TEN

Adolescent in Body and Mind

■ The average age of young girls at the onset of puberty has dropped from 12 to 10 years.

 

ADOLESCENCE IS A TIME OF TIDAL changes in the bodies of boys and girls. Everything is different, from their height and weight to the timbre of their voices. Hormones give them strange, new, powerful feelings, and the people around them begin to treat them as young adults. While their bodies develop, so do their minds, and both are driven by and must adjust to all these changes. When I first thought about approaching these subjects—body and mind—I planned to write about them separately, but it soon became apparent that I couldn’t, because they are not separate. They weave together intimately into the wonderful, delightful, and mysterious fabric of our sons and daughters at this time in their lives. We need to understand this profoundly, if we are to help them avoid becoming victims of the epidemic that has affected so many young people already.

WHEN PUBERTY STRIKES

Something happened to a patient of mine, a young girl named Andrea, that may strike you as unusual. Andrea entered puberty when she was 7 years old.

Something fundamental has changed in the biology of human female development over the past couple of decades: The average age of young girls at the onset of puberty has dropped from 12 to 10 years. Physicians aren’t exactly sure why, but some speculate that improved nutrition plays a role, while others wonder about the effects of food additives, and still others point the finger at environmental factors. We don’t yet have any answers. Unfortunately, we do have a new set of problems. How could we not, with little girls becoming women practically overnight?

Andrea’s Story

Andrea’s mother first discovered that something was happening when Andrea complained she didn’t want to go to school anymore because her friends kept saying she smelled funny. Mom had a simple solution: she bought her daughter some deodorant. But a few months later, Andrea’s breasts began to develop, and pubic hair followed. At that point she came to see me. Warning bells went off in my head. Better make doubly sure nothing is wrong, I told myself, so I performed a multitude of blood tests, an ultrasound of her abdomen, and even considered getting an MRI of her head to check for tumors. All of her tests failed to turn up any abnormalities other than what we call benign precocious puberty. Although I needed to rule out any possible medical condition, that was actually the result I had expected. While it’s true that Andrea’s situation was unusual, it was only slightly so. If she had been just one year older, she would have fallen well within the norm.

Andrea started having her period before she entered the second grade. I offered to write a prescription for medication that would stop her menstruating, but her mother decided against it. Interfering medically with a child’s natural growth and development could be a tricky and dangerous business. So instead Andrea had to carry Kotex in her backpack. One day, a few spilled out and a couple of classmates saw them. It was all the bait the young kids needed. They began whispering about her and calling her a freak. By the third grade, Andrea found it difficult to hide her breasts beneath her shirt. She had to wear a bra. Not the cut-off-undershirt kind. A real bra.

Girls entering puberty early often face terrible teasing from their classmates, who can be brutal on a child with breasts, body odor, or underarm hair. A young girl who menstruates will often be stigmatized by her peers, and any child who needs to wear a bra at age 9 or 10 will often run into spiteful jealousy among her friends. All of this happened to Andrea.

As her mother and I tried to guide Andrea through those tough, early years, here’s what I saw: She hated school—kids were still calling her a freak. Her grades dropped and she became irritable at home and in class. She actually showed signs of depression. By the time she had reached the fourth grade, boys had already begun identifying her as a “sex fiend.” She didn’t like this, of course, but she didn’t know how to respond. She wasn’t even sure what kids were talking about. She didn’t know what sex was.

Early puberty often creates these dilemmas for young girls. Budding breasts, pubic hair, and menstruation attract attention and can force a girl to confront her sexuality before she’s psychologically ready. Emotionally she may still want to play with dolls and collect stuffed animals, but at the same time she’s choosing from 20 different deodorant brands and using sanitary pads or tampons. No wonder she’s confused! She may feel overwhelmed by her changing body. She sees that she’s beginning to look like mom, but she doesn’t want to look like mom. She wants to be a kid and let mom be the adult.

In Andrea’s case, dealing with sexual issues before she was ready proved traumatic. We finally ended up sending her to a counselor in the fifth grade because she became more depressed, and in response to the boys’ taunting, her behavior started to become sexualized. She was flirting—both with the boys and with disaster. But this wasn’t the kind of flirting you would expect from a child of her age. She wasn’t teasing the boys to get them to chase her around the playground. She was enticing them by asking them if they wanted to see her private areas. Fortunately, her mother and an astute teacher caught wind of these episodes and intervened before Andrea was actually able to follow through.

How could a girl who so hated sexual teasing suddenly become so sexual? Premature puberty had thrust her into an adult world that she wasn’t ready for emotionally. Not only did she have to contend with her own feelings, but she was forced to contend with the feelings and reactions of the kids around her. She couldn’t stop the teasing, but teasing was better than getting no attention at all. And if her body could get her more attention.... Well, why not? Unfortunately, this strategy—unconscious on her part—got Andrea into trouble and ultimately made her feel even more like a freak, worse about herself, and in need of counseling.

What if Andrea’s mom hadn’t been observant enough to recognize that her daughter was having trouble? Suppose Andrea kept maturing and made it to junior high without any intervention? Now she’s 12, has periods regularly, and her breasts look like those of an 18-year-old. Instead of third-grade boys, she has 13-, 14-, and 15-year-old classmates asking her for a “peek at her privates.” What would she do if no one had stepped in to help her earlier? Would she please her classmates to get attention? Would she have sex?

As Andrea’s story illustrates, there’s little doubt that early puberty sets girls up for early sexual encounters. With so many girls now entering puberty by age 8 or 9, and the risk for disease rising so dramatically among kids who have sex at a very young age, we might see the STD epidemic grow far worse.

What can we do about it? For one thing, we can be there for our daughters. We can try to understand what they’re going through and give them whatever help they need to make their way through the minefield of experiencing childhood in an adultlike body. We can become active and try to change the world they live in, which seems all too ready to sexualize little girls in films, television, and magazines. And we can simply remember who they are. However mature a young girl’s body may look, we need to remind ourselves that a child lives inside. Finally, we must be ready to intervene strongly if we discover our daughters are becoming sexual long before it’s appropriate.

STDS AND THE ADOLESCENT GIRL’S BODY

One of the strongest reasons to encourage your daughters to wait as long as they can before becoming sexually active is that their bodies are not ready for it, even though they may think otherwise. A young girl’s cervix (opening to the uterus) develops slowly, and has several physiological differences from that of an older woman. These differences put a young girl at higher risk for STDs.

To the naked eye, a cervix looks like a plump doughnut with a tiny hole in the center. In young girls, tall, narrow, reddish-pink cells cover the cervix. These cells, called columnar cells, form a layer of skin called the ectropion. The pinkness comes from the rich blood supply in the columnar cells, which provides a wonderful medium for bacteria and viruses.

On the outer edge of the cervix are flatter, tougher cells, called squamous cells, which have a more “smushed” appearance than the columnar cells. After childbirth, or by the time a woman reaches her mid-20s, these tougher squamous cells move into the center of the cervix, replacing the reddish ectropion layer and columnar cells and, in the process, better protecting the cervix. Because they don’t have the same rich blood supply as the columnar cells, squamous cells are less attractive to the viruses and bacteria that cause sexually transmitted diseases.

In the adolescent female, a specific type of cell lining the inside of the cervical canal extends onto the outer surface of the cervix, where exposure to sexually transmitted pathogens is greater. These cells are more vulnerable to infections such as chlamydia and gonorrhea. As women age, this vulnerable tissue recedes and usually no longer extends onto the outer surface of the cervix.

Then there is the difference in the cervical tissue of a 15-year-old versus an older woman. Just as a teenager’s skin and the skin of a 30-year-old woman are different, so too is cervical tissue. In a young girl, this tissue is softer, more easily permeated by viruses and bacteria. In an older woman, it’s tougher, harder, and thus able to better ward off bacteria, viruses, and other pathogens.

In addition, the cervical mucus, which serves a protective role, differs in teenagers and older women. Many girls will menstruate without ovulating for the first year or two. When this happens, the mucus in their cervix is thinner, and has a more liquid consistency that, for some unknown reason, is more attractive for viruses and bacteria, providing a richer environment for growth than an older woman’s cervical mucus.

The attractiveness of a young girl’s cervix to bacteria and virus infections seems to lead, for some unknown reason, to a much greater risk for pelvic inflammatory disease than that experienced by adult women. Overall, an adolescent with chlamydia or gonorrhea has a one in eight chance of developing PID, compared with a 30-year-old with the same infection, who has a one in eighty chance.

Your teenage daughter needs you to help her realize that her body isn’t ready to handle physically what yours or mine can. Tell her. Talk to her and help her to wait for much better sex—great sex—when she is older. When her chances of getting PID, even if she does happen to get chlamydia or gonorrhea, drop to one in eighty. Don’t let her become one of the one in eight.

WHEN BOYS REACH PUBERTY

Boys begin moving through puberty between the ages of 12 and 16. (Unlike with girls, we haven’t seen puberty start any earlier in boys.) As levels of testosterone rise in boys, their penis grows longer, their testicles grow bigger, and they grow body and pubic hair. Soon, facial hair appears and their voice changes. They become sexually aroused and often experience their first wet dreams and regular erections. After puberty is well under way, a growth spurt occurs.

My personal experience has led me to believe that puberty can be harder for boys than for girls. There are several reasons for this. First, many boys are hesitant to discuss how they feel about the changes they are experiencing. As they see facial hair erupt and experience their first wet dreams, for instance, some feel ambivalent about growing up. Their bodies march ahead into manhood, but their emotions hang back. Or they may simply be confused about what is happening to them. But all too often, they’re left to cope with these problems on their own, because “guys just don’t talk about that stuff.” With no guidance, it’s easy for a boy to follow the lead of the media and his peers in defining his own sense of manhood. Unfortunately, these aren’t dependable guides, and they can lead a boy into unsafe places, as we’ll see in a moment.

Aside from feeling hesitant to express confusion or stresses about puberty, many teen boys also face intense pressure to become sexually active. Their culture equates masculinity with sexual activity—particularly frequent and varied sexual activity—before they have a chance to figure out for themselves what being masculine means to them personally. Let me explain how this happens.

As puberty occurs in a teen boy, he watches himself. Are his arms getting more muscular? How dense is his beard? And then he watches his buddies. How are their beards? Any hair on their legs yet? He hears stories about sex they have with girls and wonders what it feels like. He hears about putting condoms on the right way and the wrong way and wonders whether it just might be safer to try oral sex first and skip the whole condom thing. He feels the excitement of sexual arousal, which may be overwhelming at times. What does he do with those urges? He hears his buddies talk about having sex with a lot of other girls and having it a lot of different ways (oral sex, etc.). He sees men (usually young and single) having sex with women on TV and in movies and sees sex plastered across the covers of men’s magazines. In his mind, he makes a leap between his sexual urges and what he should do about them. He decides, maybe unconsciously, that he should have a lot of sex because that’s what he sees guys all around him do and because you have to have sex to be a “real man.” So he tries it. He tries once, then twice, and then again and again.

The pressures of coping with tremendous sexual urges, trying to appear manly among peers, and being hesitant to discuss their feelings about puberty can make teen boys incredibly vulnerable to having sex at a young age and with numerous partners. And both of these, in an age of an STD epidemic, spell disaster for our boys.

So here’s how we can help. First, let your kids know that being a man is a good thing. It is not something that they need to be frightened about. Let your son know that he will be a man in his own unique way. He has the freedom to be different from any bad role models he has seen.

Help him identify pressures he faces because he is going through puberty. Show him specifically where those messages are coming from—magazines, movies, etc. Believe it or not, you can do this in a way that doesn’t make you look like a movie-hating, sex-hating parent. Ask what messages he’s getting and what he thinks about them. Let him know that you are his advocate in helping him define what being a man is all about for him and that you want to make sure that the “real” him isn’t suffocated by messages about being male that he bumps into daily. (Teens love having advocates.) Teach him that all healthy boys become sexually excited by things they see. So, tell him to recognize when his happens and let him know that just because he gets excited when a girl walks by in a tight top, he doesn’t need to act on that feeling. It will pass. When he realizes that his feelings are normal and that someone understands, he feels less frightened of them and more importantly he feels that he can control them, they needn’t control him. This brings boys tremendous relief.

Acknowledge that his emotional and physical feelings will be intense and that’s okay. They’re supposed to be. You don’t have to tell him specifics about masturbation, but if you tell him in a straightforward, simple manner that boys commonly release their sexual feelings privately, he’ll know what you mean and feel less guilty. Many boys feel guilty about masturbating and regardless of a parent’s moral or ethical feelings about it, the truth is, boys experience it during puberty.

Regarding other physiological changes puberty brings to boys, simply stay attuned to those changes and be proactive when you think it appropriate. If your son breaks out with acne, don’t wait for him to ask for help. Take him to a doctor and get it cleared up. His face is every bit as important to his self-esteem as a girl’s is to her. Buy him shaving cream and a razor when he needs it (or a little before) and make a fuss over it. This lets him know that you like the changes you see and you like him becoming a man. If he needs deodorant, buy it without his asking and put it in his bathroom next to his toothbrush. Simply being on the lookout for physical changes that you see happening and acknowledging those changes in a positive, respectful way will ease the stresses he may feel and most importantly, lets him know that you like them.

A final word of caution: When a boy reaches puberty, many of us make remarks that we perceive as harmless but in fact can hurt him. Saying things like, “Boy, you can certainly catch any girl you want now” can be tough on boys. What you meant to say is that he is attractive and should feel good about himself. But what he may have heard was that he is sexual and should be able to sleep with anyone he wants. So be careful.

SEX AND SEXUALITY

When boys and girls hit puberty, it’s like a bomb goes off in their bodies and their minds, leaving them with new feelings, ideas, and opinions. One part of these normal psychological and cognitive changes is the blossoming of their sexuality.

Don’t confuse sexuality with sexual activity. The two are related, but different. A teenager’s sexuality is that part of her character that prepares her for sexual activity, as well as deeper relationships involving love, intimacy, and respect. It’s a critical part of a teenager’s identity, and influences her ability to relate to others.

Sexual activity, on the other hand, is the act of having sex.

Unfortunately, many teens do confuse sexuality with sexual activity. When teens begin to mature sexually, they feel confused about what to do with the strong, unfamiliar sexual feelings washing over them. Boys begin trying to define their own masculinity, comparing it to other boys around them and wondering if they “measure up.” Too often, however, they define masculinity as sexuality. Girls begin to fantasize about romance, and use clothing, makeup, and perfume to define their own femininity. And, too often, these accoutrements become tools to attract the opposite sex, to feel “sexy,” to lead to sex.

Take my patient Caleb. At 16, he came to me for a regular physical and immunizations. As I worked my way down my list of questions, I asked about girlfriends. “Oh, yeah,” he replied. “Lots of them.” As he described his relationships, I learned that they were really just frequent sexual encounters with girls his age or younger (even 13 or 14) whom he barely knew. Basically, he was sleeping around indiscriminately—something he told me he enjoyed. And, no surprise, upon examination I found he was infected with chlamydia, which he’d surely spread to many of those young girls.

As we talked more, it soon became clear why he behaved this way. When he was 3 years old, his father left the family, and had had numerous sexual relationships since. So there was no one to show Caleb the difference between feelings of sexuality and sexual activity. Instead, he just mimicked what he saw his father doing. And, since he admired his father, he figured that having numerous sexual encounters was the best way to embrace his own masculinity and sexuality. Thus, Caleb learned to define his sexuality by the number of girls he slept with. He never learned to develop other masculine strengths that lead to respectful and romantic intimate relationships with women.

Caleb is not alone. Many of our teenage boys are taught that being sexual means being sexually active, whether they’re taught by a parent, or by the music they listen to, the movies they see, and the magazines they read.

Just as their sexuality begins to bloom, teenagers also experience three major psychological developments that are tightly entwined with their developing sexuality: emancipation, identity formation, and the slow and gradual development of abstract thinking. Let’s take a look at each one in turn.

Emancipation

An important part of adolescence is separating from one’s parents, in a process called emancipation. Teens usually embark upon this around puberty, beginning with baby steps (driving, getting a job, developing their own opinions) and ending with the giant leap into college or on to other adult endeavors.

Although teens want to separate from you, the process itself is frightening for them. That’s why you often see your teenager taking one step forward and two steps back. Your 15-year-old daughter might be into giggling about boys and trying new makeup, while at the same time she sleeps with her stuffed animal from childhood and still wants a goodnight kiss from you.

During this process, teenagers start redefining their emotional relationship with you, moving from that of parent and child to that of parent and adult. At the same time, they’re separating from you physically. Suddenly, it seems they’re never home. They may refuse to go on family vacations, or even to go out to dinner as a family. They walk apart from you when you’re in public places, and head straight to their room when they get home. Some get after-school jobs that keep them out of the house, or start spending inordinate amounts of time at a friend’s house, perhaps even “adopting” that other family as their own.

They’re not doing this to abandon you, but to redefine their relationship with you, to move from a posture of physical dependence to physical independence. It’s a tough transition for both parent and adolescent, and, luckily, it occurs gradually, or none of us would survive it!

Emancipation takes many forms. Some teens deliberately do things they know will annoy their parents, such as skipping chores, breaking curfew, or talking back. They’re not doing these things just to be obnoxious (although it often seems that way) but, subconsciously, as a way to tear themselves away from you. This testing of the rules is their way of saying that things are changing. And with those changes, they want fewer restrictions and redefined boundaries. They want to be seen as an emerging adult, not as a child. This doesn’t mean they don’t want any rules, as we’ll see later.

This testing is similar to the way a toddler tests boundaries. He’ll wander off just a bit from you to see what happens—always keeping you within his sight. Teenagers do the same thing. When they break curfew, they’re really saying: “How far can I go?”

When teens exhibit these “testing” behaviors, of course, we get angry. That anger puts another barrier between parent and teen, enhancing that feeling of separation. In a teenager’s mind, it’s easier to need a person less if you’re mad at them. Sometimes they even pick a fight so they can feel mad, and thus have a good reason to move away from you.

For instance, I overheard the following exchange between Bo, 13, and his mother. “I decided to go out with my friends tonight and I’ll be home around eleven-thirty,” Bo told his mother.

“Eleven-thirty! I don’t think so! Your curfew is 10 P.M.,” his mother said, shocked and angry.

“So what? It should be changed. What do you think I’m going to do? Don’t you trust me?” Bo demanded.

A huge fight ensued between the two, ending with Bo storming into his room and his mother in tears.

Bo’s assertion of his new sense of independence is typical of early adolescence. He deliberately picked a fight with his mother so he could have an arena in which to begin negotiating his independence and separation. Of course, he doesn’t recognize that he did this, for, as you’ll see below, he still lacks the sophisticated reasoning that would enable him to see the full scope and consequences of his actions.

Teenagers turn to sex for the same reasons. Sex makes them feel more grown up, more like an adult. It provides a sense of independence and freedom from parental authority. It’s a behavior parents can’t see or control, an action in which the teenager is the one in control, the one making the decisions. This provides an incredible sense of power, and provides yet another way for the teenager to physically and emotionally separate from his parents.

The challenge for parents is to find safer ways for teenagers to exert their independence, like finding a first job, opening their own checking account, taking responsibility for a car. You can provide “safer” freedoms—the freedom to choose their own clothes, hairstyles, the way they decorate their room. Helping them find safer ways to define their independence, while maintaining certain boundaries, will reduce the risk that they’ll turn to sex for that independence.

The balance between providing more freedom without totally relinquishing all rules is tricky. If you’re too rigid, and don’t give your teen some opportunities for independence, they’ll rebel and look for them on their own, often turning to the risky behaviors of sex, drinking, and drugs.

But if you give them too much freedom, they may feel as if they’ve been prematurely thrust out of the nest, maybe because you don’t love them. Many parents of our generation give too much freedom too soon to our kids because we want to teach them autonomy. While your intentions may be rooted in love, your teen feels just the opposite—that he is unloved. Remember, rules and boundaries make teens feel loved. Parents who abandon too many rules too quickly communicate to their kids that the teens are adult enough to make all their own decisions. Thus, teens begin acting in “adult” ways. To them, this means drinking, doing drugs, and having sex.

I often see this in my own practice. Many concerned parents give their teens too much freedom too soon, not because they don’t love their kids, but because they’re anxious to prove their trust. Teens don’t understand this; they just haven’t developed the kind of complex thinking required to comprehend this kind of action. So they get confused and angry. They look for love and a sense of belonging wherever they can—sometimes in sex.

That’s what happened with Myra. As soon as I saw her and her parents in my office, I knew it was serious. I could hear them fighting even before I entered the exam room.

“I just don’t know what to do with her!” her dad blurted out before I even sat down. “She’s out of control.” Ever since Myra turned 14, she’d been very restless and her parents had adopted a hands-off approach. When Myra wanted to go to parties with older kids, her parents let her. When she wanted to date a boy who was 18, they let her. The consequences were predictable: Myra got pregnant and had an abortion—an event her parents didn’t learn about until several months after the fact. After the abortion, Myra became sullen and irritable. She hated being home, she wanted to be out as much as possible. So her parents let her. The more she pulled away, the more her parents let go, afraid that if they cracked down and set limits, she’d only get into more trouble.

What prompted this particular visit? I asked. Myra didn’t answer. “She thinks she might be pregnant again,” her mother said. As her father and mother spoke I could see a coldness in Myra’s eyes. Her body language was stiff and angry. She looked like she wanted to scream and cry at the same time.

When we finished talking, I examined Myra. Fortunately, she wasn’t pregnant. But she did have gonorrhea. Although I treated Myra for the STD, I urged her and her parents to see a good family counselor. At first, her parents didn’t want to go because they felt embarrassed. They insisted they loved her intensely and had always worked hard to be good parents. But they made one huge mistake. They gave Myra too much freedom before she could handle it.

As Myra herself said: “At first, I liked the independence. But later, I wished they’d given me a curfew, like the other kids had. I wanted the rules back.” She was desperately searching for proof that someone loved her and cared—just small things, like her dad waiting up for her to make sure she was okay. After a while, thinking her parents didn’t care about her all, she began having sex, hoping, deep down, she said, that she would get caught.

Myra got her wish and, with help from a good counselor, began to feel the love her parents had for her. Once her parents realized they could better communicate their love for her by providing boundaries and rules, Myra quickly settled down and stopped having sex to get their attention.

One final word of caution about emancipation: When your teen breaks those non-negotiable rules (and feisty teens will break them to test your reaction), you must enforce serious consequences. I recommend that non-negotiable rules center around safety and respect for others. For instance, driving and drinking can kill, so this is a good, non-negotiable rule. In our house, one of our own non-negotiable rules with our children centers around driving. They can’t speed. If they get a speeding ticket, the car gets taken away for a predetermined period of time, say three to six months, depending on their age. These rules and enforced consequences are critical to our teens. Just like the laws of your town, state, and country, they work to keep a collective society civilized. The family is the first place teenagers learn how rules and consequences work.

Identity Formation

As kids seek emancipation from parental control, they’re also trying to figure out just who they are. I frequently ask teens to describe themselves to me. Since most kids love to talk about themselves they dive into a list that typically goes like this: “I’m pretty good at soccer, my grades are okay, and I like clothes.” But if I ask them to describe themselves as their best friend sees them, the list of attributes is quite different. “Well, she’d say I’m a really good listener, I try to be a really good friend. Sometimes we get into arguments but I’m the first one that tries to patch things up. She might say I help her a lot and I’m always there for her.”

This is the inner and outer identity, and it is during the teenage years that adolescents are struggling to define these two sides of the same coin.

The outer self is what they look like and how they behave. They spend a lot of time trying to improve this outer self, trying to fit in with their peers in the way they dress, wear their hair, even the way they walk or talk. Included in this outer self are all the things teenagers do. The sports they play, their actions at parties, the grades they get in class. They work to excel in these areas not only because it makes them feel good about themselves, but to gain greater acceptance from others.

The inner self they describe is “the real me.” The person with the deep feelings and secret thoughts. This is the part of themselves teenagers share only with those with whom they are closest. Frequently they lament, “No one understands the ‘real’ me.” This inner self is harder to know than the outer self, because its qualities are more intangible. But it begins with qualities of character. Things such as compassion, good listening, personal opinions, and values. It is here, in this “inner self,” that the real grappling takes place. Here that a teen wonders about and worries about life after adolescence. About true likes and dislikes. Here that the fears about growing up, about friendships, about abilities, really live.

As teens work to form both their inner and outer identities, they experiment a lot, trying on different personas in much the same way we try on shoes. They try different clothes, hairstyles, and hobbies, often venturing toward behaviors and dress designed to gain peer acceptance (and shock parents, thus, again, helping them separate). Part of this experimenting involves trying out “adult” behavior—drinking, smoking, having sex.

For even as teenagers work to learn their inner and outer identity, their sexuality is bursting. Just how does this sexuality fit into this new identity?

Boys, for instance, may believe that being sexually active makes them more masculine, more grown up, and more manly, so they try it. Girls may think it makes them more popular, more feminine, more “cool.”

But this is backwards! Sex shouldn’t shape a teenager’s identity; their identity and character should shape their decisions and feelings about having sex.

Josh, 17, knew this very well. I’ve known Josh since he was in grade school. He’s always had a close relationship with his parents, so even when puberty hit, things remained fairly steady. They struggled with the typical curfew issues, and Josh tested his parents on many occasions. A couple of times he was grounded for staying out too late when he didn’t tell his parents where he was. But he enjoyed his home life, he said, and didn’t really have that many complaints.

He met Julie when he was 16. They began dating seriously and talked about having sex, but decided to wait. When I asked him why, he told me about his relationship with his father. Every year, the two of them went fishing for a week. They spent the time talking about personal issues and his dad encouraged Josh to decide what he felt was right, then stick to his guns. He told Josh the young boy never needed to prove himself to anyone, that he was great just the way he was. Those times with his father had tremendous power in shaping Josh’s feelings about his identity and his sexuality. They taught him that he was a strong person, able to make good decisions and carry them out. By spending time with him, talking and listening to him, and having fun with him, Josh’s father taught his son that masculinity is about much more than sexuality, and that relationships are about much more than sex. And yet, I’ll bet Josh’s dad had no idea of the impact those fishing trips had on the boy.

But if a teen decides to go in the other direction and become sexually active, the decision will have a tremendous effect on that teenager’s identity formation. It may change the way the teenager thinks, feels, and relates to others. It may even change his core moral values. For sexual experiences touch teens on a deeply emotional level, influencing the way they feel about themselves and others—and it’s not always positive.

When Kathy was 16, she started dating Rob, also 16. They did everything together. They watched each other’s basketball games, helped each other during stressful times at home and at school, were each other’s best friends. He made her cookies and she sent him flowers. He even came to one of her appointments with me once because he was worried about her. Their relationship clearly influenced their own identity formation. As she told me: Rob made her “better” than she felt she could be on her own.

After about six months, they started having sex. It was a relationship of tremendous respect, and Rob always wore a condom. I was sure that these two mature kids, who seemed to have a more mature relationship than many married people I knew, would one day get married. But after a year and a half, Rob decided he needed “some space.” When he broke off their relationship, Kathy was devastated. She’d adored and loved him. When he left, she said, she felt he took part of her with him.

Soon after the breakup, she began having problems concentrating and withdrew from her friends. Luckily, her parents supported her and helped her pull her life back on track. When I saw her after her first year of college, I asked how she was doing and got an answer I didn’t expect.

“I hate to think about him,” she said. “After he left for college, he kind of went off the deep end. He got into drugs really bad and started hanging around the wrong crowd. I can’t believe it.” She was still clearly hurt, both because of him and for him. “How about you?” I asked. “Any new relationships on the horizon?”

“Nope. And I don’t want any. I’m haunted by him. I trusted him. He knew me better than anyone. We shared everything. We knew everything about each other. We had great sex, too. How could I have been so stupid? I don’t trust myself anymore. I don’t know what I want, what I believe, and what I don’t believe.”

It had been more than two years since the breakup, but Kathy still felt the great hurt of that early foray into sexual intimacy. Because her identity wasn’t fully formed during her relationship with Rob, the experience scarred her in a permanent way, like a footprint in wet cement. Today, she has difficulty forming strong attachments, even to friends, because she’s afraid to trust them and herself.

Inability to Think in the Abstract

How many times have you sat down with your teenager, told him about an important issue or event, then asked his opinion. Too often, rather than an articulate, well-thought-out response, all you get is a shrug of the shoulders followed by a mumbled, “Uhhh, I dunno.” Surely this must be one of the most frustrating things about dealing with teenagers. They look like adults. They want—and demand—adult responsibility. So of course we expect them to think like adults. Big mistake.

At the beginning of puberty, teenagers simply haven’t developed the kind of abstract thinking that guides most adults. They’re still functioning on a concrete, black-and-white level. They have difficulty linking ideas and concepts together and understanding how one might affect another. They have problems seeing things from another person’s perspective, putting themselves into another’s shoes. This can, at times, make them seem as if they have no compassion. They do; they just don’t know how to express it. They also have a difficult time understanding the long-term consequences of their actions. That, for instance, sex today could lead to a baby in nine months or a sexually transmitted diseases in two weeks.

I remember giving a lecture on eating disorders several years ago. My 14-year-old daughter was in the audience waiting patiently for me to finish. At the end of my lecture about why girls starve themselves, about their depression and psychological stresses, she came up to me and, in a disgusted voice, said, “Mom, I just don’t get it. What’s their problem? If a kid won’t eat, you should just tell their parents to put them in the army, because they’ll make them eat.” Her concrete thought process led her to see a simple problem that required a simple solution. She simply couldn’t fathom the complexity of eating disorders.

Another ramification of this concrete thinking manifests itself in the egocentricity of teenagers. Put simply, they think life revolves around them. When they need to go somewhere, they don’t understand why you can’t drop what you’re doing and drive them. If they need a new outfit for a dance, they don’t understand the fact that the car payment is due, and that there is no extra cash. This egocentricity often leads teens to act impulsively, ignoring the consequences to anyone else. Teenage boys, in particular, may struggle with the need to have their sexual desires met quickly. When they feel the physical desire to have sex, they want to do it right here, right now, regardless of the consequences or how it affects anyone else. This, of course, can be very dangerous. If teens feel entitled to have all their sexual urges met when they want them met, not when the time is right, they set themselves up for all the dangers of early sexual activity, primarily pregnancy, STDs, and depression.

Part of this egocentricity displays itself as a kind of “personal fable.” Teenagers are certain they possess unusual abilities to endure dangers that would harm others. The personal fable says that, yes, people get hurt—but not me. That’s why teenagers do such stupid things, like driving 90 miles per hour, spending days in the hot sun without sunscreen, jumping off bridges into unknown bodies of water, or having sex—protected or unprotected—with multiple partners.

Consider Jessica. She was 15 when she came to see me because, despite a poor appetite and dieting, she was gaining weight. I took a complete medical history, then left the room so she could change into a gown for the examination. When I pulled back the gown, I was shocked by her protuberant belly. I placed my hands over her swollen abdomen and felt the heels of a 7- to 8-month-old fetus kicking. The kicks were so intense, they were visible through her skin.

“Do you feel anything in your belly?” I asked.

“Yeah, a lot of gas,” she said.

“Jessica,” I started, “you’ve got a huge baby in your belly. Can you feel it move?” I don’t know why I was surprised by her denial. This wasn’t the first time I’d seen it in an adolescent patient.

“I can’t be pregnant, Dr. Meeker! You’re crazy! I’ve only had sex once and we’ve broke up!”

Jessica’s denial was a classic example of the personal fable.

Unfortunately, we can’t speed up the processes of abstract thinking and we can’t zap our teens out of their own personal fable. Only time can do that. In the meantime, however, we must realize that this kind of thinking places our children at tremendous risk, and we must work with them to sidestep the temptations they’re not mature enough to resist alone.