Endometriosis

Anne had never had problems with her periods the way some of her friends did. But over time her periods started getting so painful that she dreaded their arrival. Every month for a few days she would curl up on the couch with a heating pad and take a pain reliever. The cramps eventually became so bad that she was missing school a couple of days a month, and the pain even started happening between periods.

Anne's doctor thought Anne might have endometriosis. So she referred her to a specialist in treating this condition.

What Is Endometriosis?

When a woman has endometriosis, tissue that looks and acts like the lining of the uterus starts growing outside the uterus. The most common locations for these growths — called endometrial implants — are the outside surface of the uterus, the ovaries, the fallopian tubes, the ligaments that support the uterus, the intestines, the bladder, the internal area between the vagina and rectum, and the lining of the pelvic cavity.

Endometriosis affects more than 5 million American women, including teen girls. It's not always diagnosed right away in teens because at first they or their doctors assume that their painful periods are a normal part of menstruating. But continuing, excessive pain that limits activity isn't normal and should always be taken seriously. Because severe endometriosis can make it complicated for a girl to have children in the future, it's a good idea to get medical help for endometriosis and not wait too long.

To understand why endometriosis causes problems, it helps to have a basic understanding of how the monthly menstrual cycle works: During the course of each cycle, the lining of a woman's uterus builds up with blood vessels and tissue. This happens because the uterus is getting ready to receive the egg that will be released from one of the ovaries. If the egg isn't fertilized by sperm, the uterus sheds the tissue and blood; this is the menstrual period. This entire process is controlled by the female sex hormones and usually takes about 28 to 30 days.

Because the abnormal growths associated with endometriosis are made up of the same kind of tissue and blood vessels found in the uterine lining, any endometrial implants will act just like the endometrium in the uterus. That means they respond in the same way to the hormonal changes of the menstrual cycle.

However, in the uterus, if the egg isn't fertilized, the extra tissue and blood leave a girl's body in the form of menstrual fluid. With endometriosis, though, there's nowhere for the accumulating blood and tissue to go once the implants start to break down. For this reason, the implants usually become somewhat larger with each cycle, and the symptoms of endometriosis tend to become more painful over time.

What Causes Endometriosis?

Doctors aren't sure what causes endometriosis. They do know that it is slightly more common in teens and women who have a family member who has been diagnosed with endometriosis.

There are several theories about how the endometrial tissue actually gets outside the uterus in the first place. One theory suggests that the menstrual blood flow somehow "backs up" into the fallopian tubes, carrying some tissue from the uterine lining with it. In effect, the tissue gets transplanted and starts growing outside the uterus.

Another theory is that endometrial tissue cells travel out of the uterus through blood or lymph vessels, and then start growing in the new locations where they're deposited. Yet another theory suggests that some girls are born with "misplaced" cells that can turn into endometrial implants later in life. Scientists continue to research the condition to help doctors fully understand and treat it.

What Are the Signs and Symptoms?

The most common sign of endometriosis is severe pelvic (lower abdominal) pain. It may occur occasionally or constantly, and it may be associated with a girl's period. Although slight cramps for a couple of days before or during a menstrual period are normal, lasting or intense pain that disrupts a person's day is not. With endometriosis, the pain is usually so bad that it causes a girl to miss school, sports, and social activities.

Other possible symptoms include:

• pelvic pain that gets worse after sex, or after a pelvic exam
• a very heavy period
• lower back pain
• constipation, diarrhea, or feeling pain or seeing blood when going to the bathroom (endometrial implants can press on some of the organs involved in getting waste out of the body, such as the bladder, intestines, and rectum)

If a girl notices these symptoms, it doesn't necessarily mean that she has endometriosis. Lots of other things — like an infection — may cause similar symptoms. But it's important to see a doctor right away if you notice these symptoms. If you haven't been examined by a gynecologist for the first time yet, this is a good time.

How Is It Diagnosed?

Diagnosing endometriosis isn't always easy. Lots of things can cause pelvic pain, so even if a girl's symptoms point to endometriosis, a doctor may want to rule out other possibilities.

In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history. Depending on your symptoms, a doctor may also ask you to keep a pain diary. This may involve recording the following information every time you experience pain:

• type of pain (is it sharp? dull? aching? crampy?)
• location (where is it?)
• duration (how long does it last?)
• intensity (on a scale of 1 to 10, how bad is the pain?)
• treatment (did you try anything to make the pain go away? did it help?)

The severity of the pain isn't always an indicator of how severe the endometriosis might be. A girl may have many growths and just a little pain or a few growths and a great deal of pain. Every person's situation is a little bit different.

The only way to know for certain whether a girl has endometriosis is to perform a minor surgical procedure called laparoscopy (pronounced: la-puh-ras-kuh-pee). This allows the doctor to know for certain whether a girl has endometrial implants and, if so, how extensive they are.

While a girl is under anesthesia, the doctor makes a small cut near her belly button and inserts a thin, lighted tube (known as a laparoscope) that acts as a tiny video camera so that the doctor can view the pelvic organs. During the procedure, the abdomen is filled with a gas to help the doctor see the organs better. The doctor may also do a biopsy, which means removing small pieces of the growths for examination under a microscope.

Even if a girl's symptoms point to endometriosis, a doctor may not want to perform a laparoscopy right away. He or she may first order scanning tests that can create images of the pelvic region, such as ultrasound or magnetic resonance imaging (MRI). This helps to rule out other possible causes of the symptoms. Doctors may also start by telling a girl to take acetaminophen or ibuprofen. Some doctors will prescribe birth control pills, not as a method of contraception but because they have been proven to reduce painful periods, especially those associated with endometriosis.

If these approaches don't work, and the doctor thinks a girl has endometriosis, then he or she will probably order the laparoscopy.

What Do Doctors Do?

Endometriosis can't be cured, but its symptoms can usually be controlled.

Doctors often prescribe birth control pills because they use hormones to prevent ovulation (the monthly release of an egg from an ovary). If a girl doesn't ovulate, then the endometrial implants won't build up as much, and this can make endometriosis less painful.

Other medications used to treat endometriosis work in the same way as birth control pills to modify the hormone-driven buildup and breakdown of endometrial tissue. Doctors typically don't recommend these treatments for teens until well after puberty is completed, though.

Surgery is often helpful if medications don't work. A doctor can remove endometrial growths by directing an intense light beam (laser) onto them with the help of a laparoscope. After this treatment, many girls find relief from their symptoms, but some may experience pain again if the growths return over time. Laparoscopic treatment is the typical type of surgical treatment for endometriosis, although in rare cases more extensive surgery may be needed.

Doctors often suggest lifestyle changes for teens who have endometriosis, too. A healthy diet, moderate exercise, and relaxation techniques such as yoga and meditation can help.

What's It Like to Have Endometriosis?

Apart from the pain, there are other things that can make living with endometriosis a challenge for some girls. Some girls find it difficult explaining to friends and teachers why they miss school, sports, or other activities, for example. If you feel embarrassed, ask your doctor to write a note you can give to teachers and coaches so you don't have to explain yourself. You can then work with them to be sure you don't miss out on key assignments — or fun.

You don't have to go into detail about your condition to friends or classmates unless you want to. If you think someone won't understand, just tell that person you're not feeling well. You have no obligation to provide them with a detailed explanation.

These days, more and more doctors recognize and understand endometriosis. Many girls find that medication limits the extent of their endometriosis. It also controls pain so girls with endometriosis can take part in the activities they enjoy.

Tampons, Pads, and Other Period Supplies

Once you get your period, you'll need to use something to soak up the menstrual blood. There are lots of choices out there, and it may take some experimenting before you find the product that works best for you.

Here's an overview of what's available.

Pads

Super, slender, overnight, with or without wings, deodorant, maxi, mini . . . pads may seem a bit confusing at first because there are so many different kinds. But the good news is that with all these choices, there's bound to be one that works for you.

Pads are rectangles of absorbent material that attach to the insides of a girl's underwear. They're sometimes also called sanitary pads or sanitary napkins. Some pads have extra material on the sides (called "wings") that fold over the edges of your underwear to better hold the pad in place and prevent leakage.

Some girls have periods with heavier bleeding, and others have lighter periods with less bleeding. Pads come in several different thicknesses and absorbencies for heavier or lighter menstrual periods or for day or nighttime use. That way, girls who have a lighter flow don't need to feel like they're wearing a pad that's bigger than they need — and girls with a heavy flow don't need to worry that they'll leak through their pad.

Some pads come with a deodorant or deodorizing substance in them, although these can cause irritation in the genital area for some girls.

Most pads that you buy in stores have a sticky strip along the bottom. You peel off the strip that covers the adhesive, press the pad into the crotch of your underwear (wrapping the wings around and sticking them under the crotch if the pad you're using has wings). This type of pad is disposable. Once you've removed the pad, wrap it in toilet paper and put it in the trash can (or if you're at school or out somewhere, in the special disposal box that's found in most stalls). Don't try to flush a pad down the toilet — even the lightest kind of pad may back up the toilet and make a huge (embarrassing!) mess.

It's also possible to buy reusable pads that can be washed after each wearing — these are usually available in natural health stores or online. These kinds of pads clip onto a girl's underwear (or have a special holder that clips on). Some women choose to use these pads because they think they are better for the environment or because they save money. It's all a matter of personal preference.

No matter what kind of pad you choose, it's best to change pads every 3 or 4 hours, even when your flow isn't very heavy. Regular changing prevents buildup of bacteria and eliminates odor. Naturally, if your period is heavy, you should change pads more often because they may get saturated more quickly.

Tampons

Unlike a pad, which catches menstrual blood after it leaves the body, a tampon absorbs blood from inside the vagina. A tampon is also made of absorbent material, but it's compressed into a tiny tubular shape. Like pads, tampons come in different sizes and absorbencies for heavier and lighter periods (words like "super" or "ultra" on the packaging usually mean that a tampon is designed for girls whose flow is heavier).

Tampons can also come with or without deodorant. Again, using these is a matter of personal preference. There's no real need for deodorant in a tampon, since regular changing usually gets rid of any odor. And girls should be aware that, for some people, the deodorant in tampons can irritate the vagina.

It's easy to use a tampon, but you do need to learn how. After washing your hands, follow the directions that come with the tampons carefully and be sure to relax. Some tampons come with an applicator — a plastic or cardboard tube that guides the tampon into the vagina. Other tampons are inserted with the fingers. Some girls find that using an applicator-style tampon (especially one with a rounded top) and a slender-sized tampon makes it easier at first. It also helps to first try a tampon on a heavier flow day, so that the tampon slips in easier.

Many girls worry about whether a tampon can get lost inside them. Luckily that can't happen because the opening of the cervix (located at the top of the vagina) is just too tiny for a tampon to get through. Tampons usually have a string attached to one end that stays outside a girl's body and can be used to remove the tampon at any time.

A tampon needs to be changed every 4 to 6 hours or when it's saturated with blood. Because you can't see a tampon as you can with a pad, you'll need to remember when it's time to change or you may get spotting or leakage on your underwear or clothing. Pull gently on the string that is attached to the end of the tampon until the tampon comes out, wrap it in toilet paper, and throw it in the trash. Don't flush a tampon down the toilet — even when the box says a tampon is flushable, some tampons can still cause problems in some plumbing systems.

If it's time to change your tampon and you can't find the string, don't worry! A tampon can't get lost inside you. You'll need to reach in with your fingers to find the string. It may take a minute to do because the string might be a bit hard to grab.

Menstrual Cups

Like a tampon, a menstrual cup is inserted into the vagina. Instead of absorbing menstrual blood, though, the cup catches the blood before it flows out of the vagina. Menstrual cups are made of flexible materials, like rubber or silicone. As with tampons, you can't see when the cup is full, so it will need to be emptied (or, in the case of disposable cups, thrown away) several times a day. Instructions that come with the cup explain how to do this.

Menstrual cups are not as commonly used as tampons, so they may be harder to find. Although some menstrual cups look like a diaphragm, they are not a method of contraception and will not offer any protection against pregnancy or STDs.

Avoiding Problems

One thing to remember about tampons: It's very important that you change them every few hours and that you wear the absorbency type that is right for you. Never put a tampon in and leave it in all day or all night, thinking that you won't need to change it because your period is so light. Doing this puts girls at risk for a rare but very dangerous — and sometimes life-threatening — disease called toxic shock syndrome (TSS).

TSS results from a bacterial infection that may occur when using super-absorbent tampons, especially if they are left in longer than is recommended.

Symptoms of TSS include high fever, vomiting or diarrhea, severe muscle aches, a feeling of extreme weakness or dizziness, and a rash that looks like a sunburn. If you ever have these symptoms while wearing a tampon, remove it and tell a parent, school nurse, or other adult immediately. Have someone take you to the nearest emergency department as soon as possible. The body can go into shock with TSS if someone waits too long to seek medical treatment.

Remember, though, that TSS is very rare and most women never become ill from using tampons, especially if they follow the guidelines for changing them regularly.

Tampon or Pad?

When deciding what type of protection to use, it's really up to you. Some girls like tampons because they're easy to store in a purse or pocket. Tampons and cups are also helpful for girls who participate in sports like swimming, since you can't wear a pad in the water.

Some girls prefer pads because they're easy to use and it's easier to remember when to change them since you can see them getting soaked with blood.

Many girls switch back and forth: Sometimes they use tampons and sometimes they use pads, depending on the situation, where they're going to be, and their menstrual flow. Some girls use pads at night and tampons during the day. And some girls with heavy periods use tampons together with pads or pantiliners for added protection against leakage.

If you have any concerns or questions about your period, talk to your doctor.

Polycystic Ovary Syndrome

Cecily never really worried that her periods weren't regular because, like many girls, she assumed her monthly cycle would take time to settle down. But then Cecily's periods stopped for several months, so she went to see her doctor.

The doctor noticed that Cecily's acne had worsened and that she had gained a lot of weight since her last appointment. She said she wanted to check Cecily for a condition called polycystic ovary sydrome (PCOS).

What Is Polycystic Ovary Syndrome?

Polycystic (pronounced: pah-lee-sis-tik) ovary syndrome is a common health problem that affects teenage girls and young women. Although no one really knows what causes PCOS, it seems to be related to an imbalance in a girl's hormones.

Both girls and guys produce sex hormones, but in different amounts. In girls, the ovaries produce the hormones estrogen and progesterone, and also androgens. These hormones regulate a girl's menstrual cycle and ovulation. Even though androgens are sometimes referred to as "male hormones," every female produces them.

In girls with PCOS, the ovaries produce higher than normal amounts of androgens, and this can interfere with egg development and release. Some of the eggs develop into cysts, which are little sacs filled with liquid. Instead of being released during ovulation, as an egg is during a normal menstrual cycle, the cysts build up in the ovaries and may become enlarged. Because girls with PCOS are not ovulating or releasing an egg each month, it's common for them to have irregular or missed periods.

Although PCOS (which used to be called Stein-Leventhal syndrome) was first recognized in the 1930s, doctors can't say for sure what causes it. Research has suggested that PCOS may be related to increased insulin production in the body. Women with PCOS may produce too much insulin, which signals their ovaries to release extra male hormones. PCOS seems to run in families, too, so if someone on your mom's or dad's side of the family has it, you might be more likely to develop it.

If PCOS is not treated properly, it can put a girl at risk for lots of problems. Girls with PCOS are more likely to have infertility, excessive hair growth, acne, obesity, diabetes, heart disease, high blood pressure, abnormal bleeding from the uterus, and cancer.

The good news is that, although there's no cure for PCOS, it can be treated. The most important step is diagnosing the condition, because getting treatment for PCOS reduces a girl's chances of having serious side effects.

What Are the Signs and Symptoms?

A key sign of PCOS is irregular or missed periods because the effects of the condition on the ovaries can make a girl stop ovulating. However, because it can take up to 2 years after her first period for a girl's menstrual cycle to become regular, missed periods may not be a reliable sign of PCOS in teen girls. Imbalanced hormone levels can cause changes in a girl's entire body, not just her ovaries.

So doctors also look for these other signs that might indicate PCOS:

• very heavy periods or periods that come more than once a month
  
• weight gain, obesity, or difficulty maintaining a normal weight, especially when the extra weight is concentrated around the waist
  
• a condition called hirsutism (pronounced: her-suh-tiz-um), where a girl grows extra hair on her face, chest, abdomen, nipple area, or back (a little of this is normal for most girls, though)
  
• thinning hair on the head (doctors call this alopecia)
  
• acne and clogged pores
  
• darkened, thickened skin around the neck, armpits, or breasts (this is called acanthosis nigricans)
  
• high blood pressure, high cholesterol, or diabetes mellitus (high levels of sugar in your blood)

Girls who show certain signs of puberty early — such as girls who develop underarm or pubic hair before the age of 8 — may be at greater risk of having PCOS later on.

How Is Polycystic Ovary Syndrome Diagnosed?

If you've taken your concerns about your body to your doctor, you're on the right track. Your doctor may refer you to a gynecologist or an endocrinologist for a diagnosis.

The gynecologist or endocrinologist will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. He or she will also ask you lots of questions specifically about your period and its regularity. This is called the medical history.

In addition to your medical history, your doctor will do a physical examination, which includes checking your weight, and checking especially for physical signs such as acne, hair growth, and darkened skin. If you are sexually active, the doctor may perform a gynecologic examination to rule out other possible causes of your symptoms, but this is not always necessary for diagnosis.

A doctor may also perform blood tests to diagnose PCOS or other conditions, such as thyroid or other ovarian or gland problems. Blood tests allow doctors to measure androgen, insulin, and other hormone levels. The results of these tests can help doctors to determine the type of treatment a girl will receive. Your doctor may also order another test, called an ultrasound, to look at your ovaries and to determine if you have cysts or other abnormalities of the ovaries. Because cysts are not always visible, this test is not always used.

Early diagnosis and treatment for PCOS are important because the condition can put girls at risk for long-term problems. Getting treated for PCOS is a good idea if you want to have a baby someday — PCOS often causes infertility if it's not treated. But when PCOS is treated properly, many women with the condition have healthy babies.

Also, many girls with PCOS can get pregnant. If you are sexually active and do not want to become pregnant, be sure to use condoms every time you have sex even if you have PCOS. This is important even if you are not being treated for PCOS.

How Is It Treated?

Although there's no cure for PCOS, there are several ways that the condition can be treated and managed.

If a girl is overweight or obese, a doctor will recommend that she lose weight. Weight loss can be very effective in lessening many of the health conditions associated with PCOS, such as high blood pressure and diabetes. Sometimes weight loss alone can restore hormone levels to normal, causing many of the symptoms to disappear or become less severe. Your doctor or a registered dietitian can look at your food intake and your exercise and activity to tailor a weight-loss program for you. Exercise is a great way to help combat the weight gain that often accompanies PCOS as well as a way to reduce bloating, another symptom girls with PCOS sometimes experience.

Sometimes doctors prescribe medications to treat PCOS. A doctor might first have a girl try birth control pills or another hormone pill called progesterone to help reduce the androgen levels in her body and regulate her menstrual cycle. These medicines may help control acne and excessive hair growth in some girls, but they don't work for everyone.

Other medications used to treat PCOS include antiandrogens, which counter the effects of excess androgens on a girl's body. Antiandrogens can help clear up skin and hair growth problems in girls with PCOS. Another medication, metformin, which is used to treat diabetes, can lower insulin levels. In some girls with PCOS, it can help control ovulation and androgen levels. This can make a girl's menstrual cycles more regular. Some girls and women treated with metformin have also experienced weight loss and lowering of high blood pressure.

Coping With Polycystic Ovary Syndrome

Having PCOS can be hard on a girl's self-esteem because some of the symptoms, such as skin and hair problems and weight gain, are so noticeable. Fortunately, there are things you can do to reduce the physical symptoms — and take care of the emotional side of living with PCOS.

Although the medications used to treat PCOS will slow down or stop excessive hair growth for many girls, there are lots of different types of products available to help a girl get rid of hair where she doesn't want it. Depilatory creams can gently remove facial hair on the upper lip or chin. Be sure to follow the instructions carefully so you don't develop a rash or allergic reaction.

Tweezing and waxing are other things you can do at home to manage hair growth. A girl can also visit a dermatologist (a doctor who specializes in skin problems) or qualified hair removal specialist for electrolysis and laser surgery treatments. These procedures offer longer term removal of unwanted hair, but they are more expensive.

If you have severe acne as a symptom of PCOS, it may improve if part of your treatment includes birth control pills or antiandrogens. If it doesn't, your doctor may refer you to a dermatologist for further acne treatment. A dermatologist may also be able to recommend medications to help reduce skin darkening or discoloration, and to prevent hair growth.

Some girls with PCOS may become depressed, in which case it may help to talk to a therapist or other mental health professional. Talking with other teens and women with PCOS is a great way to share information about treatment and get support. Your doctor may be able to recommend a local support group.

If you can't find a local group, the Polycystic Ovarian Syndrome Association offers a "Big Cyster" program for teen girls as well as online message boards. If you join, you'll be hooked up with other women or teen girls with PCOS to whom you can turn for advice, support, or just a listening ear.

How to Perform a Breast Self-Examination

Breast development is usually a sign that a girl is entering puberty. Most girls' breasts start to develop before their first periods. During puberty, every girl's breasts go through regular changes. As you grow and develop, you may notice small lumps and other changes in your breasts, and during your period, you may find your breasts are sensitive and tender. Most of these developments are totally normal. Getting into the habit of examining your breasts when you're still in your teens can help you get used to your normal breast changes. When you become familiar with how they feel, it will be easier to recognize anything unusual.

Why Do I Need Breast Exams?

If you go for an annual checkup with a doctor, he or she will likely examine your breasts to evaluate your development and ensure that all changes are normal. Your doctor may recommend that you get into the practice of examining your breasts yourself — called a breast self-examination (BSE) — and can show you how to do this.

A BSE can help women detect cysts or other benign (noncancerous) breast problems between checkups. It can also help some women detect breast cancer — a disease that's extremely rare among teens. It's easy to perform a breast self-examination, and it only takes a few minutes. Although it might seem strange or inconvenient at first, BSE is a skill you can use throughout your life to ensure good breast health.

How Do I Examine My Breasts?

It's a good idea to examine your breasts once a month, and it makes sense to choose the same time each month because breasts usually change with the menstrual cycle. The best time to do a BSE is about a week after your period starts.

There are two parts to a BSE:

• how your breasts look
• how they feel

The looking part is easy. Before you put on a bra, stand or sit in front of a mirror with your arms relaxed at your sides. Look at your breasts carefully. Do you see anything unusual, like a change in the way your nipples look? Any dimples or changes in the skin?

Then look at yourself from different angles and arm positions. Keep your hands at your sides, raise your arms overhead, place your hands firmly on your hips (to tighten your chest wall muscles), and bend forward. Watch for dimples or changes in the skin. Everyone's breasts look different. Get to know what yours look like.

The next part is how your breasts feel. It may seem strange at first to handle your breasts. Some girls feel self-conscious about it, but there's no reason to feel guilty or awkward. BSE is a positive way to stay healthy.

Some girls feel it's easiest to do the feeling part of the BSE in the shower — not only is it convenient, but the soap and water can also help your hands move easily over your breasts. Examine your breasts one at a time. If you're starting with your right breast, raise your right arm, place your right hand behind your head, and use your left hand to feel your breast.

One way to examine your breast is to think of your breast as a circle. Using the pads of your three middle fingers, move your fingers in a spiral motion from the outside to the inside of the circle, gradually getting closer to the nipple. Notice what feels normal and what may feel different from the last time you examined your breasts.

Use different levels of pressure — light, medium, and firm — to feel each part of your breast. This will allow you to feel the various layers of tissue in the breast. Start with light pressure, increase to medium pressure, and finish with firm pressure to feel the deepest tissue. When you have covered the entire breast, use your finger and thumb to gently squeeze your nipple, watching for any discharge. Then put your left arm behind your head and check your left breast the same way.

You can also examine your breasts as you lie on your back on your bed. Use the same method described above, raising one arm and using the other hand to check your breast in a spiral motion. While you're doing the exam, it's a good idea not to take your hand off your breast so you don't miss a spot. You should also check your armpits for any lumps. Girls who have large breasts should also feel their breasts from the side, while lying on one side and then the other.

As you feel your breasts, you may notice lumps or bumps. This is usually normal — just like so many things about people, breasts are unique. Some girls' breasts are large, some are small; some are symmetrical, others are not. Some healthy breasts feel really bumpy, whereas others are less so. Most teens have healthy breasts no matter what they look or feel like. But if you're worried about the way your breasts look or feel, let your doctor know.

Warning Signs

If you feel an unusual lump in your breast, don't panic — breast cancer is extremely rare in teens. In fact, among teen girls, the most common type of breast lump is usually related to normal breast growth and development. Other common conditions can cause a breast lump, such as a noncancerous growth known as a fibroadenoma, and small, fluid-filled cysts that tend to vary in size with a girl's menstrual cycle and are called fibrocystic breast changes.

Fibrocystic breast changes are common. In fact more than half of all women have them. They're related to the normal cycling of hormones associated with menstruation. Fibrocystic breast changes are typically worse just before and at the start of a girl's period.

If you feel a lump in your breast, talk to your doctor to see if the cause is one of these common conditions. If you have fibrocystic breast changes or other breast problems that may make it difficult to perform a good BSE, your doctor can help.

Infections can also cause breast lumps, as can an injury to the breast.

If you have any of these problems, you should talk to your doctor:

• pain in your breast that seems unrelated to your period
• a new lump, bump, or other change in your breast
• a red, hot, or swollen breast
• fluid or bloody discharge from your nipple
• a lump in your armpit

The goal of a BSE is for you to get used to the way your breasts feel. The better you know your body, the healthier you can be!

Having a Healthy Pregnancy

If you've decided to have a baby, the most important thing you can do is to take good care of yourself so that you and your baby will be healthy. Girls who get the proper care and make the right choices have a very good chance of having healthy babies.

Prenatal Care

See a doctor as soon as possible after you find out you're pregnant to begin getting prenatal care (medical care during pregnancy). The sooner you start to get medical care, the better your chances that you and your baby will be healthy.

If you can't afford to go to a doctor or clinic for prenatal care, social service organizations can help you. Ask your parent, school counselor, or another trusted adult to help you locate resources in your community.

During your first visit, the doctor will ask you lots of questions, including the date of your last period. This helps the doctor estimate how long you have been pregnant and your due date.

Doctors measure pregnancies in weeks. A baby's due date is only an estimate, though: Most babies are born between 38 and 42 weeks after the first day of a woman's last menstrual period, or 36 to 40 weeks after conception (when the sperm fertilizes the egg). Only a small percentage of women actually deliver exactly on their due dates.

A pregnancy is divided into three phases, or trimesters. The first trimester is from conception to the end of week 13. The second trimester is from week 14 to the end of week 26. The third trimester is from week 27 to the end of the pregnancy.

The doctor will examine you and perform a pelvic exam. He or she may also perform blood tests, a urine test, and tests for sexually transmitted diseases (STDs, including a test for HIV, which is on the rise in teens. (Some STDs can cause serious medical problems in newborns, so it's important to get treatment to protect the baby.)

The doctor will explain the types of physical and emotional changes you can expect during pregnancy. He or she will also teach you to how to recognize the signs of possible problems during pregnancy (called complications). This is especially important because teens are more at risk for certain complications, such as anemia, high blood pressure, and delivering a baby earlier than usual (called premature delivery).

Your doctor will want you to start taking prenatal vitamins that contain folic acid, calcium, and iron as soon as possible. The doctor may prescribe the vitamins or recommend a brand that you can buy over the counter. These vitamins and minerals help ensure the baby's and mother's health as well as prevent some types of birth defects.

Ideally, you should see your doctor once each month for the first 28 weeks of your pregnancy, then every 2 weeks until 36 weeks, then once a week until you deliver the baby. If you have a medical condition such as diabetes that needs careful monitoring during your pregnancy, your doctor will probably want to see you more often.

During visits, your doctor will check your weight, blood pressure, and urine, and will measure your abdomen to keep track of the baby's growth. Once the baby's heartbeat can be heard with a special device, the doctor will listen for it at each visit. Your doctor will probably also send you for some other tests during the pregnancy, such as an ultrasound, to make sure that everything is OK with your baby.

One part of prenatal care is attending classes where expectant mothers can learn about having a healthy pregnancy and delivery and the basics of caring for a new baby. These classes may be offered at hospitals, medical centers, schools, and colleges in your area.

It can be difficult for adults to talk to their doctors about their bodies and even more difficult for teens to do so. Your doctor is there to help you stay healthy during pregnancy and have a healthy baby — and there's probably not much he or she hasn't heard from expectant mothers! So don't be afraid to ask questions.

Be upfront when your doctor asks questions, even if they seem embarrassing. A lot of the issues the doctor brings up could affect your baby's health. Think of your doctor both as a resource and a friend who you can confide in about what's happening to you.

Changes to Expect in Your Body

Pregnancy causes lots of physical changes in the body. Here are some common ones:

Breast Growth

An increase in breast size is one of the first signs of pregnancy, and the breasts may continue to grow throughout the pregnancy. You may go up several bra sizes during the course of your pregnancy.

Skin Changes

Don't be surprised if people tell you your skin is "glowing" when you are pregnant — pregnancy causes an increase in blood volume, which can make your cheeks a little pinker than usual. And hormonal changes increase oil gland secretion, which can give your skin a shinier appearance. Acne is also common during pregnancy for the same reason.

Other skin changes caused by pregnancy hormones may include brownish or yellowish patches on the face called chloasma and a dark line on the midline of the lower abdomen, known as the linea nigra.

Also, moles or freckles that you had prior to pregnancy may become bigger and darker. Even the areola, the area around the nipples, becomes darker. Stretch marks are thin pink or purplish lines that can appear on your abdomen, breasts, or thighs.

Except for the darkening of the areola, which can last, these skin changes will usually disappear after you give birth.

Mood Swings

It's very common to have mood swings during pregnancy. Some girls may also experience depression during pregnancy or after delivery. If you have symptoms of depression such as sadness, changes in sleep patterns, thoughts of hurting yourself, or bad feelings about yourself or your life, tell your doctor so he or she can help you to get treatment.

Pregnancy Discomforts

Pregnancy can cause some uncomfortable side effects. These include:

• nausea and vomiting (especially early in the pregnancy)
• leg swelling
• varicose veins in the legs and the area around the vaginal opening
• hemorrhoids
• heartburn and constipation
• backache
• fatigue
• sleep loss

If you have one or more of these side effects, keep in mind that you're not alone! Ask your doctor for advice on how to deal with these common problems.

If you are pregnant and have bleeding or pain, call the doctor immediately, even if you are not planning to continue the pregnancy.

Things to Avoid

Smoking, drinking alcohol, and taking drugs when you are pregnant put you and your baby at risk for a number of serious problems.

Alcohol

Doctors now believe that it's not safe to drink any amount of alcohol when you are pregnant. Drinking can harm a developing fetus, putting a baby at risk for birth defects and mental problems.

Smoking

The risks of smoking during pregnancy include stillbirths (when a baby dies while inside the mother), low birth weight (which increases a baby's risk for health problems), prematurity (when babies are born earlier than 37 weeks), and sudden infant death syndrome (SIDS). SIDS is the sudden, unexplained death of an infant who is younger than 1 year old.

Drugs

Using illegal drugs such as cocaine or marijuana during pregnancy can cause miscarriage, prematurity, and other medical problems. Babies can also be born addicted to certain drugs.

Ask your doctor for help if you are having trouble quitting smoking, drinking, or drugs. Check with your doctor before taking any medication while you are pregnant, including over-the-counter medications, herbal remedies and supplements, and vitamins.

Unsafe Sex

Talk to your doctor about sex during pregnancy. If your doctor says it's OK to have sex while you're pregnant, you must use a condom to help prevent getting an STD. Some STDs can cause blindness, pneumonia, or meningitis in newborns, so it's important to protect yourself and your baby.

Taking Care of Yourself During Pregnancy

Eating

Many girls worry about how their bodies look and are afraid to gain weight during pregnancy. But now that you are eating for two, this is not a good time to cut calories or go on a diet. Both you and your baby need certain nutrients so the baby can grow properly. Eating a variety of healthy foods, drinking plenty of water, and cutting back on high-fat junk foods will help you and your developing baby to be healthy.

Doctors generally recommend adding about 300 calories a day to your diet to provide adequate nourishment for the developing fetus. You should gain about 25 to 35 pounds during pregnancy, most of this during the last 6 months — although how much a girl should gain depends on how much she weighed before the pregnancy. Your doctor will advise you based on your individual situation.

Eating additional fiber — 25 to 30 grams a day — and drinking plenty of water can help to prevent common problems such as constipation. Good sources of fiber are fresh fruits and vegetables and breads, cereals, or muffins that have lots of whole grain in them.

You'll need to avoid eating or drinking certain things during pregnancy, such as:

• certain types of fish, such as swordfish, canned tuna, and other fish that may be high in mercury (your doctor can help you decide which fish you can eat)
• foods that contain raw eggs, such as mousse or Caesar salad
• raw or undercooked meat and fish
• processed meats, such as hot dogs and deli meats
• soft, unpasteurized cheeses, such as feta, brie, blue, and goat cheese
• unpasteurized milk, juice, or cider

It's also a good idea to limit artificial sweeteners, and drinks that contain caffeine and artificial sweeteners.

Exercise

Exercising during pregnancy is good for you as long as you are having an uncomplicated pregnancy and choose appropriate activities. Doctors generally recommend low-impact activities such as walking, swimming, and yoga. Contact sports and high-impact aerobic activities that pose a greater risk of injury should generally be avoided. Also, working at a job that involves heavy lifting is not recommended for women during pregnancy. Talk to your doctor if you have questions about whether particular types of exercise are safe for you and your baby.

Sleep

It's important to get plenty of rest while you are pregnant. Early in your pregnancy, try to get into the habit of sleeping on your side. Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. Also, it makes your heart's job easier because it keeps the baby's weight from applying pressure to the large vein that carries blood back to the heart from your feet and legs.

Some doctors recommend that girls who are pregnant sleep on the left side. Because of where some of your major blood vessels are, lying on your left side helps keep the uterus from pressing on them. Ask what your doctor recommends — in most cases, lying on either side should do the trick and help take some pressure off your back.

Throughout your pregnancy, but especially toward the end, you may wake up often at night to go to the bathroom. While it's important to drink enough water while you're pregnant, try to drink most of it during the day rather than at night. Use the bathroom right before going to bed. As you get further along in your pregnancy, you might have a difficult time getting comfortable in bed. Try positioning pillows around and under your belly, back, or legs to get more comfortable.

Stress can also interfere with sleep. Maybe you're worried about your baby's health, about delivery, or about what your new role as a parent will be like. All of these feelings are normal, but they may keep you up at night. Talk to your doctor if you are having problems sleeping during your pregnancy.

Emotional Health

It's common for pregnant teens to feel a range of emotions, such as fear, anger, guilt, confusion, and sadness. It may take a while to adjust to the fact that you're going to have a baby. It's a huge change, and it's natural for pregnant teens to wonder whether they're ready to handle the responsibilities that come with being a parent.

How a girl feels often depends on how much support she has from the baby's father, from her family (and the baby's father's family), and from friends. Each girl's situation is different. Depending on your situation, you may need to seek more support from people outside your family. It's important to talk to the people who can support and guide you and help you share and sort through your feelings. Your school counselor or nurse can refer you to resources in your community that can help.

Sometimes girls who are pregnant have miscarriages and lose the pregnancy. This can be very upsetting and difficult to go through for some girls, although it may bring feelings of relief for others. It is important to talk about these feelings and to get support from friends and family — or if that's not possible, from people such as counselors or teachers.

School and the Future

Some girls plan to raise their babies themselves. Sometimes grandparents or other family members help. Some girls decide to give their babies up for adoption. It takes a great deal of courage and concern for the baby to make these difficult decisions.

Girls who complete high school are more likely to have good jobs and enjoy more success in their lives. If possible, finish high school now rather than trying to return later. Ask your school counselor or an adult you trust for information about programs and classes in your community for pregnant teens.

Some communities have support groups especially for teen parents. Some high schools have child-care centers on campus. Perhaps a family member or friend can care for your baby while you're in school.

You can learn more about what to expect in becoming a parent by reading books, attending classes, or checking out reputable websites on child raising. Your baby's doctor, your parents, family members, or other adults can all help guide you while you are pregnant and after the baby is born.

Breast Health

Maintaining breast health is of utmost importance. The American Cancer Society’s findings indicate that breast cancer is the 2nd leading cause of cancer deaths in women in the United States. (American Cancer Society, Cancer Facts and Figures 2007, 2007) Moreover, the highest incidence of breast cancer occurs in women living in North America. ( American Cancer Society, What Are the Key Statistics for Breast Cancer?, 2007) Breast cancer gets a lot of attention because of these statistics, but there are other conditions that you need to be aware. Read on for general information about breast disorders, the importance of early detection and some tips on self-examination. The information presented in this article does not replace the advice of a qualified medical practitioner. It is intended to bring awareness to this area so that you can be motivated to consult a medical professional about regular screenings and preventative health tips.

There are numerous breast disorders to be aware of; so many in fact that we’ll stick to pointing out some major categories. There are a number of breast conditions associated with infections and irritation that are due to hormonal changes and breast-feeding. Mastitis, which is caused by the blockage of milk ducts, is more common than you might think and can lead to pain, fever and abscesses, which would require surgical intervention. Pregnancy can be a beautiful life-changing event, but a woman needs to be conscious of risk factors. Fibrocystic Disease, which is characterized by benign tumours or cysts in the breast, can be disturbing because it can be mistaken for a cancerous variety. Paget's disease of the breast, on the other hand, is malignant (meaning: severe and progressively worsening) and can go relatively unnoticed until very late in its progression because the symptoms don't present themselves as harmful. These disorders all have one thing in common: they can be diminished but require a woman to be conscious of changes to her breast and body.

Early detection is vital to a woman's health and treatment options. It’s important to know that not all breast disorders are malignant. Therefore, if you notice that there have been changes to your breast or nipple shape, discharge, or skin irritation, do not be alarmed: simply report these findings to your doctor. The more in tune you are with your ever-changing body, the better off you'll be in keeping yourself healthy.

Early detection is significantly improved by routine checkups, ever improving technologies to detect cancer and regular self-exams. Prevention by maintaining a healthy lifestyle combined with early detection can help people overcome disease.

Self Examination is a necessary part of your overall health routine and maintenance. We'd like to share a few tips. Practice makes perfect: if you try to do a Breast Self Exam (say) once a month on an easy-to-remember day, you get to know your breasts well and can be more conscious of gradual changes. Try to pick a period of time when your breasts won't normally be swollen or sore (e.g. not near a period).

Also, do a visual inspection of your breasts and take note of scaliness, rashes, nipple discharge and changes in shape and color of your breast and/or nipples. Use a mirror to assist you and consider noting down observations in a journal. Also, do your self exam in a number of positions like standing, sitting and lying down. Use the first few fingers of your hand and use circular motions to inspect the tissue all around your breast, in your armpit, from your collarbone to the top of your tummy. Your best bet would be to get your doctor to show you how they do it.

If you find something unusual while doing a breast exam, don’t panic because there are a lot of conditions out there that are benign (meaning: mild and non-progressive). However, make it a point to get it checked out thoroughly. If you are not a person who has high risk factors for breast cancer, share this message with people that you care about who might be: it might motivate them to live a more consciously healthy lifestyle to try to diminish any risk factors that they might facing.

How To Put on a Female Condom

Female condoms are soft, transparent tubular sheaths that are inserted into the vagina prior to sexual intercourse and provide protection against both pregnancy and STDs, including HIV/AIDS. The inner right at the closed end of the condom aids in insertion and secures the device in place during intercourse, while the softer ring remains outside the vagina. They can not be reused. Here are step by step instructions on using the female condom.

Difficulty: N/A

Time Required: with practice only a minute or so

Here's How:

1. Check the expiry date on the package.
2. Open the package and find the closed end of the condom. Hold the inner ring at the closed end of the condom, and squeeze it together in the middle, forming a figure eight with the ring.
3. Find a comfortable position to insert the ring. Most women will do it lying on their back, squatting, or standing with one foot on a chair.
4. With your free hand, spread open the outer vaginal lips.
5. Holding the inner ring, push the ring up into the vagina as far as possible, past the pubic bone and covering the cervix.
6. Insert index or middle finger into FC, to insure it is in place. About one inch of the condom, including the outer ring will remain outside your body.
7. Once the penis enters the vagina this slack will decrease. However the outer ring should remain outside the vagina protecting the external genitalia.
8. Be careful not to let the penis push the outer ring into the vagina. Also be sure that the penis enters the vagina in the condom and not on the side between the condom and the vaginal wall. If either of these happens, stop sex play immediately and readjust the ring.
9. To take out the female condom, hold the outer ring and twist before you pull out. This will keep any fluid (semen) inside the ring.
10. Gently remove the ring and throw it out. If you want to be extra considerate, tie a knot in the top of the female condom so the semen doesn’t leak out in the garbage.

Why Are My Breasts Sore?

Like most parts of the body, breasts can be sore from time to time. Not only for girls, but for guys, too. You may be worried about your body's development, about what causes breast soreness, and even about cancer.

If you're a girl, you may have noticed a slightly sore feeling when you wash your breasts in the shower. Or maybe you felt an ache when you've rolled onto your stomach in bed. Sometimes it may have felt like your breasts gained 10 pounds overnight.

If you're a guy, you may have noticed some tenderness and even a lump beneath your nipple area.

Whether it's a dull ache or a sharp pain, soreness in your breasts can be scary. TV shows, magazines, and newspapers are filled with information about breast cancer, so it's easy to think your pain could make you a statistic, but don't freak out.

The truth is that breast pain in a teen is rarely cancer. So what is pain from and how can you be sure?

What Are Breasts and Why Do I Have Them?

All mammals have breasts and humans are no exception. Breasts, which are milk-producing glands, begin to enlarge in females around the onset of puberty. Breasts are made of fat and other tissue that surround and protect nerves, blood vessels, and milk ducts (small tube-like paths).

The main biological reason young women have breasts is to allow them to feed babies. Since long before the invention of the bottle, babies have been nursed (fed milk) straight from their mothers' nipples. Although some women give their babies formula from bottles, many women still breastfeed their newborns. In fact, doctors recommend breastfeeding as the best way to meet a baby's nutritional needs.

The timing of breast development varies from girl to girl. Most girls begin getting breasts around 10 or 11, but it's normal for breast development to start anytime between the ages of 8 and 13. In general, it takes 4 to 5 years for a girl's breasts to reach their adult size.

When guys start puberty it is common to develop a small amount of breast enlargement too. During puberty, hormones in the body cause the breasts to grow larger. The difference is for guys, this condition is called gynecomastia and is usually temporary.

What Causes Soreness?

One of the most common times that breasts might feel sore is when they are beginning to develop. First you might notice a small button-like lump beneath the nipple area. The medical name for this is the breast bud, and it is often present in guys and girls. The breast bud may be a little tender and may cause you to worry but it's a normal part of puberty.

It is also common to have sore breasts around the beginning of a girl's period, or menstruation. Before her period starts, a girl's body produces lots of the female hormones estrogen and progesterone.

Changes in these hormones can cause feelings that together are called premenstrual syndrome, or PMS. Some girls have painful cramps in their stomachs, headaches, mood swings, or cravings for certain foods right before their periods begin. During this time the body may retain water, which can make a girl feel puffy and bloated. Rings and shoes may feel tight at this time.

Just as fingers and feet swell, so can breasts. All that fluid forces the breast tissues to expand, which stretches the nerves and makes breasts feel achy or tender.

Breast swelling and tenderness can also be one of the earliest signs of pregnancy. Be sure to talk to a parent or doctor right away if you might be pregnant.

Also, if you ever notice discharge from one or both breasts, call your doctor right away.

What Can I Do to Relieve the Ache?

Most PMS symptoms, including breast soreness, should disappear as your period begins. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, might be helpful. Wearing a supportive bra might also help.

Healthy eating, regular exercise, and getting enough sleep are really your best bets for lessening the ache. You might try cutting down on salty foods and foods that contain caffeine, like coffee, tea, and even chocolate. Try caffeine-free soda or herbal tea instead. Some girls find that eating a diet rich in calcium helps with PMS symptoms.

If you're tired, take a rest! Snuggle on the couch with your pillow and watch a good movie. Sometimes getting your mind off your aches is the best thing you can do.

What if I'm Still Worried?

Sometimes these tips won't help you feel better. Maybe the pain is a little sharper this time, or maybe it lasted longer than usual, or maybe you just want to get it checked out. You don't need to sit at home and worry — visit your doctor.

Let your doctor know about your concerns. The doctor sees patients all the time for things that may seem silly, but if you're worried, then it's not dumb. Although you may feel a little embarrassed to ask about breast pain or about a lump, there's no need to. A breast exam is a quick and painless procedure. Besides, it's a small price to pay for a doctor's assurance that your aches are completely normal.

How Can I Tell My Mom I'm Smart About Sex?

My mom is always bringing up sex in our conversations. She says she's trying to educate me but it's really embarrassing. I feel like I know everything I need to know and will make good decisions when it comes to having sex. How do I convince her of this?
– Allie*

While some families can talk comfortably about sex, many can't. Even if your mom is OK with the subject, you might not be. It's hard to tell from your question, but your mom might be bringing up sex as a way to try to bond with you. She also might be worried about you, which is normal for any parent. Figuring out why she keeps bringing up sex can help you plan your response.

The simplest (though not always easiest) thing is to ask her if she's concerned about your sexual health. If she is, simply reassure her by telling her what you know — and informing her you know all about proper protection. If her answer is "No, I'm just trying to keep our relationship strong," you can still reassure her — and figure out a bonding experience that's a little less awkward.

And as awkward and embarrassing as it is to talk about sex, your mom is trying. Not every parent does.

Why Are My Breasts Different Sizes?

Having different-sized breasts is perfectly normal. It's quite common for girls to have different-sized breasts or nipples, especially as they develop during puberty. Everyone's different, and no two women's breasts will look exactly the same. In fact, asymmetry — where one body part, like a foot or a hand, is a slightly different size or shape from its partner — is quite common in humans.

When girls begin puberty, usually between the ages of 8 and 13, their breasts begin to develop starting with just a little swelling under the nipple. This is known as breast budding. You may notice that one of your breasts starts developing before the other or that one is growing more quickly. Many times this difference in breast size evens out once a girl is older, usually by age 20. But it's also perfectly normal for women's breasts to remain different sizes even when they're fully developed.

Some girls with different-sized breasts worry that there's something medically wrong, but chances are, for a teen, there isn't. If you're really worried about your breast size, talk to your doctor or gynecologist. He or she should be able to reassure you that your breasts are normal.

Girls who notice their breasts are different sizes are aware of their breasts — and that's good news. Being aware of your breasts can help you stay healthy! Learning how your breasts normally look (and feel) can help you notice any changes that might not be normal. Your doctor can teach you how to do a breast self-exam (BSE) that will help you become familiar with your breasts so you can identify any changes.

Some girls worry about their different-sized breasts for cosmetic reasons. Many girls with different-sized breasts or nipples just accept that they are normal and don't do anything differently. But other girls feel self-conscious. It's likely that no one else notices your breasts look different, though. Other people usually can't see the difference in the size of a girl's breasts — even if that difference is a full cup size.

The fact is that exercises, supplements, or diets won't change the size or shape of a girl's breasts — only plastic surgery can do that. (And most doctors recommend that a girl wait until her breasts have finished growing before considering plastic surgery.) Some girls decide to wear especially supportive bras or special inserts that make their breasts appear more equal in size. Talk to a lingerie salesperson if you want some suggestions for evening things out. It may also help to talk to your mom, older sister, or an aunt or grandmother — they may have worried about having different-sized breasts during their teen years, too.

Everyone develops differently, and it's normal for the two sides of our bodies to be a little different from each other. We humans aren't as evenly proportioned as we appear at first glance!

Finding the Right Bra

Why bother with bras? Bras not only minimize jiggling and shape the appearance of a girl's breasts, they're also helpful from a health standpoint. Wearing the right bra keeps a girl's breasts supported while she's playing a sport and can help prevent injury to breast tissue. A well-fitting bra is also important for a woman's posture, particularly if she has large breasts. A bra that doesn't fit can cause back problems, muscle tension, and even headaches. Yet 8 out of 10 women wear bras that don't fit. All About Straps, Snaps, Bands, and Cups Finding the right bra doesn't have to be an ordeal if you know the basics of bra sizing. There are two parts to a bra's size: the chest size (also called the band size) and the cup size. The chest, or band, size is the part of the bra that runs across a girl's chest and around her back. The cups are the parts of the bra that hold the breasts. Bras come in many sizes, which are different combinations of the chest sizes (shown as numbers — in the United States, these are 32, 34, 36, etc.) and cup sizes (shown as letters — AA, A, B, C, etc.) It's important to get both the chest and cup sizes right to ensure a proper fit. Some bra manufacturers are now starting to offer cup options in half sizes in addition to regular cups to help girls get a better fit. If a girl wears a bra that's the wrong chest size, the bra's band will either feel tight and uncomfortable around her rib cage or it will be too loose and ride up her breasts. Bras that are too small in the cup will compress a girl's boobs and force them to bulge out the sides (think armpit boobs). And cups that are too big can wrinkle and pucker, which won't look good under clothes. So how do you calculate your chest and cup measurements? It's easy, and it's something you can do in the privacy of your own room at home. All that you need is a tape measure. Chest measurement. Bra fitting experts offer two methods of calculating the chest measurement. The most common method involves running a tape measure just under your breasts, all the way around your back and rib cage. The tape measure should rest flat on your skin and lie straight across your back — not so tight that it digs in, but not so loose that it sags down in back. Make a note of your measurement and add 5 inches. That's your chest size. You can also estimate your chest size by running a tape measure across your chest above your breasts, under your armpits, and around your back (measure from the same back position as in the first chest measurement option). This method is easier because you don't have to do any addition or other calculation, but some people feel it's less accurate than using the first method. If your chest measurement comes out as an odd number (such as 31 inches or 33 inches), it's usually a good rule to round up to the next number. Most bras have a few sets of adjustable hooks and eyes, so you can adjust the tightness. It's a good idea to round up, rather than round down, because when you buy a new bra that hooks on the first or middle hooks — rather than on the last — you can leave room for growth. Cup measurement. As with the chest measurement, when you're measuring for cup size, make sure the tape is not too loose or too tight. If you already own an unpadded bra that fits well, wear it when measuring for cup size. Be careful about the type of bra you wear to take your measurements, though. Sports bras can flatten breasts and give a cup reading that's too small, and padded or lined bras have the opposite effect. This time, when you run the tape measure around your body, you're going to take the measurement across the fullest part of your breasts. Write down this number. Now subtract your chest measurement. If the difference between the two numbers is less than 1 inch, your cup size is AA. If it's 1 inch, your cup size is A; 2 inches, you're a B; 3 inches you're a C, and so on. So you've taken your measurements and you're in the fitting room trying a bra in what's supposed to be your size — but it doesn't seem to fit. Now what? Before you pile on all your clothes just to go out and look for a different size, experiment by making some adjustments to the bra. Extend or shorten the band around your chest slightly by moving the hooks to a different eye on the hook and eye closure (or adjust the velcro if the bra has a velcro closing). The bottom band of a properly fitting bra should ride across the middle of your back and pass under your shoulder blades to provide the right support. A bra's straps allow you to modify how the cups fit and support your breasts. When the straps are the right length, a bra lifts the breasts comfortably and the back of the bra will run straight across your back (if a bra is pulling upward in the back, it may be a sign that the straps are too tight). You should be able to get one finger under the straps to prevent them from digging into your shoulders. In general, girls who are petite will need to wear their bra straps shorter than girls who are tall. Bra Booby Traps In addition to fit, there are some other things you might want to take into account when choosing a bra. Breast growth. A girl's breasts can grow and change rapidly during the teen years, which means that until you stop developing, you might have to change your bra size several times. If your breasts are still growing, consider buying fewer bras and measure yourself frequently to double-check your size. Because growth can make a girl's breasts sensitive, you might find certain styles or fabrics work better for you. For example, some girls like seamless cups because they don't irritate the nipples; others choose styles that minimize jiggle to ease the occasional aches of breast development. Menstrual changes. Some girls' breasts change size or shape at different times in their menstrual cycles. Many girls find they like to wear different styles of bras at different times in their cycle. Different-sized breasts. Most girls' breasts grow at different rates — and many girls find themselves with one boob that's bigger than its partner. This is so common that bra manufacturers design their products so they can be adjusted to accommodate asymmetrical breasts. Start by moving the strap adjusters on a bra to different lengths to see if this helps. Some girls also use the trick of buying a bra that has removable padding and then taking the extra padding out of the cup for the larger breast. Push-up bras can work well for this because they often come with an easily removable padded section (called a "cookie") that sits under the breast. Hooks, wires, and other hazards. Take a look at the bra you're about to buy and imagine how it might survive a full day of wear. If the front closure pops open too easily, could this bra let you down in front of your entire drama class? The bra's straps may feel fine in the fitting room, but if the adjusters are sitting right on your shoulder or collarbone, how will that feel under your backpack? Test to see if the bra band is too loose by lifting your arms in the air and putting them back down by your sides a couple of times. If the bra rides up across your breasts, the band is too loose. If you're looking for a sports bra, jump up and down in the fitting room a couple of times to evaluate the bra's bounce control. You may also want to try on a T-shirt or sweater over a bra you're thinking of buying to get the finished effect. That pink rose on the front may look cute on the bra itself, but does it make you look as if you've sprouted a third breast once your T-shirt's on? No matter what the size or shape of a girl's breasts, the most important thing to remember in choosing a bra is comfort. Try on a variety of bras to find the one that's right for you. Some girls prefer the comfort of cotton, others like the support of synthetics or underwires. There are minimizer bras for girls who'd like their breasts to look smaller, or padded bras for girls who'd like a little extra shape. No one bra is better than another — it all depends on which style works best for you.

How Can I Tell My Mom I'm Smart About Sex?

My mom is always bringing up sex in our conversations. She says she's trying to educate me but it's really embarrassing. I feel like I know everything I need to know and will make good decisions when it comes to having sex. How do I convince her of this?
– Allie*

While some families can talk comfortably about sex, many can't. Even if your mom is OK with the subject, you might not be. It's hard to tell from your question, but your mom might be bringing up sex as a way to try to bond with you. She also might be worried about you, which is normal for any parent. Figuring out why she keeps bringing up sex can help you plan your response.

The simplest (though not always easiest) thing is to ask her if she's concerned about your sexual health. If she is, simply reassure her by telling her what you know — and informing her you know all about proper protection. If her answer is "No, I'm just trying to keep our relationship strong," you can still reassure her — and figure out a bonding experience that's a little less awkward.

And as awkward and embarrassing as it is to talk about sex, your mom is trying. Not every parent does.

Sexual Attraction and Orientation

It takes time for many people to understand who they are and who they're becoming. Part of that understanding includes a person's sexual feelings and attractions.

The term sexual orientation refers to the gender (that is, male or female) to which a person is attracted. There are several types of sexual orientation that are commonly described:

• Heterosexual. People who are heterosexual are romantically and physically attracted to members of the opposite sex: Heterosexual males are attracted to females, and heterosexual females are attracted to males. Heterosexuals are sometimes called "straight."
• Homosexual. People who are homosexual are romantically and physically attracted to people of the same sex: Females who are attracted to other females are lesbian; males who are attracted to other males are often known as gay. (The term gay is sometimes also used to describe homosexual individuals of either gender.)
• Bisexual. People who are bisexual are romantically and physically attracted to members of both sexes.

Teens — both guys and girls — often find themselves having sexual thoughts and attractions. For some, these feelings and thoughts can be intense — and even confusing or disturbing. That may be especially true for people who are having romantic or sexual thoughts about someone who is the same sex they are. "What does that mean," they might think. "Am I gay?"

Thinking sexually about both the same sex and the opposite sex is quite common as people sort through their emerging sexual feelings. This type of imagining about people of the same or opposite sex doesn't necessarily mean that a person fits into a particular type of sexual orientation.

Some teens may also experiment with sexual experiences, including those with members of the same sex, during the years they are exploring their own sexuality. These experiences, by themselves, do not necessarily mean that a person is gay or straight.

Do People Choose Their Sexual Orientation?

Most medical professionals, including organizations such as the American Academy of Pediatrics and the American Psychological Association, believe that sexual orientation involves a complex mixture of biology, psychology, and environmental factors. A person's genes and inborn hormonal factors may play a role as well. These medical professionals believe that — in most cases — sexual orientation, whatever its causes, is not simply chosen.

Not everyone agrees. Some believe that individuals can choose who they are attracted to — and that people who are gay have chosen to be attracted to people of the same gender. No matter what someone's sexual orientation is, in some cases it may be affected by the life experiences that person has had.

There are lots of opinions and stereotypes about sexual orientation, though, and some of these can be hurtful to people of all orientations. For example, having a more "feminine" appearance or interest does not mean that a guy is gay. And having a more "masculine" appearance doesn't mean a girl is lesbian. As with most things, making assumptions just based on looks can lead to the wrong conclusion.

What's It Like for Gay Teens?

For many people who are gay or lesbian, it can feel like everyone is expected to be straight. Because of this, some gay and lesbian teens may feel different from their friends when the heterosexual people around them start talking about romantic feelings, dating, and sex. They may feel like they have to pretend to feel things that they don't in order to fit. They might feel they need to deny who they are or that they have to hide an important part of themselves.

These feelings, plus fears of prejudice, can lead people who aren't straight to keep their sexual orientation secret, even from friends and family who might be supportive.

Some gay or lesbian teens tell a few accepting, supportive friends and family members about their sexual orientation. This is often called coming out.

Many lesbian, gay, and bisexual teens who come out to their friends and families are fully accepted by them and their communities. They feel comfortable about being attracted to someone of the same gender and don't feel anxious about it.

But not everyone has the same feelings or good support systems. People who feel they need to hide who they are or who fear rejection, discrimination, or violence can be at greater risk for emotional problems like anxiety and depression.

Some gay teens without support systems can be at higher risk than heterosexual teens for dropping out of school, living on the streets, using alcohol and drugs, and even in some cases for attempting to harm themselves.

These difficulties are thought to happen more frequently not directly because they are gay, but because gay and lesbian people are more likely to be misunderstood, socially isolated, or mistreated because of their sexual orientation.

This doesn't happen to all gay teens, of course. Many gay and lesbian teens and their families have no more difficulties during the teen years than anyone else.

The Importance of Talking

No matter what someone's sexual orientation is, learning about sexuality and relationships can be difficult. It can help to talk to someone about the confusing feelings that go with growing up, perhaps a parent or other family member, a close friend or sibling, or a school counselor. It's not always easy to find somebody to talk to, but many people find that confiding in someone they trust and feel close to, even if they're not completely sure how that person will react, turns out to be a positive experience.

In many communities, resources such as youth groups composed of teens who are facing similar issues can provide opportunities for people to talk to others who understand. Psychologists, psychiatrists, family doctors, and trained counselors can help teens cope — confidentially and privately — with the difficult feelings that go with their developing sexuality. These experts can also help teens to find ways to deal with any peer pressure, harassment, and bullying they may face.

Whether gay, straight, bisexual, or just not sure, almost all teens have questions about physically maturing and about sexual health (for example, avoiding STDs). It's important to find a doctor or health professional to discuss these issues with — someone who can provide reliable health advice.

Although sexual feelings and behavior are important parts of human development, there are still many unanswered questions about human sexuality. Researchers are constantly learning new information, and undoubtedly people will know more about sexual orientation in the coming years.

I'm 14 and I don't have my period yet. Is this normal?

A girl's period, also known as menstruation, begins after she reaches puberty. Girls usually get their first periods between the ages of 10 and 16, which is about 2 to 2-½ years after their first signs of puberty (breast development is usually the first sign of puberty, but sometimes pubic hair comes first). However, some girls start puberty a little earlier or later than others, which is still normal.

A clue you can use to figure out when you might get your period is to check your underwear for vaginal discharge. This clear or whitish, mucus-like discharge usually appears about 6 months before the first period does.

You can also ask your mom how old she was when she got her first period. Girls who get their first period later than average often find that their moms or other female relatives also went through puberty later than average.

Just because you're 14 and haven't gotten your period yet doesn't necessarily mean that anything's wrong with you. Some girls, though, may not be getting their first periods for other reasons. Girls who are underweight or who have eating disorders such as anorexia nervosa may notice a delay in the beginning of their periods. Girls who are very athletic may not get their periods until they stop exercising or competing so vigorously. Severe stress or certain illnesses also can delay menstruation.

It's also possible for a girl to get pregnant before she gets her first period.

If you have questions or concerns about when you'll get your period, you should talk to your doctor.

Am I still a virgin if I use a tampon?

Some girls worry that if they use tampons, they will no longer be virgins. The truth is, a virgin is someone who has never had sexual intercourse. Inserting a tampon is definitely not the same as having sex!

So why do girls ask this question so often? Girls who are virgins usually have a hymen, a very thin piece of skin-like tissue that stretches partly across the opening of the vagina. A lot of people mistakenly think that a girl is still a virgin if her hymen has not been broken. Most of the time a girl's hymen breaks after having sex for the first time.

But a girl's hymen can tear in ways that have nothing to do with having sex. For example, it is possible that inserting a tampon might tear the hymen (although that usually doesn't happen). So even if a tampon does break a girl's hymen, she is still a virgin until she has had sexual intercourse.