Adolescent medicine is a medical subspecialty that deals primarily with the care and treatment of patients who are in the adolescent stage of development. This period typically starts between the ages of nine to 11 for females and 11 to 14 for males.  Considered as a primary care subspecialty, adolescent medicine integrates various iatrical aspects including dermatology, endocrinology, gynecology, nutrition, psychology and sports medicine. It is likewise an integral component of internal medicine, family practice, pediatrics, and youth health.

Medical practitioners who delve in the practice of adolescent medicine often address issues and disorders with a high prevalence during adolescence. These include the following:

§ Precocious puberty

§ Birth control

§ Substance abuse

§ Acne vulgaris

§ Unintended pregnancy

§ STDs or sexually transmitted diseases

§ Eating disorders such as anorexia and bulimia

§ Menstrual disorders like amenorrhea, dysfunctional uterine bleeding and dysmenorrhea

§ Mental illnesses, particularly anxiety disorders, personality disorders, bipolar disorder, major depression, suicidal ideation and certain types of schizophrenia

Healthcare providers who deal with adolescents normally take a holistic approach as they try to gather information relevant to the patient’s well-being. The approach closely resembles the biophysical model which is epitomized in the HEADSS assessment. It is a screening acronym for adolescent patients and stands for Home, Education, Activities, Drugs, Sex, and Suicidality.

Aside from a comprehensive medical history, adolescents ought to undergo a thorough physical examination as well as a mental health status exam at least once a year. The physical exam should include sexually transmitted infections (STI) testing, a neurological assessment, and a reproductive system exam. In addition, developmental progression should be documented on an annual basis, and endocrinological tests should be considered especially among patients who fail to develop in a normal manner.

Young women must be properly educated on how to examine their breast for signs of breast cancer, and young men should know how to examine their penis and testicles for STDs and cancer. Laboratory tests, including a CBC to screen for anemia, and a fasting lipid profile or a spot cholesterol check to screen for hyperlipidemia should be undertaken at least once during the adolescent period.

For those who are sexually active, especially patients who are living in areas of high prevalence, screening tests for STDs should be done, including rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test for syphilis, screening for HIV, chlamydia and gonorrhea. Females who are sexually active must have a pelvic exam, including a Pap smear to screen for cervical cancer.

In terms of immunizations, the following are deemed imperative: a meningitis vaccination, a tetanus vaccination or booster shot, the Gardasil vaccine against HPV particularly for sexually active young women, and an annual influenza inoculation.

Puberty is said to be delayed when a girl or a boy has gone through the usual age of onset of puberty without any physical or hormonal signs that it is beginning. The typical signs of puberty normally appear by age 13 for girls and age 14 for boys. However, puberty may be delayed for a number of years yet progress normally, such a case is regarded as constitutional delay and is a modification of healthy physical development.

Delayed puberty can be hereditary, meaning the late onset of puberty may run in the family. It may also occur due to undernutrition, genetic disorders, several forms of systemic and chronic diseases, pituitary defects and diseases (e.g. hypopituitarism), hypothalamic defects and diseases (e.g. Prader-Willi Syndrome Kallmann Syndrome), gonadal defects and diseases (e.g. Turner Syndrome, Klinefelter syndrome) various forms of congenital adrenal hyperplasia, and other hormone deficiencies and imbalances.

A lack of symptoms of puberty is the main indicator that a child may be suffering from delayed puberty. Below are the most common symptoms of delayed puberty. However, it is important to note that symptoms vary among affected children. Symptoms may include:

· girls:

o no breast development by age 13

o over five years between breast development and menstrual period

o no menarche by age 16

o lack of pubic hair by age 14

· boys:

o no testicular enlargement by age 14

o lack of pubic hair by age 15

o over five years to complete genital enlargement

Delayed puberty can be accurately diagnosed by pediatric endocrinologists since they are the physicians with an extensive training and experience in evaluating the disorder. He/she may conduct a thorough physical examination as well as a complete review of the patient’s medical history and growth pattern.

Blood tests may also be ordered, particularly for the gonadotropins, because high levels immediately confirm gonadal defects or deficiency of the sex steroids. In most cases, screening tests such as a complete blood count, general chemistry screens, thyroid tests, and urinalysis may also be valuable to check for chromosomal abnormalities, diabetes, anemia, and other conditions that may delay puberty.

A bone x-ray of the wrist or hand may also be performed to determine whether the child has reached a stage of physical maturation at which puberty should be underway. Notable secondary sexual development typically starts when girls reach a bone age of 10.5 to 11 years, and boys reach a bone age of 11.5 to 12 years. Other more sophisticated and more expensive tests such as computed tomography scan or magnetic resonance imaging may be done when specific evidence suggests they may be useful.

The treatment for delayed puberty will be determined by the physician based on the following factors:

· the child’s age, medical history and overall health

· the child’s tolerance for certain medications, procedures or therapeutic approach

· extent and expectations for the course of the condition

· the parents’ opinion or preference

If the patient is healthy but simply late, no intervention is usually required. But in more pronounced cases of delay, a low dose of estrogen or testosterone for a few months may induce puberty to proceed normally. If the delay is caused by a disease, then the medical intervention is likely to focus on treating the disease. Often, when the underlying illness is treated, puberty proceeds normally. In case it becomes evident that there is a permanent defect of the reproductive system, therapeutic intervention usually involves hormone replacement or hormone therapy to stimulate the development of secondary sexual characteristics.

Over the past few decades there has been a drastic change in sexual behavior among teenagers. It is quite glaring that teen females have gradually become more liberated and sexually aggressive, to the point of being promiscuous. There is absolutely an upheaval in the sexual context of what is socially acceptable and what is not. Teenage behavior has changed dramatically and it appears to veer toward homosexual behaviors. There seems to be more awareness of sex-linked diseases and teenage pregnancy has generally become more acceptable.

Whatever norms that society has set in the past seem to have gone out the window. Some teens create their own norms based on what they “feel” instead of what is socially acceptable as appropriate behavior. Sadly, some teens have the notion that if something feels good, then it should be okay. No one can argue that sex is going to feel good. It should feel good because it was designed that way, but it doesn’t mean that it is appropriate all the time.

Sex ought to be something quite intimate – almost sacred, but it has become an art among today’s teenagers. Teens have found ways to engage in sex without inducing pregnancy. Sex itself has become a multi-million dollar industry. People know that sex sells, especially among teens. Go to the mall and you’ll see public displays of sexuality in some of the windows of shops. Go online and it’s basically the same scenario. You may even hear negative comments from teens about such stores yet they still have a strong desire to shop in such stores. Sex now has a price tag and is currently marketed as being fulfilling and romantic. It is apparently safe and easy and one can simply walk away with no strings attached.

Such a radical shift in the concept of sex among teenagers has been largely influenced by media, by peers, and by the culture and locations in which they live. There are three reasons why teens engage in sex as some form of recreation. These include irresponsible parents, puberty and desire, and the need for love. As soon as the word love comes into the picture, the green light for having sex greatly increases. If a boy professes love for a girl, then she becomes more likely to succumb to sexual pressure than if he doesn’t.

Parents need to constantly show their love to their teens because if the need for love is being met, they won’t have to look for it in the arms of another teen. Parents need to explain the emotional impact and the repercussions that come along with giving one’s sexuality to another. They need to help teenagers look past the fleeting pleasure derived from sex. Teens should learn to set lifetime goals for the future and consider whether having a child would fit into those goals. By having a clear set of goals for the future, teens won’t be easily swept by a sudden surge of emotions and they would be smart enough to gauge whether having a child is worth the risk of engaging into a momentary act of passion. Finally, parents must impart the value of self-control. Talk to your teen, explain to them how modern society is portraying sexuality and personal convictions. Keep them informed so they won’t be tempted to try something that they would regret later on.