PHN 206: ADOLESCENT SEXUAL

AND REPRODUCTIVE HEALTH

2 CREDITS

MBILLA ESTHER
MPH
 OBJECTIVES

• At the end of this lesson, students should be able to:

• Understand the concept adolescents
• Describe the Physical and psychological changes in adolescents and
the factors that influences the changes
• Understand and manage some critical issues in adolescents
 INTRODUCTION
• Adolescence emerged from a Latin word “adolescere” meaning to
grow, to mature
• Growth refers to physical and biological changes. It is defined as the
development of a person in weight, age, size and habits
• Development is an orderly pattern of changes in structure, thoughts,
feelings, or behaviors resulting from maturation, experiences, and
learning
• Development is a dynamic and continuous process as one proceeds
through life, characterized by a series of ascents, plateaus, and
declines
• The above processes are dependent on genetic, nutritional and
environmental factors
 INTRODUCTION CONT’D
• Adolescence is a transitional (temporary) phase of growth and development
between childhood and adulthood.
• It is the span of years between childhood and adulthood
• The WHO defines adolescents as individuals in the 10-19 years age group and
“youth” as the 15-24 years age
• Society heralds this period
• Adolescents are not a homogeneous group
• Needs vary with their sex, stage of development, life circumstances and the
socio-economic conditions of their environment
 INTRODUCTION CONT’D
• Adolescence is characterized by marked physiological changes, development of
sexual feelings, efforts toward the construction of identity, and a progression
from concrete to abstract thought.
• It is also viewed as a transitional state, during which youths begin to separate
themselves from their parents but still lack a clearly defined role in society
• It is generally regarded as an emotionally intense and often stressful period.
• Many changes take place during adolescence
• Prominent among these are physical changes, including puberty and social and
psychological changes, with development of reasoning skills, rational thought,
and moral judgment.
 INTRODUCTION CONT’D
• According to UNICEF, in 2022, there were 1.3 billion adolescents in the world
constituting 16 percent of the world’s total population
• Niger has the greatest (49%) adolescent population (under 15). Africa has 60%
of the entire continent aged below 25, making it the youngest continent in the
world as compared to the rest of its population.
• In Ghana, adolescents constitute 22.4% of the country’s total population
• What does this mean?
• A promising future or greater instability and civil conflict?
Implications for Ghana / Africa
• Unemployment
• Gender : Females less likely to complete school, higher unemployment rates,
early marriages etc.
• Informal sector: non-taxed leading to revenue loss
• Education : Adolescents may fall out of the education system. This may make
them become detached and isolated. They may feel worthless and incapable
of contributing to society.
• Youth gangs
• Health: HIV/AIDS, mental health
INTRODUCTION CONT’D
• Adolescent health is being promoted because it is a period health &
development compromising behaviors such as initiating the use of
substances/drugs, unsafe sexual practices resulting in teenage
pregnancy & unsafe abortions, engaging in truancy, violence &
discontinuation of school are evident.
• It is a period when their decisions, behaviors & relationships
determine their health & development.
INTRODUCTION CONT’D
• The primary target for adolescent health is 10-24 years
• The vision of Adolescent health is to have a well informed adolescents
adopting a healthy life style.
• This vision can be achieved through making available appropriate
information and counseling services
• Provide Comprehensive health services
STAGES OF ADOLESCENT DEVELOPMENT
• The Adolescent years from puberty to adulthood, are divided into three
stages:
• Early adolescence,10 - 14 years
• Middle adolescence, 15-17years
• Late adolescence, 18-19 years
 Early adolescence (10 to 14 years).
• It is characterized by a spurt of growth, and the beginning of sexual
maturation
• Rapid growth
• Secondary sexual characteristics appear
• Uses concrete thinking (“here and now”)
• Spends time thinking about rapid physical growth and body image
(how others see them)
• Mood swings
• Struggles with rules about independence/ dependence
• Argues and is disobedient
• Intense friendships with same sex
• Contact with opposite sex in groups
• Self-exploration and evaluation
 Middle adolescence (15 to 17 years).

• Secondary sexual characteristics advance

• Growth slows down
• Reaches approximately 95% of adult growth
• Brain growth occurs
• Creates their body image
• Feels very powerful
• Experiments with sex, drugs, friends, risks
• Argues with people in authority
• Peer group most important and determines behaviour
 Late adolescence (18 and 19 years)
• Physically matures
• Plans for the future
• Understands how choices and decisions now have an effect on the future.
• Plans and follows long term goals
• Usually comfortable with own body image
• Understands right from wrong (morally and ethically)
• Moving from a child-parent/ guardian relationship to a more equal adult-
adult relationship
• Decisions and values less influenced by peers in favors of individual
friendships
A Stormy phase
• Adolescence is a period of stress and strain, storm and strife
• The term 'storm and stress' was coined by G. Stanley Hall in
Adolescence, written in 1904.
• Hall used this term because he viewed adolescence as a period of
inevitable turmoil that takes place during the transition from
childhood to adulthood
• The perception of young people as emotional volcanoes ready to
explode has taken on a life of its own
• NB. Not all adolescence go through ‘a stormy phase’.
A Stormy phase
• Conflict with parents: Adolescents tend to rebel against authority
figures as they seek greater independence and autonomy
• Mood disruption: Hormonal changes and the psychological stress of
adolescence can cause uncontrollable shifts in emotions
• Risky behavior: The combination of a neurological need for
stimulation and emotional immaturity lead to increased risk taking
behavior during adolescence.
 DOMAINS OF ADOLESCENT DEVELOPMENT
• This period is characterized by enormous physical and psychological changes.
The growth and development processes are accompanied by stresses which
lead to behaviours that affect the adolescents' health.
Adolescent development areas include:
• physical
• cognitive
• sexual
• spiritual
• emotional/ Social
 Physical and physiological
Development
• Puberty is the process of physical changes through which
a child's body matures into an adult body capable of sexual reproduction.
• Puberty occurs as a result of increased hormone levels triggered by the brain
• Puberty brings changes in the way adolescents feel about themselves and
about others, particularly of the opposite sex
• Girls begin puberty at ages 10–11 and complete puberty at ages 15–17
• Boys generally begin puberty at ages 11–12 and complete puberty at ages
16–17
Problems of puberty
• Precocious Puberty
• Late or delayed puberty
Precocious puberty
• Pubertal development occurring much earlier than usual
• Identified by testicular or penile enlargement and genital or facial hair
growth occurring before age 9
• Identified by breast development, menarche and pubic & underarm
hair growth at age 7 or 8
• Generally result from improved nutrition, genetics, metabolic or
environmental factors
Delayed puberty
• Physical growth much later than average age
• Girls who have not developed breast buds by age 13 or boys whose
testicles are not enlarged by age 14
• Generally hereditary , medical conditions, eating disorders,
• Also resulting from problems with pituitary or thyroid glands and
chromosomal abnormalities
• Girls who are extremely sporty experience delayed puberty
Physical and physiological
Development
• Development of Secondary Sex Characteristics
• Hygiene: Sweat glands in the armpits and groin area are activated for
the first time during puberty, and this can lead to increased body
odour.
• Acne and skin problems: Glands in the skin on the face, shoulders and
back start to become more active during puberty, producing more oil
• This can lead to skin conditions such as pimples and acne.
Physical and physiological changes and
processes in boys and girls
Boys Girls
Testes enlarge Breasts develop
Hair grows in armpits, pubis, sometimes on the face and Hair grows in the armpits and on pubis
on the chest.

Penis gets bigger Labia and Clitoris enlarge

Erections, ejaculations and wet dreams (Semenarche - first Ovulation and menstruation start (Menarche - the first
ejaculation) menstruation)

Increase in body weight and height (muscles become more Increase in body weight and height
pronounced and stronger)

Voice changes (becomes deeper) Enlargement of hips

The skin of the scrotum wrinkles Nipples become larger and darker than before
Effect of Physical Changes on Adolescents
physical Changes on Adolescents

• They frequently sleep longer (9 1/2 hours)

• They may be clumsier because of growth spurts and body parts growing at
different rates
• Adolescent girls may become sensitive about weight
• They become worried if not physically developing at same rate as peers
(need to “fit” in early versus Late maturation)
• They may feel awkward about showing affection to opposite sex parent
• They ask more direct questions about sex in the bid to figure out values
around sex
Implications of physical development on the adolescent

• Fear, confusion or withdrawal especially during early adolescence (10 - 14)

• Obsessive concern about appearance
• Excessive dieting or exercise
• Peer emulation causing risk-taking behaviour and health and wellbeing
concerns
• Unwanted attentions - Childhood physical or sexual harassment and abuse
• Early sexual relationships
• Ridicule/negative statements affect adolescents’ self confidence and self-
esteem greatly.
 Cognitive development
Cognitive development refers to the process by which a child’s understanding of
the world changes as a function of age and experience
• During this period, all aspects of intelligence e.g. judgement, reasoning,
memory mature rapidly.
• They are no longer satisfied with just following instructions without having an
understanding as well as their inputs.
• They may challenge or rebel.
• Parents and guardians should discuss issues with adolescents for them to
appreciate their stance rather than imposing their directives on them. This
minimizes conflicts and the adolescents feel being part of the decision-
making process involving their lives.
Effects of the growing cognitive
abilities
• Desire to become more independent
• Take on increased responsibilities, such as household chores and
school/community responsibilities
• Tend to ‘test’ boundaries, challenge adult authority, break rules and seek
freedom
• Begin to consider future aspirations, careers and occupations
• Look mostly to peers and media for information and advice
• Tend to take more risks, not necessarily having matured coping skills to
face and resolve difficult situations
• Develop a social conscience: become concerned about social issues such
as poverty, injustice, violence, etc.
Social and Emotional Development
• A concern for "right", "wrong", and "social justice". A concern for
less fortunate "others“
• Become preoccupied with their looks e.g. presence of acne or
pimples, body shapes etc
• Crave for privacy and seek separate identity from their parents
• Become concerned about how the opposite sex perceives them.
• Become aware of their sexual desires and arousal.
• Develop the desire to belong and be accepted
• Desire to be like their peers, creating peer pressure.
 SEXUAL DEVELOPMENT
• This aspect results from the combination of the physical, emotional and
social development especially during puberty
• Many adolescents become curious about sex and may explore their sexuality
by themselves, with a friend, or with a sexual or romantic partner
Values and moral development (Spiritual Development)
• Many adolescents search for something to believe in that will give
meaning to their lives.
• This may lead to increased religious activities and possible fanaticism
Effects of these Changes on
Adolescents
• Inconsistency in responsibility taking and in decision making
• They spend more time with friends
• Ask more questions about sexuality
• Begin to lock bedroom door
• Involved in multiple hobbies/clubs
• Become more argumentative
Factors that Influence Adolescent Growth and
Development
• Peers
• Parents/family
• Nutrition/Exercise
• Media
• Environment, e.g., school, church, mosque
 What the Adolescent Need
• Information and skills because they are still developing
• Safe and supportive environment because they live in an adult world
• Health and counselling services because they need a safety net
 Critical Issues in Adolescence
• Menstruation
• Wet Dreams
• Masturbation
• Self-esteem
• Gender socialization
• Gender related practices
 • It refers to the ejaculation of semen during sleep.
• It is a way to gets rid of semen.

Wet Dreams: •
•
It is a normal occurrence in the adolescent boy.
It is a sign of puberty and indicates a normal
functioning of the reproductive system.

• This is the act of touching or rubbing one's sexual

organs (e.g. Penis, Vagina or other parts of the body
that are sensitive to sexual stimulation) for pleasure.
Masturbation: • It is practised by some boys and girls.
• Masturbating may have negative psychological
effects on some adolescent.
 Self-Esteem
• It is how one feels about himself or herself and the overall judgment of
one's self.
• High self-esteem is a good sense of self-respect and worth.
• The person knows he/she has value irrespective of what others think.
• It influences relationship with others and comes from positive
experience with life.
• It is also essential for emotional well-being.
• During adolescence, self-esteem may fluctuate as the adolescent
gradually discovers him or herself.
 Gender socialization
• In most cultures, girls and boys are brought up differently with different
expectations, privileges and responsibilities e.g. unequal opportunities
for jobs, education etc.
• Gender refers to the roles of men and women that are determined by
society rather than one's biological make up.
Gender related practices
• Some practices in the Ghanaian society affect adolescent health and
development.
• Some of these practices are beneficial whilst others are harmful.
Adolescent girls are usually the victims of such harmful practices
• This is because of the status, position and roles that are ascribed to them
in the society.
• They are usually in a subordinate position, and sometimes taken
advantage of
Gender related practices (Helpful social cultural practices

• The beneficial practices promote physical, mental and psychological

maturity, prevent damage and infection to the reproductive organs
and maintain fertility.
• These practices include:
• sexual abstinence/postponement of sexual intercourse, which are
cultural and religious requirement before marriage is contracted
Harmful sociocultural practices that affect the
health of the adolescent

• These cause psycho-social and physical damage and are detrimental to the
health of the adolescent. Some of these harmful practices are:
• Early betrothal/forced marriage
• Female genital mutilation/cutting (FGM/FGC)
• Trokosi - enslavement practices of adolescents especially young women
• Sexual and Gender-Based Violence ( rape, incest, sexual harassment)
• Child labour
 References
• https://
[Link]/blog/media-spotlight/201309/storming-adultho
od
• https://
[Link]/docs/default-source/mca-documents/policy-documents/op
erational-guidance/GHA-CC-10-03-OPERATIONALGUIDANCE-eng-Adolescent-
[Link]
• [Link]
,%20SRH,%
[Link]
• Slee, P. (2002). Child, Adolescent and Family Development. Cambridge
University Press, Australia.
THANK YOU