36: Early-developing girls’ perceptions of pubertal interventions

Abstract

While research abounds on the endocrinological options for delaying puberty, a paucity of studies examines girls’ beliefs about pubertal interventions (e.g., Baumann et al., 2001). The purpose of this presentation is to initiate girls’ presence in this dialogue by reporting findings from an exploratory study of early-developing girls’ perceptions of medical interventions for delaying puberty. A survey of 55 socioeconomically diverse African-American and White late-adolescent girls from three Pennsylvania high schools produced a sub-sample of 16 early developers (i.e., under age 10 at puberty). These volunteers gave two semi-structured retrospective interviews about their early puberty and perspectives on medical interventions in early puberty. The systematic analysis of verbatim interview transcripts and open-ended survey responses involved a qualitative grounded-theory method informed by the literature on girls’ adolescent development. A codebook of 70 codes was developed from the salient and common themes in the surveys and interviews and was applied to the data using the software program NVivo. Cross-case analytic memos explicated prominent motifs and deconstructed themes and the relationships between them. While many of the participants reported adverse experiences at puberty (e.g., bullying), only one advocated medical interventions. Most justified their opposition by arguing that puberty is a natural process not requiring a physician unless “something’s wrong.” Exemplary of this consensus, one participant said, “You should let it {puberty} happen because that’s the way their bodies work, as long as they understand that they’re different, but they’re not abnormal. Maybe they are abnormal, but it’s not, it’s okay. It’s unusual, it’s not abnormal.” Others argued that the social challenges posed by early puberty would strengthen a girl’s character, arguing that “they’re going to be a better person from it. They’ll learn from it.” Several were also concerned that hormonal interventions would pose adverse health consequences. As one said, “What if, down the road, that gives them problems? Like, what if down the road it keeps them from having kids someday? Or it keeps them from developing?” Three explanations for the girls’ opposition are posited: (a) Subjective: the need to feel normal led to speaking against interventions that would imply their difference and pathology; (b) Sampling: the sample was not sufficiently “early” to advocate a delay; or (c) Sociocultural: general trends toward earlier puberty in girls (either physically or socioemotionally) and the cultural disappearance of childhood might yield a more casual perspective on childhood pubertal change. In my discussion, I posit implications for physicians working with early-developing girls and ask questions for future research, such as: How do girls who have undergone treatment perceive intervention and its social and emotional outcomes? Active solicitation of girls’ voices in the dialogue on hormonal therapy is essential as they are most affected by its use or rejection. It is a means for involving girls in their own health and preventing their avoidance of treatment because of intimidation or the belief that they are not agents over their bodies.