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‘Adolescence’ refers to the transition from childhood to adulthood. It is a period when young people acquire skills that will equip them to cope with the tasks of adulthood. These include social and academic skills, and a set of principles and moral values. This period is fraught with potential pitfalls yet is generally successfully negotiated. For social and biological reasons teens have difficulty in making mature decisions, and understanding the consequences of their actions, they push boundaries and are keen to break rules Teenage behaviour is not a matter of wilful pigheadedness or a determination to drive adults crazy, and they need help to make up for what their brain still lacks in development by adults providing structure, organising their time, guiding them through tough decisions and giving lots of patience and parental love.
Relationships with the world are characterised by “sensation hunger”, loud music, dangerous driving and violent sports serve as emotional outlets- the remainder is spent on the new capacity to seek love and to love.

Adolescents face many issues :

  1. Physical awkwardness: skinny, podgy, pimply, sense of failure if they don’t look like film idols or sport stars. Acne is the commonest teen skin disorder and should be considered a disease with profound psychological effects, and treatment should take into account all aspects of the condition. The overweight adolescent risks developing low self esteem because of the criticism and rejection of adults and peers. This combined with social isolation may lead to depression, boredom, and inactivity and initiate a vicious circle of poor self image and comfort eating.
  2. Peer pressure: the most important factor in adolescent sexuality is the perceived behaviour of peer groups. There is the need to prove one’s self: not be a sissy, as ‘cool’, and to be involved in general risk taking: smoking drinking, sex, and drug use. Generally, adolescents don't want to be different from their peer group, which can make it difficult especially for teenagers struggling with sexual identity.
  3. Media: many studies have shown that violence on TV leads to aggressive and violent behaviour by children and teenagers. Short term emotional effects of exposure to TV violence are: fear, anxiety and distress. In the long term frequent exposure desensitizes the child who becomes accustomed to violence. Children shown aggressive programmes demonstrate greater willingness to hurt other children. Visual presentations of pornographic scenes can leave a lasting impression on a child’s conception of sexuality. TV also provides role models and standards of behaviour that young people try to emulate. TV violence and pornographic sexual scenes are a major health risk for children [like smoking].
  4. The internet has made extreme images very accessible to young people, and what we once called pornography is just mainstream sex now. Our media now throws sex at kids even when they are not looking for it, and hits them at an ever younger age and they may start to identify with and copy it before they are able to absorb what it all means, long before they are ready for such exposure.
  5. Alcohol: children as young as 12 drink and get drunk and it seems, have easy access to alcohol, this often leads to promiscuity and inappropriate sexual behaviour with unpleasant consequences- waking up in places they don’t know where they are or how they got there or who had sex with them!. Adverts extolling the ‘pleasure’ of alcohol never show the vomiting in the gutter, the road accidents, deaths, and the damage to fragile minds and bodies. Dependence develops over a number of years.
  6. Drugs: with all the pressures [search for excitement, curiosity, boredom, affluence, imitation of fashion-to do as others do, and peer pressure] adolescents are particularly vulnerable to the “attractions’ of chemical substance abuse. This starts with experimentation, usually between 12-16 years in South Africa, then ‘social use’-they don’t actively seek out the drug but passively accept it when offered as part of ‘acceptable peer group behaviour’, then on to ‘regular use’ when they actively seek out the drug and make sure they can maintain ready supplies, followed by dependence [to cocaine can develop in 6 weeks], or addiction when the drug/s will be the most important thing in the person’s life and any attempt to separate them from the drug/s will be met with substantial resistance. Drug dependence unless treated is a fatal progressive illness- a journey into nowhere. It may result in possible imprisonment, or overdose, or withdrawal which can be life threatening [5].
  7. Sexual problems: curiosity, coercion, fear of losing the partner, sexual desire, conflict about sexual orientation. Girls who start having sex young often do so because they want to be seen to have a boy friend, or because of coercion, and many say that they were disappointed in and regretted having sex when they were so young [usually under 16]. The initial sexual experience is crucial to sexual health. The risk of sexual dysfunction is increased if the initial experience is coercive or if they are unprotected, or the partner is clumsy or inconsiderate. Sexual activity prior to emotional maturity exposes young people to personal and family conflicts and the trauma of fleeting and broken relationships. Teenagers who start the intense level of intimacy of sex, act as if they are on honeymoon, and this level of intimacy is extremely strong- before they have gained experience in forming and changing relationships or sharing thoughts, ideas, values and feelings. Splitting up after relating at this intense level is as traumatic as divorce, and adolescents are not usually sufficiently emotionally mature enough to handle this, and tend to ‘crash’.
  8. Incest, sexual abuse: incest means physical contact associated with conscious sexual excitement between close blood relatives and step family who cannot legally marry. Incest occurs more commonly than is generally realised, and has far reaching effects into adulthood. The special relationship between girls and their fathers which develops around puberty can make them vulnerable to incest. Sexual encounters with close relatives and friends of the family are not uncommon and are often concealed because of fear or guilt, and may have long lasting effects particularly on sexual function and self worth. Young girls are at risk of exploitation ranging from coercion by a boy friend to date rape, to being inveigled into prostitution or pornographic photography or sex acts [8].
  9. Sexually transmitted diseases: teenagers attempt to prove their independence and erect a façade of control over their own lives, but the advent of Human Immune Deficiency Syndrome {HIV/AIDS} has increased the risks arising from precocious, promiscuous behaviour and casual and unprotected sex especially among teenagers [See: Safer Sex Practices]. Transmission of HIV is possible with oral and anal intercourse. In addition, herpes [lifelong recurrent attacks of painful blisters with no available cure], wart virus [Human Papilloma Virus-HPV is  related to an increase of cancer of the cervix, no available cure], and chlamydia [an infection which may block the fallopian tubes and result in infertility] are diseases which add to the risks of gonorrhoea and syphilis that were serious problems in the past but are now treatable.
  10. Pregnancy: most teen pregnancies are unplanned [98%], usually in a regular sexual relationship [59%], often occur in the first relationship, and in 5% conception occurs with the first intercourse [4], and is almost always a crisis that is life changing for the girl. She must be given sensitive counselling and the options of carrying the pregnancy to term, and either keeping the baby or giving it up for adoption, or termination of pregnancy.
  11. Contraception: although there is a steep rise in the number of sexually active teenagers around the world, only a minority of them use effective contraception. Most teens will have been sexually active for 6-12 months before seeking birth control, and they are not ideal contraceptive users [4].
  12. Learning problems: all the factors that adolescents face [conflicting feelings, difficult adjustments, rapid physical changes, developing sexuality, peer pressure and self consciousness] have a direct effect on learning. Around this time too there is a shift in expectations at school which may give rise to new learning disorders, disappointing academic performance, withdrawal behaviour, inattentiveness, poor rapport with peers, parents and teachers, impatience, lack of initiative, and truancy, and many leave school before completing their studies. Specialised treatment is indicated from the school and or a psychologist.
  13. Family problems: parents often complain that their teenager is out of control. It may be that the parents are failing to exercise appropriate authority.  What is age appropriate activity for a teenager, and part of the struggle for autonomy and separation can be perceived by anxious and angry parents as abnormal and evidence of their own failure. The atmosphere at home may be one of constant conflict, hostility, repeated challenge to parental values and transgression of parental limits. The adolescent may be alienated from his/her family and the parents unable to offer the structure and controls necessary for emotional and physical security. Fortunately most adolescents don’t experience great and lasting emotional turmoil and behaviour disturbance, nor do they become alienated from their parents [7].
  14. Anorexia and bulimia: the risk of eating disorders is raised among teenage girls where dieting is a common practice, particularly among those who are obese before puberty with low self esteem and poor body image. These problems all pose risks to health and are the cause of great emotional distress to the girls and their families and need urgent specialised professional help.
  15. Depression: is a potentially treatable cause of suicide which is far more common amongst teenagers than is generally realised. Suicide threats need to be taken very seriously and referred for professional [psychiatric] help. Depression may manifest as anger and aggression, or lowered or fluctuating moods, feelings of hopelessness, eating disorders, sleep disturbance, irritability and social withdrawal. Depression requires thorough assessment and appropriate effective treatment.
  16. Sport: is all about losing, and the sooner adolescents and their adult counsellors learn this truth, the better for all concerned. Youngsters should be motivated to achieve their own performance goals and learn that the only competition is with themselves, and they need to understand the value of maintaining high levels of physical activity for life [6].

People who are involved with children and adolescents should take an interest in their sexual development, especially the promotion and nurturance of positive self-affirming attitudes towards sex. Whether we realize it or not, all of us who are close to kids are sex educators, a responsibility that involves so much more than giving facts, - the everyday messages about their worth, the value of their bodies, and the importance of their sexuality. Young people must be provided with the knowledge and the means to make informed decisions about their sexuality, and help to cope with the pressures they face, and recognise that they have choices, and hopefully make decisions that they will be comfortable to live with throughout their lives.

There is no better sex education than observing an obviously affectionate bond between one’s mother and father. Well planned sex education programmes should start in schools at elementary level, and expand for adolescents and adults.

We cannot protect children from exploitation by teaching them to mistrust their sexuality. They need to know that they are guardians of their bodies with the right to enjoy its pleasures and speak up when touches don’t feel good.
With deep rooted self worth, clear information, consistent care – and a little luck- they will be equipped to cope with the hard realities of sex and love.

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