E2: 7 Domains of Becoming a Woman

When Does a Girl Physically Become a Woman?

So 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: physical, emotional, social, intellectual, financial, environmental, and spiritual.

Now, for some, becoming a woman is really when she has her first period. But when a girl has her first period—and I call it a girl—she might be 10, 11, or 12, and we don't usually think of her as a woman.

In the olden days, meaning going back several hundred years to Scandinavia where they were keeping records, girls had their first period at 17, 18, or 19. And in revolutionary times, girls had their first period at 15 or 16. And now girls have their periods on average about 12.

But there are, what some people believe, environmental factors that make earlier and earlier puberty now an issue. So many girls are having their first period at 9 or 10. So, we would not call them women.

Well, how about when she completes puberty and looks like a woman? So it takes about three to five years from the first period to the time a woman has rounded out her body. But then if you add 3 to 5 to 10, you get 13 to 15, and we still wouldn't say that is a woman.

So we're still kind of stuck at when does a girl become a woman? How about when they first have sex, like the song by Gary Puckett & The Union Gap? You've got to look that one up.

Well, there are unfortunate children who have sex and there are 12-year-olds who have sex and we don't consider them women. And there are 40-year-old virgins who are very clearly women who haven't had sex. So first sex doesn't really trigger the woman stuff.

However, first sex does begin to trigger how we take care of women medically, what we screen them for, and how we think about contraception, if that's appropriate.

So let's look at this question through the lenses of the seven domains and just see what we see.

So we're going to be talking a little bit about the physical stuff. When do doctors think it's time to move from your pediatrician to your grown-up doctor? What about adolescence and how does that play into this? Adolescence means the maturing of the brain, and for many people, maturing of the brain happens at about the same time that puberty happens. But more and more, functional MRI studies, brain studies, show that the brain isn't mature until the 20s. So does that mean you can't be a woman until your mid-20s if your brain is still developing?

For me, I think the first womanly thing I brought on was I snuck into my father's Dopp kit and stole his razor and shaved. He had a straight razor. Not a straight razor, but he had a double-bladed razor. And I shaved my legs and my armpits, there wasn't much there, but on a weekly basis, I was using my father's razor.

And of course, that got my father's razor a little dull and then he recognized that someone had been using his razor. There was a little kerfuffle because I was taking his personal grooming things to do my personal grooming.

That was the first time I did something to make myself what I perceived as more . . . not the things that were imposed, but biology imposed on you. These little things sprout on your T-shirt and all of a sudden you're cycling with Luna.

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". 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." So, that's what it is for healthy kids.

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."

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: Right. I was trained in adolescent gynecology, and as a sub-specialist I was trained in pediatric gynecology, pediatric endocrine problems, girls who have periods too soon, girls who were developing too soon, girls who might have a mass at 3 or 4 in their ovary. But I can't say that I really understand the adolescent mind. You probably understand the adolescent brain better than I do, whereas I can take a look down there in anybody. So it's a dance to do.

Dr. Gellner: It is. We're lucky that we work closely with gynecologists and we can say, "Hey, I can take care of everything else going on with this girl, but I don't know what's going on here. I'm not comfortable doing that type of an exam." I'll do external exams and we'll test for sexually transmitted diseases and yeast infections and bacterial vaginosis and all sorts of things like that. That, I can do.

Dr. Jones: How about talking about sex and contraception?

Dr. Gellner: I do that starting at 12.

Dr. Jones: Thank you.

Dr. Gellner: It's in our flow that we start talking about these touchy subjects as early as 12 as part of our well-child visit protocol. And what we do is we say, "Okay, you're 12. I'm going to talk to you about some things." And I'll often say, "Are you comfortable talking in front of your parents? Would you like to talk to me about anything privately with your parents not here?" I always give my teenagers that option. Most of them are like, "No, I'm okay. I'm pretty open with my parents." Or sometimes the parents will say, "Uh, yeah, can you talk to her about this?"

And so, we just go from there and we'll ask about, "How is school going? Do have a boyfriend? Do you have a girlfriend? Are you on any birth control? Are you using any protection whatsoever? How are your periods? Have you ever had thoughts of hurting yourself? Have you ever had thoughts of suicide?" Those are all things that are actually part of a standard well-visit from the age of 12 to 18. So I think it all goes down to the "Do you have a good relationship with your provider to begin with?"

Dr. Jones: I think it's difficult for making this transition when you have kids for whom the medical home . . . and you've been the medical home to help guide them and coordinate their care. So to transition to another adult medicine specialist, that could take a little while.

Dr. Gellner: It can.

Dr. Jones: And take some trust and the kid might be uneasy. Any kid with developmental delay might have a number of issues.

Dr. Gellner: Right. And most of us work together really well. There are a lot of med-peds providers, and so they're dual board certified. So they're certified in internal medicine and pediatrics. Most of them went into that because they like that broad range of care, and then they can handle things a little bit more tricky than maybe a family practice provider could.

And quite often, the med-peds people really like that transition age because that's one of the things that drew them to med-peds. They like helping people with this transition. It's usually like ages 17 to 23. They're like, "Yeah, I'm really comfortable taking care of that group because I know how to help them navigate the waters into adulthood."

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.

But when I start talking to them about puberty changes, I always start saying, "So, are you checking down there? Do you know how to check down there? Has anyone ever talked to you about checking down there? Does everything feel okay? If anything doesn't feel okay, would you tell somebody?"

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: So to round it up, it sounds like mostly for healthy kids, the transition is made at about 18. That's about the time that kids are moving either from high school to college or moving from high school out into the work world. And so, that's a good time for kids with problems that might need a specialist. They might get referred earlier. And then there are some kids who might need some extra special time in that transition.

Dr. Gellner: Correct.

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.

Dr. Jones: That's a perfect answer. Thank you, Dr. Gellner.

Good Judgement is the First Step to Wisdom

This is really a powerful concept, is when does a girl intellectually become a woman? Now, here we have this problem with the brain development, in that 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.

There's a famous story in medicine about all these young interns standing around the old, gray-haired, not a woman, it's a man, and they say, "Dr. Smith, how is it that you always make the right clinical decision? You're always right." And the guy says, or the woman says, "Good judgment." And then they say, "But, Dr. Smith, how did you get good judgment?" And he looks at them and says, "Bad judgment."

The concept of being able to take experiences and link them together with new information is called judgment, and it's the first step to wisdom.

It's very 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 girl becomes a woman intellectually when she's able to take facts, link it to experience either that she's learned about or she's personally experienced, and make a judgment that's wise.

That link from girl to woman intellectually is the first step to wisdom. Boy, oh boy, aren't we interested in finding that? Boy, oh boy, aren't we interested in having our adolescent girls make that step?

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. In fact, it's when a child, instead of becoming me, me, me, or an adolescent becomes me, me, me, starts thinking of themselves as part of something bigger.

Kids know who they are. They're kids. And grown-ups are supposed to have done that work already. The adolescent's search for identity often includes a spiritual quest.

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.

But we know that kids who have some particular sense of spirituality do better through this rocky transition if they have something that's bigger than themselves.

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 very important time, the spirituality, often rocky in terms of self-identity for the adolescent.

And so, when does a girl become a woman spiritually? That's a tough one, but she probably knows it when she feels it.

Why are Adolescent Girls so Emotional?

When does a girl become a woman emotionally? Well, we sure know when a child becomes an adolescent emotionally, because all of a sudden tears just spring out of their eyes and the level of disgust gets way high.

When does a girl move beyond the adolescent emotionally to a woman? And 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.

We do know that a 5-year-old girl's brain has been developed in utero differently than a boy because a 5-year-old boy's brain, when it was in utero, saw testosterone. So a 5-year-old boy's brain is structurally a little different because of their in utero environment. But at 5 for a boy and 5 for a girl, their hormonal environment is really quite the same.

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.

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

The adolescent girl has emotions bouncing around her brain. Immediately she's reacting to them before she can even think about what she's thinking about. She has an immediate response. It comes out her eyes, comes out her mouth, comes out of her behavior before she can even identify and label what she's feeling and regulate it.

A girl becomes a woman when she can finally use that emotional platform, which her brain has been developmentally prepared for, in a way that's useful to her and hopefully to others around her, and not just blow off whenever she feels like it. That ability to recognize the emotion, label it, use it appropriately, and regulate it is when a girl becomes a woman.

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? 

This is a particular issue in the American culture of independence. Around the world, leaving home is not so important. In Italy, men don't leave home until the average of 35 years of age, and that's kind of old. And for me, as an American, I would say any male living at home at 35 is still a boy and not a man. But in their culture, having mom around to feed them and do their laundry and take care of them until they adopt a woman in their life to do that, that's something that's pretty common.

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.

We're going to talk briefly to Chloé, who is our producer, about her own experience in her culture.

 

Dr. Jones: 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. 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: This is actually the unique aspect, I think, of the American culture, because part of the American culture was to pack up and move west. And we moved from our nuclear family, which was large a couple hundred years ago, to nuclear families, which were tiny.

And that's actually uniquely American because we evolved in social groups where the youngers eventually took care of the elders. And in South Asia, India, and Pakistan, the women may leave quite young if they are married off and go to their husband's family and they become the slave of the mother-in-law.

Chloé: Right. I know the horror stories.

Dr. Jones: But the males stay home and then bring their brides home so that they can get the help raising their children and then can help raise their grandparents.

Chloé: Yeah, that's exactly how it is. I mean, not exactly, but it's kind of the same structure as the Vietnamese culture and most East Asian cultures as well. And so, I think they make that conscious decision to kind of stay close.

Dr. Jones: 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.

Chloé: Exactly. It was this big community. I mean, I don't think we looked at it so much as you have to stay home to take care of the parents, but it more so is taking care of each other.

Dr. Jones: Right. And 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: Well, 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

By the way, 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. Let's talk about that for just a little minute. This is not common and there is a lot of debate in the medical literature, of which there's not very much, and among pediatricians about when you begin to intervene to make a girl into a man.

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. It can be a changing thing for kids and sometimes kids can try it on for a little while and then they decide they're fine with their assigned gender. But for some girls, they don't want to become women. They want to become a man.

It's very important that if you're a parent or a grandparent, you listen to this child, that you listen openly to your child, 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.

In general, you don't want to make any permanent changes until a kid is 18, or old enough, mature enough to make permanent changes. There are options in terms of suppressing hormones while a kid grows so the girl doesn't go through the womanly bits when she really wants manly bits. She doesn't have to go through the hips and the thighs and the breasts of puberty that happen. There are some pediatricians who can actually offer help to suppress female hormones, but it's a reversible thing.

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.

Then, make sure that the child is in the hands of a pediatrician who understands transgender care, transgender psychology, and transgender biology and therapy so that we can make sure that the changes that a child would like to experience to go from girl to man is something that's not irreversible until they're old enough to make that decision as an adult.

When Does a Girl Become a Woman?

So, we've come to the end of this particular "Seven Domains," and the question is "When does a girl become a woman?" We've explored a whole bunch of different parts of this. As with all "Seven Domains" topics, it's so much more than that.

Thanks for joining us and keep in touch. Come to the website, womensseven.com and that seven could be the number or S-E-V-E-N. Womensseven.com. And we're on Pinterest at Women's Seven. And join us wherever you get your podcasts.

But I'm going to leave with the "When does a girl become a woman?" haiku.

 

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

 

Bye-bye.

The "bye-bye" isn't part of the haiku. Thanks for joining us. We'll be back with you soon with another "Seven Domains" topic. Bye-bye.