My Terrible Secret

Shahbaz,

This is in reply to your Nov. 7 post.

``....for the first time in my life it felt good to be a man, for the first time in my life it felt good to be human and weak, for the first time I fell in love with women every week- life sucked in colors and I was truly alive : crying, laughing, singing and screaming with joy..`` In the midst of all the ``action`` in your life, may I also suggest a test to see if you`re HIV positive YET??

Ghalib

Re: Shahbaz

My dear friend, I hope you will take what I have to say in a constructive spirit and not feel offended.

I think your parents have been criminally abusive to you. Based on what you revealed in earlier messages (in response to Anita`s remarks in the article where we were discussing kids) I conclude that your father should have done jail time for child abuse. Unfortunately, there are many, many desis living in the West who, as you rightly point out, live in their self-segregated cultural ghettos and desperately try to turn the clock back on their ``zeebra`` children. You seem to have only experienced that sub-set of the desi population sample. I am willing to grant you that what you consider as representative desi model lies within one standard diviation of the mean. But as you increase your sample you will notice that there are many, many desi people who do not fit the model you experienced as a child.

There are those of us who grew up in the old country (not the west) and yet never experienced any of the ``desi style`` abuses you take for granted as the norm in the desi household.

I think you`d do yourself a favor if you could transend beyond your personal experiences as a child.

sincerely,

...SR

you tell them!

i am to this day sick and tired of the secrecy surrounding menstruation. its just like any other bodily function, but just becuase it is linked to puberty and only happens to women, its got all this shame attached to it. even adult men and women cannot deal with it.

Re SR:

The author of this courageous essay probably was not expecting a medical exposition, but since you bring it up, the early age of menarchal onset here is indeed striking.

While it is true that the age of menarche in girls has been slowly decreasing, and is attributed to a host of psychosocial (early sexualization through media exposure affecting endogenous hypothalamic gonadotropin releasing hormone activity etc.)and nutritional factors, the most important determinant is still genetic i.e age of maternal, as well as other female relatives` onset of menarche.

The appearance of secondary sex characterstics (breast budding in girls, testicular enlargement with reddening and thinning of the scrotum in boys) are usually the first signs of puberty. The appearance of secondary sex characterstics before the age of 8 in girls (and therefore menarche before the age of 10, since there is on average a two year lag between start of breast development and periods), and before the age of 9 in boys is definitely considered precocious in any part of the world.

Precocious puberty is much more common in girls, than in boys. Most often, no cause can be found and it is labelled idiopathic. However, there can be well-characterized medical reasons for it that need to be ruled out before it is labelled idiopathic.

Similarily, delayed puberty (beyond the age of 16) can also have a number of causes, the most important factor again being familial. High activity levels such as seen in elite athletes and ballet dancers (I suspect your wife was dancing through her teenage years), and poor caloric intake (e.g anorexia nervosa) are additional important causes today. From a medical standpoint, delayed puberty is generally more concerning than precocious puberty. As the author well illustrates, in Pakistan, it is probably the other way around.

Finally regarding your remark about pediatrician epidemiologists, I suspect you refer to me. Unfortunately, I have only a passing interest in reproductive endocrinology. The love of my life remains infectious disease epidemiology.

Anita

The author has touched upon a very important subject. It is terrible that our culture promotes the absurd concept of shame in context with a child`s natural development. I remember when my daughter had her first experience with menstruation. She was in the UK at the time and I went there and took her for a two week vacation. It was quite traumatic for her because she was not with her mother and had, by that time, learnt to be quite aware of the modesty issues in the tradition of our culture. It took a lot of reassurance and she was visibly uncomfortable at first. But in the end it brought us closer. Now, at 16, she talks to me like she would with her school buddies.

One more issue came to my mind. The early age of onset. My wife says she was almost 17 (though she admits being late compared to her peers. It was 14 to 15 back then. Now a days is generally 11 to 13. Eight, however, is rather early, but it is happening more and more.

They claim it is because of ``better`` nutrition. Hogwash...I remember a study from the late 70`s where they found young Porteurician girls getting their menstrual onset as early as 5. It was eventually found that the local poltry farms were feeding too many anabolic hormones to their chicken. I wonder how the poultry industry in Pakistan is contributing to the early onset of menarche? Perhaps some of our Ivy League type pediatrician epidemiologists will answer that question when they return to Karachi?

...SR

A moving article, KMJ. Menstruation and sexual development need to be more openly discussed in our culture, especially with children before the onset of puberty. By hiding this very natural fact of female biology, we unnecessarily imbue it with shame and fear. I believe many of the neuroses and pathologies of our culture stem from sexual shame and repression. We need to talk about sexuality a lot more, not in a prurient and juvenile way, but with reason and with an understanding that it`s a vital part of our physical and emotional development.

As an adolescent male, I had a similar experience with my own burgeoning sexuality. When I experienced my first nocturnal emission at age 13 during a dream, I was completely shocked and frightened by what had happened. I was sure I had some terrible disease, maybe even cancer, because this strange fluid was coming out of me! For days I walked around in dread and despair, too afraid and ashamed to tell my parents what had happened. Private parts had always been a taboo topic for discussion, and I wasn`t about to breach that taboo, not even if my life was at stake. Fortunately, by some great coincidence, I happened to watch an episode of the medical drama ``St. Elsewhere`` which was on TV a few days later, and one of the story lines was about a boy who experienced the same thing as me and was too afraid to tell anyone. The kind old doctor explained that this was completely normal and the first of many nocturnal emissions to come, a natural part of becoming a man. I was SOOO relieved!! If I hadn`t seen that show, I don`t know how long I would have continued in my despair.

Moral of the story: Talk to your kids openly and frankly about sexuality without making them feel ashamed or

afraid of it. You will save them from a lot of pain.