Figure 108.1 Issues of sexual identity Figure 108.2 Checking the testes At birth or in early childhood various anatomical abnormalities are evident within the reproductive, genital or urological organs that result from failures in embryological development: absence of vagina or other parts of the female reproductive tract. Occluded vagina but remainder present and normal in shape; ambivalent or ambiguous genitalia – actual sex determined through chromosomal analysis and endocrine status. In the male micropenis, hypospadias (urethral opening on underside of penis), epispadias (urethral opening on upper part of penis), and cryptorchidism (undescended testis). These are assessed for surgical intervention at an appropriate age in order to protect future function where possible and prevent other problems (e.g. testicular cancer if testes remain undescended) and to protect the child’s body image. Reproductive and sexual functioning is a combination of mind and body function. Adolescence is when these processes and functions mature and become a focus of attention. Part of becoming a sexually mature adult may involve difficult decisions about sexual identity. This is not necessarily easier with the modern, open and free views of sexuality as the issue needs to be considered earlier in development. In addition, hormone levels are relatively unstable and interlinked with basic drives centrally controlled within the brain: sleeping, eating, drinking and exercising. The moody, relatively uncooperative and uncommunicative teenager is difficult to establish a rapport with, thus. ‘You have an issue – this is a confidential service and we are here to help’ facilitates a working relationship. Signs of puberty may not necessarily be welcomed or understood by the child , despite videos and classroom teaching sessions. Puberty can occur precociously as early as 8 years of age or be delayed beyond 16 years. Signs of puberty are facial, underarm and pubic hair, with increases in glandular activity – sweat = odour; sebaceous gland activity – potential acne; pubic hair; voice change and break; growth spurts, which = potential acne; the voice changes or breaks; and growth spurts continue until maturity. Increase in height and weight, female body shape – breast development, widening hips, hair growth pubic, underarms with increased sweat gland activity – odour, and sebaceous gland activity – potential acne; particularly linked with menstrual cycle post menarche. A girl’s menstrual pattern is one of the major indicators for her general as well as reproductive health.
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Reproductive and sexual problems
Structural abnormalities
Developmental issues
Male signs of puberty and potential problems
Penile and scrotal developmental problems
Trauma
Female signs of puberty and potential problems
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