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You are listening to Seven Domains of Women's Health:

E2: 7 Domains of Becoming a Woman

Nov 16, 2020

When does a girl become a woman? Of course, it depends. It depends on how you define "woman" and that depends on the seven domains of a woman's health. For some, becoming a woman is when she has her first period. For others, it's when she's able to form her own judgment and thought. But, as with all "Seven Domains" topics, it's so much more than that. Pediatrician Cindy Gellner, MD, joins this episode of 7 Domains of Women's Health to discuss when a girl becomes a woman.

Episode Transcript

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When Does a Girl Physically Become a Woman?

So when does a girl become a woman? We're going to ask pediatrician Cindy Gellner, popular host of The Scope's "Healthy Kids Zone". And she and I are together in an interview as the first time two hosts have been together on an interview. And we want to know when she thinks it's time to transition from a kids doc to an adults doc. So it's the girl's zone and the woman's zone together today.

Dr. Jones: Okay, Cindy... So when do you say to a young woman that it's time for you to see either an adult gynecologist or an internist or family doc? How do you say make that decision for a healthy kid?

Dr. Gellner: So for most of us, when you're doing the 17-year-old well-visit, at the end of that usually . . . At the end of any well-visit we'll say, "Okay, your next well visit is," whenever it is. And for kids after the age of 3, it's in one year. And so, for teenage kids, when we get to the 17-year-old well-visit, we'll say, "Okay, your next well-visit is in a year. However, I can only see you until you're 18, and after that, then we need to have you established with an adult provider."

And during those teenage visits, we talk about a lot of things, including sexuality and gynecology issues, period issues, all that. So for some girls, if they're having a lot of issues, especially if they're sexually active, things like that, then sometimes we start having the conversation a little earlier about saying, "Okay, you're having a lot of issues that are gynecology-related." As a pediatrician, I can handle some of those. But if there are a lot of issues going on I just say, "It's getting out of the scope of what my practice is as a pediatrician."

And most parents are usually okay with that. They'll be like . . . I explain it as you wouldn't want a gynecologist to take care of your child's asthma. You really don't want your pediatrician taking care of gynecology issues that are out of our scope, and they're like, "Oh, yeah."

Dr. Jones: Let's talk about gynecology. Let's talk about girl problems or young woman problems. What kinds of things do you feel comfortable . . . Let's say you've got a 16-year-old who has really painful periods.

Dr. Gellner: So I take care of that all the time. So painful periods unfortunately are a fact of life, and I talk to them about all the things they can do -- naproxen, heating pads, things like exercise, actually getting out and moving and not sitting in bed.

A lot of parents are like, "What else can I do for them?" And the thing is birth control is about the only thing you can really do to help.

Now, some people are okay prescribing birth control. Some are not. Many pediatricians were okay doing Depo shots and were okay doing the pills. We don't do IUDs and we don't do implants like Nexplanon. And that's where, if it's out of our comfort zone, we refer to someone like you who's more comfortable managing these types of situations, because it's not something a general pediatrician normally does.

Most of us are actually pretty open about saying, "You know what? This is your body. If you're here for a physical, we're going to talk about every part of it because it's important. If there's something going on, you need to let somebody know because sometimes it's concerning."

Dr. Jones: Okay. Here's the tough question, you, a mother of boys and you're the dog mom of a boy and you are the wife of a boy. When does a girl become a woman in one sentence?

Dr. Gellner: When does a girl become a woman? When she's ready.

Good Judgement is the First Step to Wisdom

Early on in adolescence is the important restructuring, rewiring of the brain. And what happens is that adolescents often are pretty good at taking new information in, but they can't link it up together in a meaningful way.

Now, we do spend a lot of time with adolescents putting them in classrooms, and many adolescents go to college. But it's not a college or your education that makes you intellectually a woman. It's your ability to link up information that you have with experience and make good judgment.

It can be rare for an adolescent female or male to be wise, but it's not uncommon for a young woman in her late 20s or early 30s to be wise, because that final maturation of the frontal lobe that allows people to actually put together information, link it together, and add judgment to experience, to content, that makes an adult brain.

A Sense of Something Bigger Helps Adolescents with Self-Identity

Some religious traditions, like Judaism, have a ceremony, a big-deal ceremony. It's a bar mitzvah for boys and a bat mitzvah for girls. And in that religious practice, it says when the child is now responsible for their new actions, or it was their parents and now they're responsible, which is a step toward adulthood. It doesn't say anything about a girl becoming a woman, but she's now responsible for her actions, which is what we tend to think an adult does.

There are cultures that have a celebration, like the quinceanera, to celebrate when a girl becomes a woman. In Hispanic cultures, there's a 15th birthday celebration where all the families and all the neighborhoods come together to celebrate this girl's transition in the culture from girl to woman.

But spirituality is a deeper, deeper thing. And in fact, it's when a child, instead of becoming me, me, me, or an adolescent becomes me, me, me, starts thinking themselves as part of something bigger.

Now, what does this mean? It means that some kids who have been raised in a certain faith find themselves questioning that faith, and they may leave that faith either forever or for a little while. And some kids actually find a new faith and grab it very dramatically, like they grab new love. They become totally engaged in a new faith.

Adolescents are so introspective. It's all about me, me, me, and if they have a sense of something bigger than themselves, it helps them get out of their own heads. So this is a very important time, the spirituality, often rocky in terms of self-identity for the adolescent.

Why are Adolescent Girls so Emotional?

Why aren't boys emotional? Well, in fact, they are. And this is a question when boys and girls express their emotions differently, there is a lot of cultural norm here about what's accepted.

So if you take a look at a 5-year-old girl and a 5-year-old boy before their adolescent hormones have kicked in, you find that adolescent girls are much more likely to roll their eyes than adolescent boys. They're much more likely to cry. They're much more likely to have a tantrum, at least in Western, American culture. That may not be true around the world.

At puberty, we see probably the effects of rising testosterone in boys leading to behaviors that are different than women. They are more likely to be risk-taking, which may be a testosterone effect. They're more likely to express rage and anger, which can definitely be a testosterone effect. And they're more likely to seek out risky sex, which is probably also a testosterone effect.

Now, for adolescent girls, they tend to see estrogen and progesterone. Progesterone is a pro-social hormone. We're learning more and more about progesterone's effect on the brain. Girls don't make progesterone until they start ovulating.

So we have this new brain that is rewiring itself for adulthood. We have this new brain that now is rewiring itself emotionally with new hormones. So when does a girl become a woman emotionally? It's when she can finally make the link between how she's feeling to a label of what she's feeling and how she's going to respond to it.

Leaving Home and the Transition to Adulthood

In our culture here in the U.S. we think that a woman or a girl becomes a woman when she leaves home, is financially independent, she can pay her bills, and that's something that is prolonged in kids who go to college. And nowadays, even more kids are staying at home longer and their parents are still paying for their cell phones and maybe their rent. So does this interfere with the transition of girl to woman, boy to man?

Now, this is a particular issue in the American culture of independence. Around the world, leaving home is not so important. In other cultures, in particular South Asian and Asian cultures, children don't necessarily leave home because they may be making the generally slow transition from childcare person, the person that the adults take care of, to the person that takes care of the adults. So it's a slow transition from the child to the person who takes care of the grown-ups.

Evolutionarily, there are some very smart people who look at the grandmother theory, which is that women who live with their grandmothers around . . . and it could be their grandmothers-in-law, meaning their babies have a grandmother-in-law to help raise them, those kids do better, and those mothers are more able to have more children. So we weren't really meant to separate from our parents.

So Chloé is here. Chloé is my producer, and she gave me the powerful insight and took me out of my own culture. She woke me, she woke my brain to cultures outside my own, particular cultures where the kids are expected to provide for their parents.

Dr. Jones: In the U.S., we leave our parents behind and good luck to them. But tell us a little about Chloé who's still at home.

Chloé: Yes. So I am still at home, and I'm really proud of that. Being in America and being an American, I have to kind of explain why I'm still home at 28 years old. I come from a Vietnamese background. That's my culture.

And in our Vietnamese culture, and most East Asian cultures too I believe, it's very rare for the children to leave home because, like you mentioned earlier, we kind of transition from being taken care of by our parents to us taking care of them as they age. And so it's almost kind of frowned upon if you leave home. Not so much as like, "Oh, shame on you. You left your parents." But if you are able and you're in the same proximity, then it's common for the parents to live with you or you to live with your parents, vice versa.

It's just been a very common thing in the Asian culture. So I never really have to explain to any Asian people that I live at home. But being in America, a lot of people say, "Oh, where do you live now?" and I'm like, "I'm still at home," they kind of look at me funny a little bit.

Dr. Jones: I think that's an unfortunate part of what happens when, by our culture, kids are supposed to pack up and move out. So that was our culture. That's what my parents did. But the loss of intergenerational caregiving, which actually lets adulthood move back and forth, be more fluid, becomes really important to you.

Chloé: And I think so much of it has to do with society and the impact of age. How old are you that you're old enough to move out? Are you 18? Are you 19? Are you 20? Are you 21? There are all these sort of age guidelines and rules about when you can do certain things, and I think a lot of us base adulthood around those ages.

I think, for my generation anyway, once you're out of high school, once you are college, you grow up, but you always continue to grow up. When you're in elementary, you're an adult when you go to high school, but then you're in high school, you're an adult when you go to college. But then you're an adult when you graduate college. And then you're an adult when you get married. And then when do you move out? When is it too late? When is it too soon?

Dr. Jones: Oh, I think you're so right. And this gets back to when does a girl become a woman? And the answer is, partly, it depends. That's what we started with. It depends. And within the seven domains, and we've kind of talked about the seven domains, it depends on which domain you want to look at. But I'm going to quote Cindy Gellner here when I asked her when she thought a girl becomes a woman, and she said, "When she's ready."

Not All Girls Want to Become Women

Some girls want to stay as little girls, and some girls want to grow up to be men.

There are some girls who've known since they were very young that they weren't girls. And they had what's called the gender dysphoric disorder of childhood, meaning they're children and they don't think their assigned gender, girl or boy, is the right one and they feel bad about it. So they want to be boys.

The most important thing is to listen with love to your child or your grandchild who says, "I don't want to become a woman. I want to become a man." Offer an ear and be careful to listen out for problems that the child might be having in school where bullying can be a tremendous problem. Give the child outlets for the path they want to take in a way that's comfortable for them and for you and your family.

And then as the child comes into their early tweens, come to a developmental pediatrician who's got some expertise in transgender care for adolescents.

Health Haiku

New bumps on T-shirt
Mood swings in sync with Luna
Girl becomes woman

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