To Investigate Gender Differences In Awareness Of Physical Developments Of Adolescents and Comparison Between Girls and Boys
ACKNOWLEDGMENT
I am very beholden of Allah Almighty who is the master of Life, Death , Universe , Mountains , Oceans, Trees, Lands, Seven Skies , Stars, Moon , Eden, Hades and most beneficent Merciful and Gracious.
I pay my civic tribute to the beloved Last Prophet of Allah Almighty, Hazarat Muhhamd (PBUH) for whose every thing of this world has been created. I am much elated to be the flower and disciple of magnificent Prophet Hazarat Muhammad (PBUH).
We want to thank the Department of Gender Studies, who facilitated us and provide us an opportunity to go through thesis work, processed in the department. In this regard the most prominent personality whom we feel honor to thankfully mentioned is our supervisor.
Last but not least, we salute our parents whose love , affection, highness, encouragement and prayers have made us able to stand where we are. Allah’s blessing to all of them and upon us
Abstract
Aim of the study was to investigate gender differences in awareness of physical developments of adolescents and comparison between girls and boys. It was also aimed to find out impacts of awareness and unawareness among adolescents. Sample of study was male and female school going students of 9th and 10th class age 13 to 16 years, from Lahore city. A close ended questionnaire was formed for data collection as a tool.
Results were found that most of girls and boys have no prior information or guideness about physical changes. Most of girls discussed about these changes to their mothers while majority of boys discussed with their friend. Girls were shyer than boys when they got information while boys were more isolated then girls.
Majority of adolescents have view that they should be given proper information about sexual and physical changes before entering into age of puberty. Due to lack of awareness girls and boys have to face lot of health and physical problems as acne, low blood pressure, fainting and most prominent in girl’s menstruation problems, which can be overcome by giving them proper information.
Chapter 1
Introduction
Puberty is defined as the period of life when persons reach sexual development (United Nations, 1997). It’s the point in time when adolescents experience a transform in their corporeal, social, and emotional sides of life. In sequence to successfully compact with this conversion, they necessitate information and obvious image of their physical changes to avoid from physical harms, shame, vagueness, and uncertainty (Khan, 2000). Consequently, sexual health of the immature people is an increasing alarm today and is being considered a keystone of health and a major determinant of individual social growth(Pine & Khan, 2003).
Puberty indicates the procedure of bodily changes by which a child’s body becomes a fully developed body able to reproduction and it generally happens in the 2nd phase of life. The World Health Organization elaborates the ages from 10 to 19 as puberty age. It’s a phase in which the person’s character in stipulations of culture and health is formed and the maturity in societal, physical, emotional, mental and psychological aspects of life happens. Also, the common sense, intellect and mind potentials attain perfection and make the intellectual and psychological capacity developed (Afghari, Eghtedari, Pashmi, & Sadri, 2008). Amongst distinct ranks and ages of growth, teenage years are very significant and wonderful for the reason that the changes that happen to a pubescent influence family and the public as well(WHO, 1999)
In some cases parents forget their duty to convey health Knowledge to their kids because of either shame or unawareness or life commitments. They cannot recognize the challenge, pain and trouble their children have in this course and set the responsibility of informing their children on the shoulders of teachers who may ignore it as well and return it back to the parents. In such condition adolescents will go to class fellows, siblings, street talks, and mass media to acquire the knowledge they want. It will guide to incorrect, imperfect or deficient information and confusion of the circumstances. Hence, these adolescents can generate troubles for both themselves and their parents and set their physical, psychosomatic, and social health in danger. Researches carried out in Isfahan province have showed that over 50% of young girls and 23% of parents have not adequate information about physical and psychological changes in teenage and had no evidence how to face the issues of this particular age and how to become healthy. Studies in the developed countries also have reflect that 65% of teenagers, particularly females do not have enough and proper information about puberty and sexuality and just 32% of them had an acceptable behavior toward facing puberty problems(Dube & Sharma, 2012).
A study done amongst teenage girls of African American and Latina aged 13 to 19 years presence at public high schools discovered that in the presence of health care system, female youngsters were incapable to get adequate care by reason of confusion(Mckee, Karasz, & Weber, 2004)
Appropriately there are 16.5 and 25 million of teenagers of 10 to 15 years and 15 to 24 years in Pakistan. The relative number of female adolescents of age 10-14 and 15- 19 is 9 million and 6.5 million respectively. Two third of the said people live in city areas and rest of live in rural areas (Nasar, Pasha, Hanif, & Ismail, 1998). Though research nearby adolescents’ sexual problems remains limited, mostly due to the community taboos restricting broad dialogue of the topic especially along with young (Ali, Ali, Waheed, & Memon, 2008). It is shown by the limited literature that people of Pakistan generally and adolescent group specially have limited access to puberty related health education and services. A survey conducted by Aahung, a non-governmental organization revealed that adolescents had lack of confidence and had insufficient information about their bodily changes. The study acknowledged child sexual abuse, sexual harassment and shame and guilt associated with the body changes as key concerns inhibiting health seeking behavior of adolescents(Mohamed, 2002).
A greater awareness of puberty among boys than girls is revealed by a study conducted by Pakistan Voluntary Health and Nutrition Association (PAVHNA). According to the findings of study, 90% of the boys and 80% of the girls had discussed bodily changes with peers and family members. Findings of another survey showed that girls were most likely to hear about puberty from their mothers, sisters and friends. They were less likely to be informed about puberty before it occurred. The study also highlighted that the timing of information on puberty was insufficient as 75% of girls felt that they should have been informed about puberty in advance (Sathar, Haque, Faizunnissa, & Sultan, 2002).
A study on reproductive health awareness in adolescent girls was conducted in Peshawar. Eighty eight percent (88%) of the students in the study clearly expressed their exact for sex education in schools. Girls were shy about discussing menstruation and felt that virginity was a virtue. The study concluded that there was a great need for multidisciplinary instructive programs in schools to give adolescents “the right answers at the right time” (Majid, 1995). Studies have also exposed that majority of female adolescents have very partial information about menstruation.
A qualitative research based study in Karachi found various falsehood about menstruation. Majority of the girls supposed menstruation as the ability to give birth and bathing as harmful during menstruation. Most girls felt it wrong to talk about their bodies. They also affirmed that they would tell their mother if they experienced any discomfort in genital area (Mohamed, 2002)
Another study found that females were considered unclean while menstruating. Some were made to sleep on a mat on the floor, forbidden to bath, and advised to avoid some foods (Mumtaz & Rauf, 1996)
The above literature clearly shows that there is lack of knowledge related to puberty and related health among the female adolescents. Due to which, female and male adolescents face a number of problems during their reproductive life and especially at the time of puberty, pregnancy and childbirth.
This study operates to explore the understanding of puberty and related health problems among female and male adolescents in Lahore, Pakistan. The objectives of the study are to check the common facilities available and accessible to gain knowledge about puberty among adolescents; to estimate the proportion of female and male adolescent applying the availability of facilities; and to assess the level of understanding related to puberty and related health problems among adolescents.
Statement of the problem
Researchers wanted to know about the puberty age health issue which has to face the adolescents (girls and boys) in starting point of sexual and reproductive development due to the lack of information and knowledge. Researchers checked how much they have knowledge about the changes happening in their bodies and have they some fair or confusion to that particular period of reproductive growth. What type of assistance or guidance is provided to adolescents about sexual health and by whom it is provided and to what extent it is beneficial for adolescents? What are gender difference (in boys and girls) about awareness of sexual and physical developments?
Objectives of the study
The objectives of the study are to find out:
- To access the knowledge of adolescents, regarding puberty age physical developments and the sources of information.
- The gender difference in awareness about physical changes at age of puberty.
- Adolescents (girls and boys) reaction to physical changes accruing at age of puberty.
Research Questions
- What are gender differences in knowledge of physical developments at age of puberty?
- Is there adolescents (girls and boys) have any prior knowledge about physical developments during puberty age what was the reaction of adolescents?
- What are the sources of information about physical changes accruing at the age of puberty?
Significance of Study
This study is very important in respect of checking awareness level in adolescents (boys and girls of enrolled students in 9th and 10th class students aged 13 to 16 years) about physical changes. This study will help for generating new recommendations about providing physical developments at puberty age to youngsters. This study is significantly important to explore time period changes in sexual awareness among boys and girls. This study will be helpful for knowing the level of awareness about body changes among adolescents, information available to them; problems facing by them and what facilities and education are required to overcome those particular problems.
Chapter 2
Life stages
Descriptions of life stages can be found in early Greek literature from the time of Hippocrates, and are based on observable changes in individuals during life, primarily based on biology. Researchers have replaced the last stage, “Old Age” (which begins at age 55 in psychological literatures) with four stages that I believe more accurately reflect life today.
As important as the stages themselves are, the change periods between stages are the periods of most obvious change, times which are sometimes difficult. Preparation and understanding help. Below are listed ten life stages, with a very brief description of each stage. Note that after age sixty, the stages are no longer related to chronological age.
| LIFE STAGE | CHARACTERISTICS OF LIFE STAGE |
| Infant | Birth through two years. Dependent, brain developing, learning motor skills and sensory abilities. |
| Child | 3-9 years. Growing and mastering motor skills and language. Learning to play and socialize. Continued growth, formal school and organized activities. |
| Adolescent | 10-19 years. Growth spurts. Puberty brings hormonal changes and reactions. Strong emotions may rule decisions. Behavioral risks. |
| Young adult | 20-29 years. Completing education and beginning career and family. Potential coping and financial pressures. |
| Adult | 30-39 years. Managing family and career growth. Increasing numbers of couples are starting families in this stage. Continued coping pressures. |
| Middle age | 40-60 years. First signs of aging and effects of lifestyle; menopause, children are leaving the nest, grandchildren arrive, career peak. Aging parents may require care. |
| Independent elder | Age 60 onward. More signs of aging and lifestyle effects. Eligible for government provided retirement and health care benefits or private pensions. Retirement, discretionary time. Some health problems and medications. May care for others. |
| Vulnerable elder | Optional stage. Beginning of frailty, cognitive or multiple health problems. Require some assistance. Not able to drive. Possible move to Assisted Living. |
| Dependent elder | Optional stage. Requires daily care. Unable to perform all personal functions. Possible move to a nursing home. |
| End of Life (Up to six months) | Diagnosed with terminal condition or end stage of disease. May require hospice care, hospitalization or nursing home care. |
Growth at Puberty
Puberty is a dynamic period of development marked by rapid changes in body size, shape, and composition, all of which are sexually dimorphic. One of the hallmarks of puberty is the adolescent growth spurt. Body compositional changes, including the regional distribution of body fat, are especially large during the pubertal transition and markedly sexually dimorphic.
The hormonal regulation of the growth spurt and the alterations in body composition depend on the release of the gonadotropins, lepton, the sex-steroids, and growth hormone. It is very likely that interactions among these hormonal axes are more important than their main effects, and those alterations in body composition and the regional distribution of body fat actually are signals to alter the neuroendocrine and peripheral hormone axes. These processes are merely magnified during pubertal development but likely are pivotal all along the way from fetal growth to the aging process.
Pre-Pubertal Growth
Growth during childhood is a relatively stable process. The infancy shifts in the channel of growth are complete, and the child follows the trajectory previously attained. Until about age 4 years, girls grow slightly faster than boys and then both genders average a rate of 5 to 6 cm/year and 2.5 kg/year until the onset of puberty (Tanner J. M., 1989). A general rule of thumb is that a child grows 10 inches (25 cm) in the first year of life, half that (5 inch or 12 to 13 cm) in the second year, and then 2.5 inches (5 to 6 cm) until puberty. Assuming an average birth length of 20 inches (51 cm) results in an average 1-year-old being 30 inches (76 cm), a 2-year-old 35 inches (89 cm), a 4-year-old 40 inches (102 cm), and an 8-year-old 50 inches (127 cm)(Tanner J. M., 1989).
A wide range of normal exists for the growth velocity, however, and it depends on which percentile a child is growing. Those children growing along the 3rd percentile average 5.1 cm/year, whereas boys growing along the 97th percentile grow 6.4 cm/year and girls 7.1 cm/year during childhood to maintain the ambient trajectory (Roche & Himes, 1980)
To maintain growth along the 10th percentile height, a child must grow at the 40th percentile for velocity; to grow along the 90th percentile for height, a velocity at the 60th percentile is required. This implies that a child who persistently grows at the 10th percentile for velocity will progressively cross percentiles downward on the standard height curve. Some children have a small increase in the growth velocity around 6 to 7 years of age (“mid-growth spurt”), but this is not a consistent finding, and the gain in height is generally of small magnitude. A seasonal variation in growth has been noted in some children. Linear growth tends to be greater in spring than in fall, but weight gain is greater in the fall months. This emphasizes the need for repeated measurements over the course of a year to accurately assess a child’s growth pattern(Martha, et al., 1989).
Pubertal Growth
Puberty is a dynamic period of development marked by rapid changes in body size, shape, and composition, all of which are sexually dimorphic. It is characterized by the greatest sexual differentiation since fetal life and the most rapid rate of linear growth since infancy. The onset of puberty corresponds to a skeletal (biological) age of approximately 11 years in girls and 13 years in boys(Tanner, Whitehouse, Marshall, & Carter, 1975)
On average, girls enter and complete each stage of puberty earlier than boys, but there is significant intra individual variation in the timing and tempo of puberty, even among children of the same gender and ethnic background. One of the hallmarks of puberty is the adolescent growth spurt. As puberty approaches, the growth velocity slows to a nadir (“preadolescent dip”) before its sudden acceleration during mid-puberty. The timing of the pubertal growth spurt occurs earlier in girls, typically at Tanner breast stage 3, and does not reach the magnitude of that of boys. Girls average a peak height velocity of 9 cm/year at age 12 and a total gain in height of 25 cm during the pubertal growth period(Marshal & Tanner, 1969).
Boys attain a peak height velocity of 10.3 cm/year, on average, 2 years later than girls, during Tanner genital stage 4, and gain 28 cm in height (Marshall & Tanner, 1970) The longer duration of pre-pubertal growth in combination with a greater peak height velocity results in the average adult height difference of 13 cm between men and women (Tanner J. M., 1989). Puberty is also a time of significant weight gain; 50% of adult body weight is gained during adolescence. In boys, peak weight velocity occurs at about the same time as peak height velocity (age 14) and averages 9 kg/year. In girls, peak weight gain lags behind peak height velocity by approximately 6 months and reaches 8.3 kg/year at about 12.5(Barnes, 1975; Marshal M. A., 1978).
The rate of weight gain decelerates in a manner similar to that of height velocity during the latter stages of pubertal development. Sexual maturation occurs during puberty under the influence of gonadal steroid hormones (predominantly testosterone in males and estradiol in females) and the adrenal androgens, primarily dehydroepiandrosterone sulfate (DHEAS). Development usually occurs in a defined sequence within each gender, but individual variation does occur normally. Adrearche, the production of adrenal androgens, generally occurs 1 to 2 years before the other hormonal changes of puberty, although visible evidence is generally not apparent until after thelarche in girls or testicular enlargement in boys. In both genders, adrenarche results in the appearance of sexual hair, adult-type body odor, and occasionally acne, and is a separate process from that of the centrally mediated gonadarche. In boys, testicular enlargement and a thinning and reddening of the scrotum herald gonadarche. On average, this occurs between ages 11.5 and 12 years, but a broad range of normal exists. The onset of these changes before age 9 is considered precocious and later than age 14, delayed. The testes undergo enlargement from the prepubertal volume of 3 ml or less to 4 ml at the onset of puberty and undergo a 10-fold increase in size by the end of pubertal development(Marshall W. A., 1975).
Approximately 75% of boys will reach their peak height velocity during Tanner genital stage 4 and the remainder during stage 5. Sperm production and ejaculatory capability are present early during sexual development (biological age of 13.5 to 13.7 years) and do not correlate well with testicular size or other physical signs of sexual maturation. The first evidence of gonadarche in girls is the appearance of breast buds (thelarche). This sign typically occurs between age 8 and 13 years, with an average of 11 years. Development before age 8 is considered precocious and later than age 13 delayed(Tanner J. M., 1989), although more recent data suggest that normal development may begin months earlier (HermanGiddens, et al., 1997). The pace of pubertal development correlates with the levels of sex steroid hormones during early puberty (Ridder, et al., 1992).
In girls, the duration of pubertal development is usually 3 to 3.5 years but may be completed within 2 years or take up to 5 to 6 years. Menarche usually follows the onset of breast development by about 2.5 years. In North America, the average age of menarche in girls of European descent is 12.8 to 13.3 years but slightly earlier in girls of African origin 12.5 years(Zagharias, Wurtman, & Schatzoff, 1970) Menstrual cycles tend to be anovulatory in more than half of girls up to 2 years beyond menarche, resulting in irregular intermenstrual intervals (Finkelstein, 1980).
Development Changes
Body changes in Boys
Everyone’s bodies change at different rates. To the left are the changes boys go through during puberty. These changes are exciting and normal. Boys that know about development: changes, terms, and expectations tend to do better during the transition. During this time it is very important to take care of one’s body. One can do this by: eating good foods, exercising, and giving self-exams. (Ordered in the most common developmental order)
- Testicles and scrotum grow
- Pubic hair begins to grow
- Penis grows in size
- Erections and Ejaculations
- Growth spurt in height
- Shoulders broaden
- Voice changes
- Oilier hair and skin
- Nipples get bigger and darker
- Peck muscles enlarge
- Muscles get bigger
- Hair on legs darkens
- Feet get bigger
- Facial hair
- Arm hair
- Hair on chest and back
Physical Changes in Girls during Puberty
Puberty is all about raging hormones. Hormones that were hibernating suddenly awaken and signal girl body to enter puberty. Hormones cause the changes that are associated with puberty. Below is a time line for physical changes that occur during puberty.
- Breasts
- Pubic Hair
- Acne
| Puberty Event | Age at which it happens |
| Growth of breasts | 8-13 |
| Growth of pubic hair | 8-14 |
| Body Growth | 9 1/2-14 ½ |
| First Period | 10-16 ½ |
| Underarm Hair | 2 years after pubic hair shows up |
| Acne | Around the same time as underarm hair |
Puberty is not the same for everyone, so some girls will grow pubic hair before they develop breasts, and that is absolutely normal.
Physical Changes for Females
- Pubic Hair
- Sex Organs Grow Larger
- Adolescent Growth and Development
- Vagina
- Female Reproductive Organs
- Breast Buds
- Breast Development
- Sex Hormones Signal Changes
- Growth Spurt
- Acne
Teaching the Child Islamic Rules Regarding Puberty
When the child reaches puberty, he becomes fully accountable for his deeds in front of Allah (SWT). It is first and foremost the responsibility of the parents to carry this message to the child.
The parents of the adolescent boy should inform him that the first time he ejaculates he becomes accountable for his actions in front of Allah (SWT), and he should perform the acts of worship in the same way that adult Muslims do. When the girl is about nine years old, her parents should inform her that the first time she sees blood (menstruation), she becomes accountable for her acts and the worship acts prescribed on the Muslim women are also prescribed on her.
When the child reaches puberty, there are rules that the parents should explain to him, which include:
If the child has a sexual dream, he does not have to take a bath (ghusl) unless he sees or feels wetness in his clothes or sheets due to sperm ejaculation in the case of the boy, or vaginal discharge in the case of the girl (the type of viscous discharge that commonly occurs after a woman has had orgasm). Such was the answer of the Prophet (SAW) to KhawlahBint Hakeem, who asked him if a woman should make ghusl when she has a sexual dream. He (SAW) said:
“No ghusl on her unless she has a discharge,
similarly there is not ghusl on the man unless he ejaculates.”
[Related by Ahmad and Al-Nasa’i]
When the child wakes up and sees or feels wetness due to sexual discharge, he/she should perform ghusl even if he/she did not remember having any dream.
When the boy ejaculates due to sexual arousal, whether voluntary or involuntary, he should perform ghusl. The same rule applies for the girl if she had an orgasm or vaginal discharge.
Young men and young women who are about to get married should know that during sexual intercourse, as soon as penetration occurs they both should perform ghusl whether there was discharge or not. The Prophet (SAW) said:
“When he sits between her arms and legs, and the two organs touch, and his organ disappears (in her), there should be ghusl, whether he ejaculated or not.” (Related by Muslim)
When the girl does not see any more blood at the end of her menses, she should perform ghusl. The married woman should know that after child birth she should make ghusl as soon as she stops bleeding. The next step is obviously to teach the child how to perform ghusl and the Sunan acts of ghusl. He or she should know the acts that are unlawful to him or her while in a state of sexual impurity. These include: During menstruation, or after birth bleeding, a woman is forbidden to pray, fast, enter a mosque unless passing through it, make tawaf (i.e. circumumbulate the Ka’bah or have sexual intercourse, for Allah (SWT) says:
“They ask you concerning menstruation. Say: that is an Adha (a harmful thing for a husband to have asexual intercourse with his wife while she is having her menses), therefore keep away from women during menses and go not unto them until they have purified (from menses and taken a bath)…”
[Al-Baqarah 2:222]
Men and women who are in a state of sexual impurity (janabah) are prohibited from reading the Quran or touching it before making ghusl. It is not recommended to read the Quran or touch it before ghusl. The Prophet Muhammad (SAW) used to recite the Quran under all conditions except when he was in a state of Janaba that is after having sexual intercourse when it was necessary for him to take a bath. They are also forbidden to pray, enter the mosque, or make tawaf.
The child should learn to inspect his/her clothes and keep them clean from sperm (or vaginal discharge), or in fact, any liquid discharge from the sexual organs.
There is NO evidence whatsoever that says that a woman who is on her period or a woman who is having post-natal bleeding that she can not touch the Qur’an. See The Natural Blood of Women (by Dr, Ameenah Bilal Phillips) for evidence (Al-Jumuah Magazine, 1995).
Sexual Awareness and Behavior
Male Awareness and Sexual Behavior
Boys and young men may have more access to the outside world and exposure to diverse sources of sexual information, nevertheless, they seem to be deeply concerned about elements of their own sexuality. The prevalence of misinformation, perpetrated by so-called sex clinics which seek to “cure” men of unwanted sexual habits, as well as traditional and religious taboos, exert a powerful hold on males. Since they seem reluctant to discuss their concerns and questions about their own sexuality with peers, it may be only when they marry and experience intimacy with their wives that they can lay some anxieties to rest.
Some small studies venture into the unexplored territory of young peoples’ attitudes towards sexuality. Although they do not represent a wide sample of respondents, their findings can be used in developing future research. For example, young men seem particularly anxious about masturbation, homosexuality, nocturnal emissions, and infertility. In a study conducted among 188 male patients (ages 18-30) presenting at Aga Khan University in Karachi, 80 percent said they had masturbated at some point in their lives. Their misconceptions included the belief that masturbation causes impotence (22 percent), physical illness (31 percent), and weakness (63 percent). Strong feelings of guilt remained with 69 percent of respondents. The misconceptions were more prevalent among respondents from lower and middle-income groups. Their concerns were often exploited by sex clinics, where they would pay thousands of rupees for treatment for infertility prior to getting married, simply because they had masturbated(PIPHRO, 1999)
A series of focus groups with adolescents in Chanessar Goth, a low-income multi-ethnic community in Karachi, were conducted by Aahung (part of the Karachi Reproductive Health Project) in preparation for developing an AIDS awareness program within the local schools. The discussions with both boys and girls attending the Urdu-medium secondary schools revealed that adolescents exhibited a general lack of confidence and ability to be assertive, and had inadequate information about the body. Child sexual abuse, sexual harassment, drug use, and shame and guilt associated with the body were identified as key concerns that inhibited their health-seeking behavior. In in-depth interviews conducted with 71 boys ages 11-19, 18 percent said one should not talk about his body, and 11 percent said they would not tell anyone if they experienced discomfort in their genital area. Most boys believed that masturbation endangered one’s health, and commonly associated it with causing the penis to become crooked or loose(PIPHRO, 1999).
Young men are also concerned about nocturnal emissions (or “wet dreams”), possibly to a lesser extent than masturbation. In the Qidwai study (1996), 94 percent of respondents admitted to having nocturnal emissions and 15 percent considered them a cause of physical illness. Respondents associated dark circles around the eyes with the consequences of masturbation and nocturnal emissions(PIPHRO, 1999).
A study in Punjab of male needs and attitudes regarding reproductive health found that men, women, and service providers all felt that men lack awareness and knowledge of reproductive problems. This included their own issues, identified as infertility, sexually transmitted diseases, weakness, sexual “debility,” and masturbation. Service providers specifically suggested that information and education begin to be provided to boys at age 14, and that services are also needed to help prevent the spread of homosexuality and prevent frequent masturbation (PIPHRO, 1999).
Onset of Menstruation
The onset of menstruation may mark an abrupt change to quasi-adult status in a girl’s life in Pakistan, or it may mark the beginning of a long transition period to full adulthood. A girl’s experience of menstruation will depend on her class, educational, cultural, and social background. Under Islamic laws, such as the Hudood Ordinances, the onset of menstruation is used to determine her adult status under the law, making her liable to severe punishment for sexual activity. While the age at marriage for girls has risen over the years, in some parts of the country they are betrothed or married soon after their menses begin. In traditional communities, menstruation usually marks a stricter enforcement of purdah (segregation) norms, resulting in a girl covering her head and finding her mobility outside the home restricted, and, at worst, causing her withdrawal from school.
In a study on the transfer of health and reproductive knowledge in a southern Punjab village menstruation was “the watershed between being a girl child and becoming a woman” (Mumtaz & Rauf, 1996). A girl was immediately expected to observe purdah and wear a burqa, and would be married within two to three years of her first period. Although such dramatic changes in a girl’s status do not occur among all communities in Pakistan, particularly in urban centers, the social silence maintained around menstruation that was observed by the researchers can be observed across class and cultural divides. Girls in the study relied on elder sisters or sisters-in-law for information about menstruation and its practical management.
Some practices related to menstruation are worrisome from the health and hygiene point of view. For example, Mumtaz and Rauf (1996) found that women were considered unclean while menstruating. Some were made to sleep on a mat on the floor, forbidden to bathe, and advised to avoid some foods (in the belief that certain foods would make them ill).
The Aahung (1999) interviews conducted with 80 girls ages 11-19 in the low income community of Chanessar Goth, Karachi, found that 64 percent of the girls believed that it was harmful to shower during menstruation. Only about half of those interviewed said that menstruation was related to a woman’s ability to give birth, while the rest were unsure whether the two were linked. Both of these studies reveal a low level of awareness about the process of menstruation. The relationship between poor hygiene practices and infections in women and girls needs to be examined in future research.
While a variety of home remedies and traditional therapies are used to manage menstrual cramps, until recently premenstrual syndrome has not been recognized as a problem. However, in a study of 1,600 women in Karachi the total incidence of PMS was 33 percent. (Shersha et al. 1991) The figure was slightly higher for married women (34 percent) than for unmarried women (32 percent). It was inversely proportional to the number of pregnancies. Complaints of symptoms associated with PMS were most frequent in the lower socioeconomic groups and among those women who lived in parts of Karachi most affected by the law and order problem.
Mensch et al. (1998) point out that more research needs to be done on customs and restrictions, particularly the health dimensions, surrounding menstruation. In a country with a cultural mix, such as Pakistan, there is a need to understand in more detail how girls from different tribes and regions manage the practical and health dimensions of menstruation. While anthropological literature, and some development literature, includes limited information on practices surrounding menstruation among different tribes, the subject has not been the focus of sustained or comparative research.
Female Awareness and Sexual Behavior
Since the cost of female sexuality is so high, so too are the fears surrounding sexuality. Women and girls interviewed in rural Punjab exhibited a morbid preoccupation with the dangers posed by the world outside their homes and villages. This arose mainly through fears of male sexual harassment, rape, abduction, and loss of reputation in case a community member observed a female speaking with a male who was not related. Although girls resented the restrictions imposed on them, they had internalized these fears and were reluctant to express any positive sentiments about their own sexuality (Khan, 2000).
Yet, since so little is known about female sexual attitudes and behavior, and open discussion is so strongly discouraged, it is impossible to determine the real sentiments and activities of girls in Pakistan. Where field-workers have access to adolescent girls and enjoy their confidence, as in the FPAP Girl-Child Project, findings have formed an important part of the knowledge base of the staff but have not been formally compiled for others to access. It is not possible to confirm, for example, if the rise in age at marriage has had any bearing upon premarital sexual activity among unmarried adolescents.
Research from other developing countries suggests a change in awareness and behavior. It is possible that trends in India, arising out of a comparable social and economic environment, may serve as an indicator of what might be happening in Pakistan. In India, roughly one in four unmarried adolescent boys ages 10-19 have had sexual relations, as reported by school and college students through self administered questionnaires in four small surveys. In contrast, sexual activity among unmarried adolescent girls is at a lower level. However, almost 25 percent of rape victims are under age 16, and 20 percent of all sex workers are adolescents, according to Indian government figures. Unmarried adolescents are a disproportionately large number of abortion seekers. (Jejeebhoy 1998) In a survey of mainly female university students in Delhi, it emerges that women were fairly open in expressing their sexual needs, including masturbation, and few thought that intercourse required marriage first. Nonetheless, only a small minority had premarital sex or dated, suggesting that their attitudes were more open than their behavior.
Further, there was a high level of ignorance about contraception and basic sexual functioning. (Sachdev 1998)
Access to Information and Knowledge about Sex
There is some level of demand for sex education among young people. (Raoof Ali 1999; Qidwai 1996; Aangan 1998) Boys and girls are concerned not only with their own developing sexuality, but request more information about the other sex. Boys may be more open in demanding information, while girls are generally more inhibited about expressing their concerns. (Aangan 1998)
The mainstream media and education system do not offer adolescents the information they need. Parents are also not a source of sex education for their children. The tacit assumption among adults and policymakers, as well as health and family planning service providers, seems to be that young people will get whatever information they need when it is proper, that is, when they are married. It may be pointed out here that media and educational tools are not only inadequate, but they fail to obtain opinions and views from young people themselves. Tacit assumptions about adolescents’ needs and future aspirations may be faulty. UNFPA produced an unusual documentary in 1999 in which dozens of adolescent boys and girls across the country were interviewed, eliciting their views on a range of issues for the first time. More endeavors such as this would help projects/programs be more responsive to adolescents’ stated needs.
The reality of adolescents’ lives, which includes sexual abuse and rape, misconceptions and anxieties about their developing sexuality, lack of information about the other sex, pregnancy risks, and sexually transmitted diseases, is being denied out of fear that information will lead to an increase in premarital sex. As a result, even adolescents who are married and in need of sex education have no source of neutral information to protect their health and improve their sexual relations. Figures from numerous developing countries show that adolescents, including married girls, have little knowledge of both their reproductive health and biology or how to protect themselves from disease. (Mensch et al. 1998)
Adolescent girls are more likely to get their sexual and reproductive knowledge from women within their families. Unfortunately even this hypothesis is difficult to verify through research, since unmarried girls and young women are often forbidden to give interviews to outside researchers(Khan, 2000; Mumtaz & Rauf, 1996). The information adolescent girls do receive from the women in their families is likely to be related to menstruation, while information about sex itself may only be passed on to a girl from a female relative on the wedding day itself (Mumtaz & Rauf, 1996). There is no formal research available on unmarried girls’ concerns about sex or reproduction prior to marriage. However, research findings among married couples have established that women’s need for sexual satisfaction within marriage is accepted by couples, and it is not necessarily the case that women always subsume their sexual needs in deference to their husbands, as is sometimes assumed. (Ministry of Population Welfare and Population Council 1998)
Needless to say the formal education curriculum, including medical training, does not include sex education, although population and family planning issues are incorporated. Sexuality, apart from reproductive biology or contraception that are taught in specific settings, is a taboo subject. While the new Education Policy (Ministry of Education 1998) states that curricula at the secondary level will include additional subjects such as awareness about drugs, AIDS, and environmental issues, it still falls short from recommending a basic introduction to the facts of life. Even this effort at reproductive health education is further limited in impact because only a small proportion of all adolescents complete secondary school.
The National Health Policy states that reproductive health as well as health education will be among the Health Ministry’s priority programs. (Ministry of Health 1997) The discussion of reproductive health mentions that all aspects of the reproductive system and its functions will be taught, but the document does not mention sexuality. Activities will be undertaken to empower the community to work for the promotion of its own health, but clearly without basic sex education being taught to young people. This gap in curricula, combined with the fact that young people do not rely on their parents for information on sexual issues, means that sources of information are often unreliable and exploitative (PIPHRO, 1999).
There are some projects underway that will begin the process of sex education, although they are tentative and introductory. Neither the family planning program nor the kind of objectives stated by the government, as indicated in the preceding discussion, were incentive enough to inspire service providers to discuss sex education; however, the threat of an HIV/AIDS epidemic has forced those tackling these issues to discuss sexual relations in unprecedented detail with their target communities. For example, Aahung, the AIDS awareness program at the Karachi Reproductive Health Project, is trying to develop a curriculum for secondary schools, for both male and female students, in which sexuality and reproductive health can be taught. They are currently experimenting with modules in selected secondary schools in Chanessar Goth, a low-income, multi-ethnic community in Karachi.
The Family Planning Association of Pakistan, the largest NGO in this sector, has stated, “reproductive health care also includes sexual health, the purpose for which is the enhancement of life and personal relations” (FPAP 1995: 45). Although FPAP has targeted young people in a number of other projects, it is currently preparing the groundwork for a new initiative. Join In Educating Adolescents and Teenagers (JEAT) is directly aimed at addressing the knowledge and attitudes of young adults toward reproductive and sexual health, with a view to influencing their behavior in favor of the small family norm and responsible parenthood. The project has multiple components including: a) establishing baseline information on adolescents’ existing level of information on sexuality and reproduction; b) establishing a resource and information base on adolescent sexual health; c) developing modules on reproductive and sexual health for youth; and d) sensitizing staff on youth issues and training counselors to work with youth. The program will work with adolescents already participating in existing youth activities.
Certain other nongovernmental organizations have a great potential to become providers of reproductive health education because they have access to a broad spectrum of young people in Pakistan. For example, the Girl Guides and Boy Scouts Association, and Pakistan Red Crescent Youth Societies do provide basic health and nutrition information, but stop short of introducing sex and related reproductive health matters in their activities. This reflects social taboos that make sex education, and even associations of adolescents, threatening activities in Pakistan.
Sources of Information
A rare study on reproductive health awareness in adolescent girls was conducted with 300 students in Peshawar high schools (Majid, 1995). A questionnaire was distributed to girls in Classes IX and X, presumably ages 14-16. Majid concluded that teenage sexuality was not a major issue for the students, but that there was still a great need for multidisciplinary educational programs in schools to give adolescents “the right answers at the right time.” Certainly students clearly articulated their demand (88 percent) for sex education in schools, which belied the low level of expressed curiosity about sex. Finally, girls were shy about discussing menstruation and felt that virginity was a virtue.
Following were the sources of sex education.
- Mother
- Sister
- Friend
- Teacher
- Internet
- Media
- Books
- Magazines
- Matters related to sex discussed in their families
Chapter 3
Methodology
The technique of methodology is considered gigantically remarkable for analyses of sociology exertions and empirical research. According to the reference of Merton (1957) the methodology as logic of scientific procedure. According to Nachmias (1992) the scientific methodology is a system of explicit rules and procedures upon which research is based and against which the claims.
The most important purposes of this chapter is to manifest unlike technique and tools employed for the collection, analysis and interpretation of the data nexus with the perusal of investigation. This study was identified the knowledge of sexual changes in adolescents during the puberty age. Moreover, it would find out the resources of knowledge, reaction of the resource person and what was the adolescent’s reaction. The universe of the present study was consisted on Lahore city.
Type of Research
This research is quantitative in nature, and data was collected in a survey using a close ended and open handed questionnaire. The instrument was developed to measure the knowledge and information about sexual and reproductive physical changes between girls and boys. Respondents were also asked to report their problems at that particular point of time, available assistance and guidance from parents, teachers, mates or by any other source.
The Universe
Sets of individual or objects having common observable characteristics constitute a population or universe (Dixon and Marry, 1957). The universe of the present study was consisted on adolescent boys and girls age of 13 to 16 year of Lahore city.
Population
The population under investigation were enrolled students in 9th and 10th class at the age of adolescence (13-16) from the private schools of Lahore, Pakistan. Since these puberty age physical changes of every one are diverse and discrete, so it is not easy to investigate the entire population.
Sample
A sample shows a representation of large whole (Goode and Hatt, 1952). The factors of time, cost and physical limitations usually play an important role in social researches; therefore, it is more economical and efficient to base studies on samples rather to study the entire universe.
Researchers adopted convenient sampling technique to collect a sample of 160 students enrolled in 9th and 10th class aged 13 to 16 years from the private sector schools of Lahore, including 80 from each gender. The convenient sampling technique was used for this study and two schools were selected: Educators school (boys and girls campus) and The city school (boys and girls campus) and 80 (40 girls and 40 boys) sample was selected from each school. Reason to select these schools was that they permitted to fill up questionnaires from their students.
Rational behind selecting the private schools was that students of private schools are more broad minded and they have less hesitation to provide required information for thesis work. It was persumed that teachers of private schools had discussed about sexual problems with their students rather than the public schools teachers who are conservative minded. It was also reason to select private schools that the financial and social class of private schools is different from public schools, it was persumed that parents had provided better conditions to their children. Age 13 to 16 years was selected for this thesis work because that is the time period when girls and boys are passion from puberty age, they are actually population who are facing puberty age issues. If researchers select any other age, that may be different mental condition and views may have been changed. So this specific age was selected.
Data collection
Tools for data collection
The most important part of statistical work is perhaps data collection. The researcher develop questionnaire to collect data of this study.” It is technical procedure which enables a social scientist to get the accurate information (Good and Hatt, 1952)”.
Questionnaire
For conducting the research a close-ended questionnaire was designed because the population of research was in very young age they can’t answer the open-ended questions. Only one open-ended question was added and in that most of the respondants answered in ‘no comments’.
Students were not aware of the terms of the research that’s why options were given and urdu meaning was also written over the difficult words.
Researcher translated the questionnaire in Urdu and Punjabi according to the environment at the time of filling questionnaire from respondents.
Data analysis
After receiving completed questionnaires, the data was be reviewed and organized and interpreted in tabulation and frequencies.
Statistical Analysis
For analysis purposes following statistical techniques have been utilized:
Percentage
For the estimation of frequency distribution of various traits of respondents and for the sake of making comparisons among some of variables, percentages were calculated with the help of following formula:
F
P = ——– x 100
N
Where:
P = Percentage
F = Number of observations
N = Total number of respondents.
Field Experiences
- Researchers have to face lot of difficulties to fill the questionnaires.
- Researchers contact to Beacon house school, divisional public school and Lahore grammar school but their administration did not allow researchers to fill out their researchers due to security and administrative reasons.
- Finely researchers have get permission from educators school because the principle of the said school was old pioneer who did his B.sc honors from zoology department of p.u in 1975.
- An amazing experience was that when the Principle of Educators school asked that who signed the reference letter. Researchers were worried that topic is so broad that’s why principle may have any objection on it that it was not a permissible topic. But latter on it was objection on the spelling of Master’s degree, and principle has opinion that supervisor had not read the letter and signed it. While it was the responsibility of supervisor.
- Boy students were not taking the research seriously and also making fun with each others. They were also asking about The research from researcher and enjoying it and laughing. Researcher provides them friendly environment to fill the questionnaire.
- Girl students were feeling very shameful and were also angry to their teachers, why they are going to fill out such type of personal questions.
Operational definition of variables
-
Puberty
Puberty is defined as the period of life when persons reach sexual development.
-
Knowledge
Facts, information and education: the theoretical or practical understanding of puberty age health problems.
-
Adolescence age
Adolescence is the time period between 11 and 18 years of life (WHO definition), but researchers picked up only age group of 13 to 16 years from standard age.
Limitations of study
There are some limitations of this research, first is that our population at the age of adolescence is in millions and researchers had selected sample of size 160 which is proportionally very low and results may be ambiguous. Other limitation is that respondents are of age 13-16 year who had hesitation and feel shy to provide original information to researchers. The time was also limited in the sense to get all the knowledge and information from children about sexual changes and problems.
Chapter 4
Analysis and Interpretation of Data
This chapter deals with the analysis and interpretation of data. “Knowledge about puberty age physical developments”. The instrument used to collect data was Questionnaire. Data was presented in form of tabulation and it is interpreted in frequencies and percentages.
4.1 Age of Respondents
According to the topic adolescents were approached to gather the data. Data in table shows that students of 16 years old were 40% which were more in ratio while at second 29% students were fall in 15 year age.
Table 4.1
Sample Description of the Study on the Basis of Age
| Age | Girls | Boys | Total (F) | Total (P) | ||
| frequency | Percent | Frequency | percent | |||
| 13 | 8 | 10 | 6 | 8 | 14 | 9 |
| 14 | 16 | 20 | 19 | 24 | 35 | 22 |
| 15 | 23 | 29 | 24 | 30 | 47 | 29 |
| 16 | 33 | 41 | 31 | 39 | 64 | 40 |
| total | 80 | 100.0 | 80 | 100.0 | 160 | 100 |
4.2 Class of Respondents
Table 4.2 shows that Student of 9th and 10th were the targeted population but the majority of students (62%) were studying in class 9th among the girls were (52%) and the boys were (71%). Rest of the 38% was studying in 10th class.
Table 4.2
Sample Description of the Study on the Basis of class
| Class | Girls | Boys | Total(f) | Total (p) | ||
| Frequency | Percent | Frequency | Percent | |||
| 9th | 42 | 52 | 57 | 71 | 99 | 62 |
| 10th | 38 | 48 | 23 | 29 | 61 | 38 |
| total | 80 | 100.0 | 80 | 100.0 | 160 | 100 |
4.3 Father’s Educations
Data in table 4.3 shows that fathers of respondents were Illiterate 6%, Primary 2%, Middle 4%, Secondary 8%, F.A 13%, B.A 23%, M.A 30%, Above 14% respectively. It shows that mostly fathers were highly educated who have masters degree.
Table 4.3
Sample Description of the Study on the Basis of Father Education
| Father Education | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| Illiterate | 8 | 10 | 2 | 3 | 10 | 6 |
| Primary | 2 | 3 | 1 | 1 | 3 | 2 |
| Middle | 2 | 3 | 4 | 5 | 6 | 4 |
| Secondary | 4 | 5 | 9 | 11 | 13 | 8 |
| F.A | 10 | 13 | 11 | 14 | 21 | 13 |
| B.A | 25 | 31 | 12 | 15 | 37 | 23 |
| M.A | 21 | 26 | 27 | 34 | 48 | 30 |
| Above | 8 | 10 | 14 | 18 | 22 | 14 |
| Total | 80 | 100.0 | 80 | 100.0 | 160 | 100 |
4.4 Mother’s Education
Data presented in table shows that both(boys and girls) respondent’s 7% mothers were Illiterate, 3% respondent’s mothers qualification in the sample was Primary, 8% were Middle, 17% were Secondary, 20% were F.A, 28% were B.A, 15% were M.A and 3% were above degrees. So it was concluded that the majority of respondent’s mother’s qualification were B.A degrees (28%).
Table 4.4
Sample Description of the Study on the Basis of Mother Education
| Mother Education | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| Illiterate | 6 | 6 | 5 | 6 | 11 | 7 |
| Primary | 3 | 4 | 2 | 3 | 5 | 3 |
| Middle | 7 | 9 | 5 | 6 | 12 | 8 |
| Secondary | 12 | 15 | 15 | 19 | 27 | 17 |
| F.A | 15 | 19 | 17 | 21 | 32 | 20 |
| B.A | 24 | 30 | 21 | 26 | 45 | 28 |
| M.A | 12 | 15 | 12 | 15 | 24 | 15 |
| Above | 1 | 1 | 3 | 4 | 4 | 3 |
| Total | 80 | 100.0 | 80 | 100.0 | 160 | 100 |
4.5 Sample Description of the Study on the Basis of Father Income
Table 4.5 shows that 34% girls respondents and 9% boy’s father income were 10000-20000, 21% girl’s and 40% boy’s were 21000-40000, girl’s 8% and boy’s 17% were 41000-60000 and fathers with 61000-80000 income were 35% of girls respondents and 33% of boys respondents. So it is concluded that the majority of the respondent’s father’s income was 61000-80000(35%).
Table 4.5
Sample Description of the Study on the Basis of father income
| Fathers income | Girls | Boys | Total (f) | Total (p) | ||
| Frequency | Percent | Frequency | Percent | |||
| 10000-20000 | 27 | 34 | 7 | 9 | 34 | 21 |
| 21000-40000 | 17 | 21 | 32 | 40 | 49 | 31 |
| 41000-60000 | 7 | 9 | 14 | 18 | 21 | 13 |
| 61000-80000 | 29 | 35 | 27 | 34 | 56 | 35 |
| Total | 80 | 100 | 80 | 100 | 160 | 100 |
4.6 Opinion about Puberty
Table 4.6 indicates that almost half of the respondents (48% ) were of the view that puberty is to become sexual active (53% girls, 44% boys) and 31% (41% boys and 21% girls) were Don’t know that what suppose to be puberty, 21% of both sex (26% girls, 15% boys) were remained said to be elder. It was a presumption that boys have more awareness but here it’s different. Result shows that girls have better understanding about puberty; they have awareness that puberty mean to be sexually active and functioning of reproductive organs. So, it is concluded that almost half of the students were become sexual active with this statement.
Table 4.6
Opinion about puberty
| Opinion about Pubertal | Girls | Boys | Total(f) | Total (p) | ||
| Frequency | Percent | Frequency | Percent | |||
| Don’t know | 17 | 21 | 33 | 41 | 50 | 31 |
| Become sexual active | 42 | 53 | 35 | 44 | 77 | 48 |
| To be elder | 21 | 27 | 12 | 15 | 33 | 21 |
| Total | 80 | 100 | 80 | 100 | 160 | 100 |
4.7 Physical Changes in Body at Puberty Age
Data in table 4.7 indicates that 28% girls have pubic armpit and leg hair growth that kind of physical changes in their body at pubertal age, 33% have rapid growth especially an increase in height and 15% remained said other. Only 9% said menstruation cycle started and only 6% said that breast development seems to be happening. So, it is concluded that most of the girls said rapid growth especially an increase in height with this statement. And less number of girls have feel breast development, it shows that breast development starts later on than the height and menstruation.
It describes that 49% boys feel accelerated growth especially height that kind of physical changes in their, 14% were voice changes with the statement, 20% were increased shoulder width, 16% pubic, beard and armpit hair growth and 1% were remained any other. So, it was concluded that most of the boys were accelerated growth especially height with this statement.
It is concluded that girls and boys have different physical changes during puberty age. But majority of both genders has narrated that accelerated growth happens at the time of puberty.
Table 4.6
Physical changes in body at puberty age
| Girls | Boys | ||||
| Type of Physical change | Frequency | Percent | Type of physical change | Frequency | Percent |
| Public armipt and leg hair Growth | 22 | 28 | Accelerated growth, especially height | 39 | 49 |
| Rapid growth especially an increase in height | 26 | 33 | Voice changes | 11 | 14 |
| Brest development | 5 | 6 | Increased shoulder width | 16 | 20 |
| Increased hip width | 5 | 6 | Public, beard, and armpit hair growth | 13 | 16 |
| Onset of menstruation Cycle | 7 | 9 | Any other | 1 | 1 |
| Other | 12 | 15 | Total | 80 | 100 |
| Don’t know any sign | 3 | 4 | |||
| Total | 80 | 100 | |||
4.7 Reaction towards Physical Changes in Body
Data shows that 33% girls and 43% boys (in total 38%) handle confidently that they react towards physical development in their body, 16% girls and 10% boys were no change, 10% girls and 6% boys ignored, 28% girls and 19% boys became shy and 14% girls and 29% boys were became curious about physical appearance. So, it was concluded that in total population 13% felt no change, 38% handled confidently, 8% ignored, 23% became shy, 18% were more curious about these change. Most of the adolescents handled confidently while at second became shy. Girls were shyer than boys because of the social taboos in our society. Reason behind this is our cultural context which does not allow girls to express their problem to any one and other reason is that girls live in private sphere so they have less confidence. And boys were in more number who handled confidently because they have easy access to the information and they are living in outdoor sphere more time.
Table 4.7
Reaction towards physical changes in body
| Reaction | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| No change | 13 | 16 | 8 | 10 | 21 | 13 |
| Handle confidently | 26 | 33 | 34 | 43 | 60 | 38 |
| Ignore | 8 | 10 | 5 | 6 | 13 | 8 |
| Became shy | 22 | 28 | 15 | 19 | 37 | 23 |
| Became curious about physical appearance | 11 | 14 | 18 | 23 | 29 | 18 |
| Total | 80 | 100 | 80 | 100 | 160 | 100 |
4.8 Discussion about Physical Changes to Anyone
Data in table 4.8 shows that 85% girls and 89% boys said yes that they have discussed about these physical changes to anyone and 15% girls and 11% boys were remained said No. In total 87% of population discussed and 13% has no discussion with anyone. So, it was concluded that most of the students said Yes with this statement.
Table 4.8
Discussion about physical changes to anyone
| Discussed | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| Yes | 68 | 85 | 71 | 89 | 139 | 87 |
| No | 12 | 15 | 9 | 11 | 21 | 13 |
| Total | 80 | 100 | 80 | 100 | 160 | 100 |
4.9 To Whom Discussed about Physical Changes
Data in table shows that (among the 68 frequency and 85% total who said yes) the majority 73% girls discussed with their mothers. Reason behind this is that girls are more affiliated with their mothers and in our society they have no other source to know about this type of information. Secondly girls discussed with their elder sisters. There was very less number who discussed with friends, teachers or others. On the other hand (among the 71 frequency and 89% total who said yes) 45% boys discussed with their friends and at second large number they discussed with elder brother. It was concluded that girls are more frank with their mothers while boys have more discussed with their friend. It may have reasons that girls are living in private sphere while boys are living in public sphere.
Table 4.9
To whom discussed about physical changes
| Approached Person | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| Parents | 50 | 73 | 12 | 18 | 62 | 44 |
| Elder Sister or Brother | 10 | 15 | 16 | 22 | 26 | 19 |
| Teacher | 2 | 3 | 10 | 14 | 12 | 9 |
| Friends | 4 | 6 | 32 | 45 | 36 | 26 |
| Any other | 2 | 3 | 1 | 1 | 3 | 2 |
| Total | 68 | 100 | 71 | 100 | 139 | 100 |
4.10 Reaction of the Approached Person
Data in table shows that majority of population 57% said that they been provided correct information by the approached person. Rest of the respondents (less than half) 40 % have got false information or not proper information.
Data in table 4.10 indicates that 15% girls and 11% boys said Got angry the person who was approached, 15% girls and 11% were change the topic, 3% girls got false information, 65% girls get correct information reason is that girls mostly discussed with their mothers or sisters and they have naturally love and affection for each other and 3% were remained said any other. It was concluded that in total population reaction of approached person was same in 2 aspects, 13% got angry and change the topic. Girls were more than boys who get correct information.
Table 4.11
Reaction of the approached person
| Reaction | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| Got angry | 10 | 15 | 8 | 11 | 18 | 13 |
| Change the topic | 10 | 15 | 8 | 11 | 18 | 13 |
| False information | 2 | 3 | 17 | 24 | 19 | 14 |
| Provided correct information | 44 | 65 | 36 | 51 | 80 | 57 |
| Any other | 2 | 3 | 2 | 3 | 4 | 3 |
| Total | 68 | 100.0 | 71 | 100.0 | 139 | 100 |
4.11 Get False Information and Reaction towards Changes
Data in table indicates 31% boys said upset/Tensed that they got false information then what was their reaction towards these changes, 37% boys were isolated with the statement, 21% boys were curios, 7% boys were Shy and 2% were remained said any other. On the other hand 45% girls were upset, 23% were isolated, 4% were curious, 23% shy, 4% said any other in response of getting false information from the approached person. In conclusion 36% of total population was upset while 31% was isolated. Girls were more in number than boys who were upset and became shy due to social taboos prevailing in society. While boys were get more isolated than girls.
Table 4.11
Get false information and reaction towards changes
| Reaction on false information | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| Upset/Tensed | 10 | 45 | 10 | 31 | 20 | 36 |
| Isolated | 5 | 23 | 12 | 37 | 17 | 31 |
| Curios | 1 | 4 | 7 | 21 | 8 | 15 |
| Shy | 5 | 23 | 3 | 8 | 8 | 15 |
| Any other | 1 | 4 | 1 | 3 | 2 | 3 |
| Total | 22 | 100 | 33 | 100.0 | 55 | 100 |
4.12 Get Correct Information and Reaction towards These Changes
Data in table shows that 50% girls and 47% boys handle confidently towards these physical changes when they get correct information from the concern person. In total there were 49 % who handle confidently; reason behind this may be the more access to the internet literature and media. While 9% girls and 25% boys ignored the situation, 16% girls and 22% boys were tensed and 25% girls and 6% boys were shy when they knew about these changes. Consequently for most of the population the correct information was a blessing that they become mature and faced confidently. And results shows that girls were more shy (25%) and boys were more tensed (22%).
Table 4.13
Get correct information and reaction towards these changes
| Reaction on correct information | Girls | Boys | Total (F) | Total (P)
| ||
| Frequency | Percent | Frequency | Percent | |||
| Handled confidently | 22 | 50 | 17 | 47 | 39 | 49 |
| Ignored | 4 | 9 | 9 | 25 | 13 | 16 |
| Become tensed | 7 | 16 | 8 | 22 | 15 | 19 |
| Shy | 11 | 25 | 2 | 6 | 13 | 16 |
| Total | 44 | 100 | 36 | 100 | 80 | 100 |
4.13 Age at First Menstruation
Data shows that majority of girls (near about half ) 44% faced menstruation at the age of twelve years. At the second 19% girls onset menstruation at the age of thirteen years. While 10% students were 10 years that at what age it was happened, 11% were 11 years, and 16% were remained 14 years. So, it was concluded that most of the girls were 12 years old when they experience menses. These results show that girls are getting early puberty at age it is happening is twelve year.
Table 4.13 Age of first menstruation
| Frequency | Percent | |
| 10 years | 8 | 10 |
| 11 years | 9 | 11 |
| 12 years | 35 | 44 |
| 13 years | 15 | 19 |
| 14 years | 13 | 16 |
| Total | 80 | 100.0 |
4.14 Prior Information about Menstruation
Data in table 4.14 indicates that 69% girls said yes that they have prior information about menstruation (periods) before start and 31% were remained said no. So, it was concluded that most of the girls said Yes with this statement.
Table 4.14
Prior information about menstruation
| Frequency | Percent | |
| Yes | 55 | 69 |
| No | 25 | 31 |
| Total | 80 | 100 |
4.15 Source of Information about Menstruation
Data in table 4.15 shows that 39% girls said that they got information from mother about menstruation, usually in our society mothers talks to their daughters about this physical change, 35% were get information from friends, 17% from elder sister, 6% were media and 2% were remained internet literature. So, it was concluded that majority of girls (more than one third and less than half) 39% girls was provided information by their mothers.
Table 4.15
Source of information about menstruation
| Frequency | Percent | |
| Mother | 31 | 39 |
| Friends | 28 | 35 |
| Elder sister | 14 | 17 |
| Media | 5 | 6 |
| Internet literature | 2 | 3 |
| Total | 80 | 100 |
4.16 Do You have Information about How Boys Attain Puberty?
Table 4.16 shows that 84% boys said yes that they have the awareness about “wet dreams and 16% were remained said no. So, it was concluded that most of the boys have information about wet dreams because it is a common phenomenon in teenage and usually boys discuss it with their friends. Another reason is that boys have less social taboos and easy access to internet and sex related literature.
Table 4.16
Do You have Information about How Boys Attain Puberty?
| Frequency | Percent | |
| Yes | 67 | 84 |
| No | 13 | 16 |
| Total | 80 | 100 |
4.17 Age at First Erection or Ejaculation
Data presented in table 4.17 shows that 19% boys were 13 years that in which age they experienced it, 35% were 14 years, 36% were 15 years and 10% were remained 16 years. So, it was concluded that majority of the boys were 15 years with this statement. Is shows that boys be adult later than girls.
Table 4.17
Age of first erection or ejaculation
| Frequency | Percent | |
| 13 years | 15 | 19 |
| 14 years | 28 | 35 |
| 15 years | 29 | 36 |
| 16 years | 8 | 10 |
| Total | 80 | 100.0 |
4.18 Source of Information of Ejaculation
Data in table 4.18 shows that majority of boys (almost half) 46% boys get information about ejaculation and wet dreams with their friends, because boys have more frankness with their friends and they can easily discuss broad topics as sex with each other. At second position (one quarter) 25% boys got information from internet literature. While 11% boys avail information from media. And 8% said elder brother that was source of information, 7% boys said Father and 2% were remained said any other. It was concluded that major source of sexual awareness for boys is friends and secondly internet literature.
Table 4.18
Source of information
| Frequency | Percent | |
| Father | 6 | 7 |
| Friends | 37 | 46 |
| Elder brother | 6 | 8 |
| Media | 9 | 11 |
| Internet literature | 20 | 25 |
| Any other | 2 | 3 |
| Total | 80 | 100.0 |
4.19 Problems on the Onset Menstruation Cycles
The data indicates that majority of girls (less than half but more than one third) 40% girls have pain during their menstruation periods. The second majority of girls (almost one third) 31% faced no problem in their menses periods. While 9% girls were nervous to see menaces blood and 7% girls were blaming themselves for this change in body. Rests of the girls tick other options. It is concluded that almost half of girls feel pain in abdomen and genital parts during menstruations.
Table 4.19
Problems on the onset menstruation cycles
| Frequency | Percent | |
| Pain | 32 | 40 |
| No problem | 25 | 31 |
| Headache | 1 | 1 |
| Anxiety | 4 | 5 |
| Nervousness | 7 | 9 |
| Blaming oneself | 6 | 7 |
| Stress | 3 | 4 |
| Curious about yourself | 2 | 3 |
| Total | 80 | 100 |
4.20 Understanding of Menstruation Cycle
Table 4.20 shows that 70% girls said natural cycle process that they consider menstruation cycle, 6% were some kind of disease, 2% physical problem, 11% were internal bleeding process and 10% were remained said discharge of impure blood. So, it was concluded that most of the students said natural cycle process with this statement. It shows that majority of girls have proper understanding of menstruation cycle.
Table 4.20
Understanding of menstruation cycle
| Frequency | Percent | |
| Natural cycle process | 56 | 70 |
| Some kind of disease | 5 | 6 |
| Physical problem | 2 | 3 |
| Internal bleeding process | 9 | 11 |
| Discharge of impure blood | 8 | 10 |
| Total | 80 | 100 |
4.21 Interval between Two Menstruations
Table 4.21 shows that almost half 49% girls said that their interval between two menses is more than 28 days, 40% girls said 25-28 days interval between two menstruations and 11% were remained said other. So, it was concluded that most of the girls stated that menstruation interval is more than 28 days. Naturally it is different menses interval in all girls, there is no fix time period which may accurate.
Table 4.21
Interval between two menstruations
| Frequency | Percent | |
| 25-28 days | 32 | 40 |
| More than 28 days | 39 | 49 |
| Other | 9 | 11 |
| Total | 80 | 100 |
4.22 Infections after Onset of Menstruation Cycles
Table 4.22 show that 39% girls have itching in genital areas that infections girls can faced after onset of menstruation cycles, 10% have swelling over vaginal area and majority (slightly less than half) 40% have rashes over vaginal lips due to constant use of pads or any other practice while 11% girls have no any sort of infection. So, it was concluded that most of the girls said rashes over genital area.
Table 4.22
Infections after onset of menstruation cycles
| Frequency | Percent | |
| Itching | 31 | 39 |
| Swelling | 8 | 10 |
| Rashes | 32 | 40 |
| No Infection | 9 | 11 |
| Total | 80 | 100 |
4.23 Hygienic Practices during Menstruation
Table 4.23 describes that 69% girls use homemade disposable that hygienic practices do you use during menstruation, 12% were homemade reused with the statement and 19% were remained said any other. So, it was concluded that most of the students said homemade disposable with this statement
Table 4.23 Hygienic practices during menstruation
| Frequency | Percent | |
| Homemade disposable | 55 | 69 |
| Homemade reusable | 10 | 12 |
| Any other | 15 | 19 |
| Total | 80 | 100 |
4.24 Health Problems Girls Face During Sexual Development
Table 4.24 describes that majority of girls (almost half) 49% feel pain during the puberty age developments and 20% (less than one quarter) of girls face low blood pressure health problem. Reason is vaginal monarch bleeding which causes pain. And if bleeding happens continuously it causes low blood pressure due to blood shortage. Less than quarter 15% girls have clear whitish vaginal secretion during age of puberty while only 4% girls were obesity and 5 % have acne on their face. While 5% girls had not faced any problem.
Table 4.24
Health problems girls face during sexual development
| Frequency | Percent | |
| Low blood pressure | 16 | 20 |
| Pain | 39 | 49 |
| Clear or whitish vaginal secretion | 12 | 15 |
| Fainting | 2 | 2 |
| Obesity | 3 | 4 |
| Acne | 4 | 5 |
| No Problem | 4 | 5 |
| Total | 80 | 100 |
4.25 Health Problems After Initial Sexual Changes in Boys
Table 4.25 describes that 21% (almost quarter) boys feel weakness at he age of puberty, 21% boys were sexually frustration in their bodies. While 15% boys were hyperactive. Only 6% boys were who have no problem at all. Rest of the boys remains with other options. So, it was concluded that most of students feel weakness at the puberty age, there are two reasons of it, one is ejaculation of sperms at that time when sperms are producing in less quantity and second is the deit problem, boys do not take proper diet according to their bodily needs.
Table 4.25 Health problems after initial sexual changes in boys
| Frequency | Percent | |
| Sexual frustration | 17 | 21 |
| Hyperactive | 12 | 15 |
| Stiffness | 9 | 11 |
| Aching in muscles and joints | 7 | 9 |
| Low blood pressure | 5 | 6 |
| Weakness | 17 | 21 |
| Obesity | 4 | 5 |
| Acne | 4 | 5 |
| No problem | 5 | 6 |
| Total | 80 | 100 |
4.26 Point of View Awareness about Physical and Sexual Changes should be Given before Entering in the Age of Adolescence
Data in table 4.26 shows that majority of adolescents (near about half) 47% said that parents should provide information about physical and sexual changes before entering in the age of adolescence. Because it is the responsibility of parents. Children feel more comfortable to discuss with their parents specially girls who have more attraction with their mothers. While 24% girls and 37% girls (31% in total population) students said teacher should give information 30% girls and 14% boys (in total 22% of population) were remained proper education should be provided in schools. So, it was concluded that most of the students said parents should provide information with this statement.
Table 4.26
Point of view awareness about physical and sexual changes should be given before entering in the age of adolescence
| Sex Education | Girls | Boys | Total (F) | Total (P) | ||
| Frequency | Percent | Frequency | Percent | |||
| Teacher should give information | 19 | 24 | 30 | 37 | 49 | 31 |
| Parents should provide information | 37 | 46 | 39 | 49 | 76 | 47 |
| Proper education should be provided in schools | 24 | 30 | 11 | 14 | 35 | 22 |
| Total | 80 | 100 | 80 | 100.0 | 160 | 100 |
Chapter 5
Summary, findings, conclusion and recommendation
The aim of the study was to learn the differences between boys and girls regarding awareness about their sexual developments.
A questionnaire was developed for data collection the close-ended questionnaire was designed that cover all the important aspects of an adolescent’s physical changes and problems, which result due to the lack of awareness about sexual development in his or her body before reaching adolescence age.
The factors kept in mind were the physical and sexual changes in boys and girls during adolescence age, informational source, parents attitude, towards physical changes, the reaction of boys and girls after getting awareness, physical health problems boys girls faced after sexual changes in their bodies, and suggestions for raising awareness about these physical and sexual changes before entering adolescence age.
The target population for the present study was the male and female students ranging from ages 13 to 16 from schools of the city of Lahore.
The convenient sampling technique was used for this study and two schools were selected : Educators school (boys and girls campus) and The city school (boys and girls campus).
The data was presented in the form of frequencies and percentages.
After analysis of the collected data, the following findings were drawn.
5.1 Findings
- According to age of students 40% were 16 years old which were more in ratio while at second 29% students were fall in 15 year age.
- According to class (62%) were studying in class 9th and 38% was studying in 10th
- Majority of father were educated 30% were M.A and 14% above M.A respectively.
- Only few (7%) mothers were illiterate rest of the mother were educated in different levels.
- When it was asked what is puberty 48%) answered become sexual active while 31% don’t know about puberty. It means that their is existing one forth population who have no idea about puberty.
- At puberty age different changes accrues in body in both boys and girls although these are different in nature. Majority of girls 28% and boys 49% feel rapid and accelerated growth in height.
- Majority of girls and boys (38%) react positively against these physical changes and handled confidently. Girls were shyer (18%) than boys (23%) because of the social taboos in our society And boys were in more number who handled confidently because they have easy access to the information and they are living in outdoor sphere more time.
- Results shows that 85% girls and 89% boys said yes that they have discussed about these physical changes to anyone and 15% girls and 11% boys were remained said No.
- Majority 73% girls discussed with their mothers while majority of boys 45% discussed with their friends.
- Majority of population 58% said that they been provided correct information by the approached person. Rest of the respondents (less than half) 42% have got false information or not proper information. Girls were more in number than boys who get correct information.
- Results show that 38% of total population was upset while 31% was isolated when they have got false information about sexual changes. Girls were more in number than boys who were upset and became shy due to social taboos prevailing in society. While boys were get more isolated than girls.
- Almost half of population 49 % handle confidently when they got correct information. And results shows that girls were more shy (25%) and boys were more tensed (23%).
- According to results 80% girls said yes that you remember your first menstruation and 75% boys said yes that they remember your first erection or ejaculation.
- Majority of girls ( near about half ) 44% faced menstruation at the age of twelve year and 36% boys reached at puberty in age of 15 years. These results show that girls are getting early puberty at age it is happening is twelve year.
- Results shows that 69% girls said yes that they have prior information about menstruation (periods) before start and 31% were remained said no.
- It was concluded that most (89%) of the boys have information about wet dreams because it is a common phenomenon in teenage and usually boys discuss it with their friends. While 74% boys said yes that they have prior information about ejaculation or wet dreams before start.
- According to data results 39% girl’s source of information about menstruation was mothers. It was concluded that majority of girls (more than one third and less than half) 39% girls was provided information by their mothers. Majority of boys (almost half) 46% boys get information about ejaculation and wet dreams with their friends. It shows that, for girls mothers are the source of information while for boys friends are best source of information.
- In girls (less than half but more than one third) 40% girls have pain during their menstruation periods.
- Seventy percent girls said natural cycle process that they consider menstruation cycle, 11% said it is internal bleeding process.
- Almost half 49% girls said that their interval between two menses is more than 28 days, 40% girls said 25-28 days interval between two menstruations. Naturally it is different menses interval in all girls, there is no fix time period which may accurate.
- Different girls have different health problems in menses, majority (slightly less than half) 40% have rashes over veginal lips due to constant use of pads and 39% girls have itching in genital areas.
- In girls (almost half) 49% feel pain during the puberty age developments and 25% (one quarter) of girls face low blood pressure health problem.
- In boys 24% (quarter off) boys feel weakness at he age of puberty, in second number 21% boys were sexually frustration in their bodies.
- majority of adolescents (near about half) 47% said that parents should provide information about physical and sexual changes before entering in the age of adolescence. Because it is the responsibility of parents.
5.2 Conclusion and Discussion
It was persumed that boys have more knowledge than girls about the puberty and physical developments which was persumed by the results of Tiran &Kurun. But the findings of the study shows that girls were more aware about puberty, 53% girls knows that peberty is being sexual active and 44% knew that what is puberty which is against the prior research results Sadri, 2001, Tiran and Kurun and PAVHWA. These results are similar with the findings of study by Hassan,2004 conducted in department of gender studies, University of Punjab.
Present study shows that major symptoms of puberty felt by boys and girls was accelerated growth in height which corrobrates the prior research Hassan, 2004. Results of the study narrates boys were in frequent number who handeled the physical changes confidently while boys were more isolated than girls, and boys were more shy than boys on facing the physical changes because of our social taboos which restrict the open discussion, similar results to Qazi, 2003.
Findings of our study elaborates that 85% girls and 89% boys discussed about physical changes to any one , among them 73% girls discussed with their mothers while 24 % girls discussed with peers or friends, elder sisters, which apposite results of Diers & Grant 2003. Results shows that near about 67% boys discussed with their friends or peer groups and elder brothers. Its significant that boys boys are more frank with their friends and brothers while female feel comfortable to discuss with their mothers.
When researchers try to checked the reaction of the approached person it was calculated that 57% of concerned persons provided correct information to the adolescents which are opposite results to Hassan,2004.
Present study shows that mostly girls got their first monarch at the age 12 to 14 years. At least 79% girls menstruated at age of 12 to 14 years while 21% girls menstruate before the age of twelve years. These are the girls who are availing puberty at early age which is due to fast food culture and openly available sexual information by media and internet literature.
There were two categories of adolescents who discussed who discussed with any body, one were who get correct information and second were who get false, changed topic or improper information by the approached person. Both categories have different reactions over correct information and incorrect information, adolescents who got correct information handled confidently and reacted in calm and good manner towards these physical changes but the adolescents who got false or improper information were more isolated and shy. These results are matched to prior research findings Hassan 2004 conducted in Gender Studies.
When a question was asked to boys, how boys attain puberty, majority of boys have knowledge that how they attained puberty, and majority of boys told that they got information about puberty from their friends and internet literature which is opposite to results of Hassan 2004.
A separate portion about menstruation was put in the questionnaire for girls, which has some concrete questions about menstruation. Majority of girls have attain knowledge about menstruation from their mothers and elder sisters. Less number of girls have approached to internet literature or media for availing knowledge about menses. On the questions about menstruation problems girls quoted that 40% girls felt pain during menstruation period and secondly are nourvess and blaming themselves. It was good finding that about majority of girls understand that menses is a natural cycle process while few girls tells that its a disease or any physical problem, ratio of them was only 9%. The present study reveals that only 11% girls have faced no infection during menstruation periods. Majority of girls feels itching and rashes at genital areas during their monarch period, while few girls (10%) felt swelling over genital lips. These findings are corroborated with the findings of study by Hassan,2004 in department of Gender Studies.
Some girls faced some physical problems during their periods, major problems were pain, low blood pressure and whitish secretion from vagina.
Opinion was get from young boys and girls from providing sex education. Majority students have opinion that parents should provide information before entering in puberty, above 90% girls have opinion that prior information of reproductive and sexual health should be given before entering in puberty age and getting menstruation periods, these results are similar to the Diers & Kurun. It was an important statement that 24% girls and 14% boys were in favor that proper sex education should be provided in schools.
It was an interesting fact that few students who were boys, attained knowledge about puberty from Qari Sahib or mosque.
None of the students have stated that no prior information is required. The entire sample was agreed that proper information should be provided about sex and reproductive health to adolescents either by parents or teachers, or by adding some chapters in curriculum in schools. Same was the findings of Nazia Hassan 2004.
5.3 Recommendations
On the basis of findings and conclusion of the study, the following recommendations were given.
- It is suggested that education regarding puberty should be provided in 8th and 9th class, it does not mean that a subject of sex should be added in syllabus but its rather that a chapter regard puberty should included in the syllabus of 8th and 9th class because this is the particular age when youngsters specially girls attain puberty.
- It is true that now a days relationship between parents and children have become more frank and broad but it is also true that some parents provide false or improper information to their children which causes confusion and some other problems. So its suggested that there should be organised some workshops for parents in which parents should make awared that they should provide proper information to their children because that is natural process in youngster and they required good information to feel these changes in productive manners.
- It is further suggested that educational institutions should organize special sessions separately for girls and boys in which given them knowledge about symptoms of puberty, changes occurring at puberty, problems at puberty and how can be these problems removed or avoid by making some precautions.
- It is suggested that material related to mences as pads, tablets etc should be available in girls schools at their sudden menstruation periods.
5.4 Suggestion for Further Research
- It was find out in this study that majority of girls have got their first menstruation in 13 years old or before that. Its mean that girls are getting early age puberty. Its suggested that factors which are causing early age puberty should be explored by further researches.
- Physical changes general phenomena in this age, but pain was a common problem in girls. There should be conducted research why girls have to face pain, what are factors behind it and it can be avoided by taking some preventive measures at this age.
- Youngsters also become mental adult and mature at puberty age. Further researches can be conducted on emotional and behavioral changes in girls and boys at puberty age.
References;
- Afghari, A., Eghtedari, S., Pashmi, R., & Sadri, G. H. (2008). Effects of puberty health education on 10-14 year-old girls’ knowledge, attitude, and behavior. Iranian Journal of Nursing and Midwifery Research, 13(1), 38-41.
- Ali, T. S., Ali, P. A., Waheed, H., & Memon, A. A. (2008). Understanding of puberty and related health problems among female adolescents in karachi, pakistan. Journal of Pakistan Medical Association, 56(2), 78-72.
- Barnes, H. V. (1975). Physical growth and development during puberty. Medical Clinics of North America, 1305-1317.
- Dube, S., & Sharma, K. (2012). Knowledge, attitude and practice regarding reproductive health among urban and rural girls: a comparative study. Journal of Ethnobiology and Ethnomedicine, 6(2), 85-94.
- Finkelstein, J. (1980). The endocrinology of adolescence. Pediatric Clinics of North America, 53-69.
- HermanGiddens, M., Slora, E., Wasserman, R., Bourdoni, M., Koch, G., & Hasemeier, C. (1997). Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network. Pediatrics, 505-512.
- Khan, A. (2000). Adolescents and reproductive health in pakistan: a literature review. Islamabad, Pakistan: Population Council.
- Majid, S. (1995). Reproductive health awareness in adolescent girls: report of a survey. Journal of the College of Physicians and Surgeons Pakistan, 214-220.
- Marshal, M. A. (1978). The relationship of puberty to other maturity indicators and body composition in man. Journal of Reproduction and Fertility, 437-443.
- Marshal, W. A., & Tanner, J. M. (1969). Variations in patterns of pubertal changes in girls. Archives of Disease in Childhood, 291-303.
- Marshall, W. A. (1975). Growth and sexual maturation in normal puberty. Clinics in Endocrinology and Metabolism, 3-25.
- Marshall, W. A., & Tanner, J. M. (1970). Variations in patterns of pubertal changes in boys. Archives of Disease in Childhood, 13-23.
- Martha, P. M., Rogol JR, A. D., Veldhuis, J. D., Kerrigan, J. R., Goodman, D. W., & Blizzard, R. M. (1989). Alterations in the pulsatile properties of circulating growth hormone concentrations during puberty in boys. The Journal of Clinical Endocrinology & Metabolism, 69(3), 563-570.
- Mckee, M. D., Karasz, A., & Weber, C. M. (2004). Health care seeking among urban minority adolescent girls: the crisis at sexual debut. Annals of Family Medicine, 2(6), 549-554.
- Mohamed, S. (2002, 5 9). Addressing gender inequality in adolescent life skills education: aahung’s experience in pakistan. Retrieved November 28, 2014, from iwhc: https://iwhc.org/article/addressing-gender-inequality-adolescent-life-skills-education-aahungs-experience-pakistan/
- Mumtaz, K., & Rauf, F. (1996). Woman to woman: transfer of health and reproductive Knowledge. Lahore: Shirkat Gah.
- Nasar, A., Pasha, A. G., Hanif, N., & Ismail, Z. H. (1998). The 1998 population censun. Karachi, Pakistan: Social Policy and Development Centre, Government of Pakistan (GOP).
- Pine, P., & Khan, A. (2003). Adolescent and youth reproductive health in pakistan: status, issues, policies, and programs. Islamabad, Pakistan: Population Council.
- PIPHRO. (1999). Sexual awareness: specific conclusion. Badin, Sindh, Pakistan: Pakistan International Peace & Human Rights Organization .
- Ridder, C. d., Thijssen, J. H., Burning, P. F., Brande, J. V., Zonderland, M. L., & Erich, W. B. (1992). Body fat mass, body fat distribution, and pubertal development: a longitudinal study of physical and hormonal sexual maturation of girls. The Journal of Clinical Endocrinology & Metabolism, 442-446.
- Roche, A. R., & Himes, J. H. (1980). Incremental growth charts. The American Journal of Clunical Nutrition, 33(9), 2041-2052. Retrieved from https://ajcn.nutrition.org/content/33/9/2041.full.pdf+html
- Sathar, Z. A., Haque, M. U., Faizunnissa, A., & Sultan, M. (2002). Adolescents and youth in pakistan 2001-2002 a nationally representative survey. Islamabad: Population council.
- Tanner, J. M. (1989). Foetus into man: physical growth from conception to maturity. Cambridge, Massachusetts (MA), United States: Harvard University Press.
- Tanner, J. M., Whitehouse, R. H., Marshall, W. A., & Carter, B. S. (1975). Prediction of adult height, bone age, and occurrence of menarche, at ages 4 to 16 with allowance for mid parental height. Archives of Disease in Childhood, 14-26.
- United Nations. (1997). Demographic Year Book – 1995. Department for Economic and Social Information and Policy Analysis, Statistics Division. New York: United Nations.
- WHO. (1999). Improving health through schools: national and international strategies. Geneva, Switzerland: World Health Organization.
- Zagharias, L., Wurtman, R. J., & Schatzoff, M. (1970). Sexual maturation in contemporary American girls. American Journal of Obstetrics & Gynecology, 833-846.