lives and demonstrate consideration for others”. In this case, sexual matters refers to genital anatomy, conception, contraception and venereal disease. Theoretically, the stipulations for providing sex education, integrated into other school subjects are reasonable enough, but in practice, pedagogic, psychological and political problems arise. Discrepancies as to what sex education should include, and how it

462

LISBETHSHORE

is to be provided, certainly exist. Each teacher is in fact left alone to administer the teaching and fulfill the somewhat loosely stipulated requirements [3]. In addition to providing concrete information, sex education should provide a forum for the psychosocial initiation of adolescence, by utilizing the role models teachers provide and the peer identification with pupils. However, in my findings specifically regarding the pupils’ experiences, it appears that these psycho-social dimensions are not dealt with in sex education, to the extent desired by the pupils themselves, and not to the extent to which concrete information, for example about contraception, is provided. As stated by almost all of the 200 pupils interviewed: “we’ve learned enough about the technical issues, and about ‘being careful’, but nothing about our feelings!“. PSYCHOSOMATIC EXPERIENCES MENSTRUATION

OF

Whereas in most traditional societies, the onset of pubescence marks the transition from the ‘barrenness of childhood to the fertility of adolescence and adulthood-a milestone to be celebrated-it appears that in Western culture, the transition is often characterized by inconvenience (as with menstruation) and the need for caution. If we look at the girls’ own descriptions of their psychological and somatic experiences of menstruation, it appears that for the majority, the menstrual period is experienced with more emotional than physical discomfort. Of the 253 girls responding to the question of how they feel during the menstrual period, 30% state they feel quite normal, without any somatic symptomatology. Nearly 40% complain of minor physical discomfort, stomachaches and back pains. Only 10% experience the period as marked by severe physical discomfort, necessitating medication and a day off from school. But 20% describe psychosomatic symptomatology-tiredness, irritability and minor physical discomfort. However, responses to a subsequent question of what possible changes they may experience in themselves related to the menstrual period evidence a greater emphasis on negatively connotated emotional symptomatology. As in responses to the former question, 38% of the respondents claimed to experience no noticeable psychomatic disequilibrium. But as many as 60% described the period as accompanied by irritability, ‘sourness’, ‘crying bouts for no reason’, hypersensitivity and mood swings. Of these responses, 6% additionally complained of physical discomfort. Less than 2% described the menstrual period as affecting a new sense of maturity, and in one case, as necessitating a greater awareness of personal hygiene. If indeed girls in early adolescence attribute varying states of emotional disequilibrium to the menstrual period, with relatively few accompanying it could suggest that this somatic complaints, symptomatology is to some extent socially determined. For generations Western culture has imbued the female physiology with negatively laden stigmata-the weaker sex given to unreasonable

emotional outbursts, both pre-menstrually. during menstruation and during menopause. The dystonic affects related to the menstrual period have been discussed in psychoanalytic literature. According to Sklansky “the common usage of the phrase ‘the curse’ to describe the menses while often acknowledged as only a figure of speech, nevertheless indicates the long history in mankind of anxiety, awe and prejudice related to this primary female function” [4, .p. 2671. He further claims that “clinical experience would indicate that positive reactions to the menses are still rare, and that perhaps a favorable change in the cultural attitude toward women, girls and girl babies will ultimately be seen in a more positiue attitude in girls toward their menses” [4, p. 2671 (emphasis mine). Only in the last decade have feminist attitudes and viewpoints been acknowledged by a greater number. The Women’s Movement has made concerted efforts to dissolve the image of the weak, emotionally unstable and defiled woman. In other than Western societies, menstrual blood is regarded as impure, a contaminant and yet in Western culture it is moreover regarded as causally related to a myriad of erratic and often anti-social behavior modes. Unfortunately some women themselves have adhered to such beliefs, and here I think specifically of the Pre-Menstrual Syndrome and the criminal offences pardoned by its presence. I suggest that our culture places such emphasis upon rationality that little credence is given to emotionality. Affective modes-lability, anger and sadness-such as those described by the adolescent respondents in this study are considered as counterproductive, especially when expressed by womenand are attributed to the menstrual period. It is possible that these affective modes are in fact relegated. to the menstrual period-the ‘socially accepted’ alloted time for affect? Consider the fact that anger is most often regarded as a taboo affect, especially in women, and that not infrequently are expressions of anger explained by ‘she must be having her period’. Why else could she possibly be angry? Certainly, there are medical arguments to explain the discomfort some experience during the menstrual period. Congestive dysmenorrhea, accompanied by such symptoms as backaches, abdominal pain, irritability and depression, has been suggested attributable to progesterone deficiency. However, as stated in the widely read and popular book Our Bodies, Ourselves “sometimes expecting to feel premenstrual tension and depression may increase the severity of the depression. We must not forget that the problems we get depressed about are usually there all the time, but perhaps we. have been ignoring them the rest of the time” [5, p. 351. A relevant component of a health and sex education program would be to stress that venting anger and indeed expressing any emotional affect is permissible and should be appropriately directed, by women as well as men. And that just as the menstrual period may be accompanied by only few or minor physical discomforts, the psychological disequilibrium may be a minor aspect. Furthermore, this disequilibrium may in fact be causally related to external, social factors, rather than to physiological functions.

Experiences of puberty development The girls who stated they were symptom-free during menses, did, however, claim to experience affective changes such as irritability and mood swings, related to pubescence in general (30%). 25% of the girls who experienced minor physical discomfort during menstruation similarly claimed that irritability and sourness, were feelings accompanying puberty changes. Hence, it would seem that in one way or another---either specifically related to the menses or the pubescent stage in general-affective states of disharmony are experienced. Accounts of puberty as a stage of developing greater maturity and autonomy were most often related by the girls who were symptom-free during menses (over 40x), whereas only 13% of those who attributed irritability and mood swings to the menstrual period claimed to feel ‘more mature’. SOURCES OF INFORMATION

Reactions to the physical changes of puberty, and most crucially, to the onset of menses may be greatly influenced by the societal attitudes towards these changes, as they are reflected in the media and by significant others; in parents, peers and teachers. A relevant correlation may be made between the nature of the feelings a pubescent girl has toward menses and the extent to which she has been informed of or prepared for, the transformations of puberty and by whom. Furthermore, with whom are these experiences most often shared? Teacher and mother are cited with almost similar frequency by the girls (30% each) as their first source of information about sexual matters, followed by peers (20%). They claim to have learned most from their teachers, however, and less from their peers than either teacher or mother. The imparter of the most information and perhaps even the perceived validity of this information, does not appear to coincide with the person with whom the girls prefer to discuss sexual matters: the order of preference is now peers (70x), followed by mother (56%). Of a choice of eight different persons, the teacher is placed last as the one they would most readily discuss sexual matters with. There is an apparent difference between boys and girls in this study, regarding the sources of information received. Only 8% of the boys had turned to their mothers for their first information about sex (as opposed to 30% of the girls). For them, the emphasis was placed on the information received in schoolfrom a more indirect, but perhaps considered a more authoritative, source (almost 50%). Contrary to the girls, boys claim to have learned more from their peers than their mothers. For both sexes, father plays very minor role as a source of sex information and was thus liarned by only 1.5% of all respondents. When combined with the answer category ‘both parents’ the percentage still remains under 57;. This has similarly been found in a previous Danish study of the school youth and socio-sexual experiences [6] and can perhaps yet again dispel the myth of the father-son woodshed talks about sex. It seems that both sexes turn to peers for purposes of identification and sharing of experiences and only

463

thereafter turn to an adult role model when in need of more concrete, perhaps more accurate and specific information. This emphasis upon peer identification has similarly been found in a British study from the 60s; Schofield [7] found that peers were placed as the most important source of information, but this information was regarded by the respondents as qualitatively poor. These findings could suggest that pubescents do in fact place a greater import on the psychological dimensions of the pubertal transition itself, than on concrete, or even accurate information regarding sexual matters. Correlated with experiences with menstruation, no notable differences can be seen with regard to symptomatology among those who prefer to talk with peers and those who prefer mother. That is, both among girls who experience no symptoms related to menstruation and among those who recount either psychological or somatic symptoms, peers and mother rank in the same order of preference. As mentioned previously, there is an emphasis upon the affective changes accompanying the menses, among the respondents. If one can surmise that the girls share their experiences with peers, with girlfriends, then it could appear that the peer group collectively maintains and perhaps mutually supports attitudes and expectations regarding menstrual distress. PUBERTY It is also interesting to note that when girls were asked to describe general experiences of puberty, the emphasis was placed on psychological-rather than physical-growth or change. The psychological transformations described ranged from feelings of irritability, mood swings, to greater interest in the opposite sex and concern with appearance, to an increased sense of maturity (and desire to be taken seriously by adults) to a need for autonomy and independence from parents. SUBJECTIVE EXPERIENCES OF PUBERTY

Girls Boys (N = 158) (n = 113) General growth Development of sex characteristics Psychological and physiological changes Several psychological changes Mood swings, irritability Shyness, insecurity Greater interest in world events Greater interest in the opposite sex Greater sense of maturity

;;I}

13.3 16.5

17.1

1

19.0 0.6

4;:;}58.4

16.8 3.5 6.2 0.9

69.7 1.3

24.8 1.8 :

12.7

6.2

19.6

6.2

464

LISBETHSHORE

This range of psychological changes is described by 70% of the girls, whereas only 17% attritute general growth and development of secondary sex characteristics to the pubertal period. The remaining 13% describe changes related to both physical and emotional development. The girls’ greater emphasis upon the psychological transformations of puberty could be explained by the fact that the question of menstruation had already been dealt with in the questionnaire, so that it might seem superfluous to note this in a subsequent answer. But the development of primary and secondary sex characteristics changes in the genital area and growth of breasts and hips, was mentioned by surprisingly few girls. It would appear that changes related to the assertion of autonomy and the process of individuation receive most attention from these pubescent girls. This emphasis is in marked contradiction to the pubertal transformations experienced by their male peers. Amongst the boys in the study, growth and development of primary and secondary sex characteristics were most frequently described as major pubertal changes. Only about 20% describe changes of a psychological character, and almost 60% describe puberty in terms of growth and development of the genitals, the emergence of body hair, deepening of the voice and growth and development in body size and musculature. Specific descriptions of puberty development in terms of feelings of greater maturity were found among almost 20% of the girls, but only among 6% of the boys. For some time it has been generally acknowledged by parents and professionals that there is a greater physical and emotional maturity among girls, relative to their pubescent male peers. Here, it is interesting that the differences in levels of maturity were recounted by direct subjective accounts of the pupils themselves. In the psychoanalytic literature, the great attention paid by pubescent boys to their physical growth and development has been attributed to phallic narcissism as well as to the fact that boys can readily visualize their genital development. It has also been suggested that few pubescent girls admire their genitals as boys do, and that for many, penis envy is literal and specific [8]. Furthermore, it is stated that not only are adolescent boys much preoccupied by the size of the penis, but that this phallic narcissism may be maintained by compensatory mechanisms, in the development of athletics and intellectual interests [9]. The differing ways in which pubescent males and females experience themselves and the process of growth may have an influence upon their choices or preferences in interests and future plans. In this study, the girls’ emphasis upon the psychological/emotional dimensions, and the boys’ emphasis upon the physical manifestations of puberty development, may in part explain the differences evidenced, using parameters of school subject preference, free-time reading choice and career or educational goals. Psychoanalytic theory emphasises the sublimation or compensation aspects of phallic interest among boys as an explanation for choice of social and

intellectual interests, but I suggest that here again, the socialization of sex role adherence plays an influential part in promoting sex-specific interests and behavior. In this study for example, twice as many girls as boys preferred their courses in Danish and foreign languages, and twice as many boys as girls preferred mathematics and physics. The fact that fewer girls than boys state mathematics as a favourite subject may be less an indication of active choice than a result of a sex-role socialization process-i.e. that girls have been instilled with the notion that they cannot master mathematical skills, and therefore must choose other avenues to excel in. However, another argument may be made in favor of a similar socialization process among boys. namely that their competence lies in technical/manual skills, and that therefore language skills cannot be mastered to the same extent as among girls. Of the practical and manual subjects, woodworking, photography and electronics were chosen by 25:< of the boys but by only 3% of the girls. Conversely, home economics and cooking were preferred by ten times as many girls as boys. It could be that the emphasis among boys on learning practical and technical skills (apart from household skills), is in preparation for future employment. Almost 35% plan to enter a trade apprenticeship following secondary school: only 64; of the girls had similar plans. 66:; of the girls looked forward to some sort of higher education, as opposed to 40% of the boys. Although twice as many boys as girls planned to enter the job market immediately following school. this category comprised less than 5”,/, of all the respondents, and considering the high rate of unemployment among youth today and the difficulty in entering the job market, it seems surprising that nearly 25:/, as yet have no plans regarding employment or educational choices. A division of interests can further be illustrated by the respondents’ reading habits. Apparently, girls read more than boys in their free time. 30% of the boys claimed not to read outside of school-only 10% of the girls stated the same. Nearly 50% of the girls cited titles of literary works recently read, either classical literature or newer novels geared to youth. This was true of only 250,: of the boys. However, almost 20% of the girls frequently read romance magazines, and 10% of the boys enjoyed books and magazines dealing with electronics and sports. CONCLUSION

The subjective experiences of pubertal development can be important to consider when developing sex education programs, and when regarding adolescent behavior patterns. For example, should some time be spent in smaller groups, to permit greater openness in discussions of specific pubertyrelated topics, and should more emphasis be placed on emotional development and social issues, rather than the so-called ‘technical’ aspects of sexuality? In this study, interview responses could suggest that regarding sex education. the cart came before the donkey-i.e. the technical, specifically heterosexual, genital sexuality with its precautions about con-

Experiences of puberty development traception and venereal disease, were dealt with before the pupils were emotionally and experientially prepared. Most of the pupils had experienced neither intercourse nor petting, and were in fact less preoccupied with this than their teachers would have them be. Pupils of both sexes were more concerned with psycho-social issues; group dynamics in the classroom, friendships, peer pressure and exclusion were frequently named as desired discussion topics, as were dating, falling in love, ‘how does the opposite sex feel?‘. Furthermore, the rate of teenage abortions and the frequency of venereal disease may be less related to actual knowledge of preventive methods, than to the emotional readiness for implementing this knowledge when the need arises. The less tangible issues of understanding the changes taking place in one’s body and mind, the acceptance of new roles and responsibilities are tasks for the health and teaching professions, when dealing with adolescents. Learning to communicate openly is perhaps more important than memorizing the func-

465

tions of contraceptive venereal diseases.

methods or the symptoms

of

REFERENCES

1.

BIOS P. On Adolescence.

Free Press, Glencoe, 1962.

2. Danish Board of Health. Statistics on Contraception and Abortion 1981, Vol. 1, p. 4, 1982. 3. Paludan L. Shore. The family planning rights of minors in Denmark. In The Family Planning Rights of Minors: A Comparative Study (Edited by Trost and Rodman). Giiteborg, 1982. 4. Sklansky M. The pubescent years. In Latency, Adolescence und Youth (Edited by Greenspan).

5. 6. 7. 8.

Washington, DC, 1980. Boston Women’s Health Collective. Our Bodies. Ourselves. New York, 1971. Hesselhmd H. Socio-sexuelle erfariwer hos skoleunp_ ‘, dom. Aalborg 1977. Schofield M. The Sexual Behavior of Young People. Boston 1965. Ritvo S. Adolescent to woman. J. Am. Psychounulyt. u

Ass. 24, 1976.

9. Sklansky M. op. cit.