Puberty. Characteristic signs of puberty in boys. Pay more attention to foreplay

Puberty is the period of a person’s life during which his body reaches biological sexual maturity. This period is called puberty and is characterized by the appearance of secondary sexual characteristics (see), the final formation of the genital organs and gonads. The time of onset of puberty depends on many factors - nationality, climatic conditions, nutrition, living conditions, gender, etc. On average, in boys it begins at the age of 15-16 years, in girls from 13-14 years and ends at the age of 20 and 20, respectively. 18 years old. It should be emphasized that there are significant individual deviations in the timing of the onset of puberty. Physiologically, this period is characterized by the maturation and onset of functioning of the gonads. In the adrenal cortex, androgens begin to be intensively produced (see), the secretion of pituitary gonadotropins increases (see Gonadotropic hormones), which accelerates the development of the gonads. In girls, with increased function of the ovaries, which produce, the mammary glands, external and internal genital organs: uterus, labia begin. At the age of 14-15 years, sometimes earlier, the formation of the menstrual cycle occurs (see). An objective criterion for the maturity of the gonads is menstruation in girls and (see) in boys. The most common sequence of appearance of sexual characteristics is presented in the table.

Often normal puberty occurs in a slightly different sequence. In these cases, it is sometimes very difficult to find a clear boundary between normality and pathology. One of the reasons for such deviations is disorders of hormonal systems; in other cases, the constitutional characteristics of a teenager during puberty, as well as psychogenic factors that can cause pronounced endocrine disorders, acquire a certain significance. It is extremely important to take these cases into account, since the irrational use of hormonal drugs during treatment can lead to significant damage to many systems. During puberty, small temporary deviations are sometimes observed, that is, variations in the normal development process. They are regarded as physiological phenomena. Girls may experience significant growth of the mammary glands (macromastia), and precocious puberty does not occur. Physiological variations of puberty also include juvenile uterine bleeding, amenorrhea (see). Painful menstruation is often observed, accompanied by headaches, vomiting, and weakness. These disorders are usually observed in girls with an unstable nervous system. Boys may have slight enlargement of the mammary glands (pubertal gynecomastia), which goes away completely.

Late(pubertas tarda) is considered puberty, observed in girls at 18-20 years old, in boys at 20-22 years old. For this pathology, therapeutic measures should be aimed at improving living conditions, nutrition and the introduction of male and female sex hormones and drugs containing pituitary gonadotropic hormones. Delayed sexual development and stunted growth are observed with infantilism (see). Underdevelopment of the reproductive apparatus and the absence of sexual characteristics of a given sex - hypogenitalisl (see) - are caused by dysfunction of the endocrine glands and, above all, the pituitary gland.

Early(pubertas praecox) is considered to be puberty, which occurs in girls under 8 years of age and in boys under 10 years of age and is characterized by the premature appearance of secondary sexual characteristics, rapid development of the genital organs and accelerated growth. In boys, this manifests itself in accelerated growth, and then an early cessation of growth (which subsequently leads to short stature), rapid growth of the genitals and the appearance of secondary sexual characteristics (hair growth, low timbre of voice, pronounced skeletal muscles). Wet dreams are also possible. In girls, growth accelerates, and then growth stops early, becomes wide, and the size of the uterus and ovaries increases. There are cases of menstruation in preschool age.

Early puberty in combination with accelerated growth, but a sharp disproportion of the skeleton, short stature and mental retardation is defined as macrogenitosomia praesox.

The question is closely related to the problem of puberty. This is a system of medical and pedagogical influences on adolescents with the aim of instilling in them certain norms of behavior in sexual life. The task of sex education is to create a physically healthy generation, whose sexual life should be subject to the moral norms of our society. The joint education and upbringing of boys and girls, their early involvement in public life, the combination of education with industrial work, and widespread development among young people create the basis for reasonable family education.

Puberty (lat. pubertas) is the process of growth and differentiation of the gonads, genital organs and secondary sexual characteristics. Puberty occurs with complex changes in the nervous, endocrine, cardiovascular and other systems of the body, as well as in physical development, and ends with the onset of puberty.

The hypothalamic region, which is in an inextricable functional relationship with the pituitary gland, plays a major role in puberty. During puberty, the activity of gonadotropic hormones of the pituitary gland noticeably increases, and the content of androgens and estrogens in the blood and urine increases. Estrogens synthesized by the ovaries cause enlargement of the uterus, vagina, labia minora, mammary glands and keratinization of the vaginal epithelium. Androgens cause sexual hair growth, growth of the penis and scrotum in boys, and the clitoris and labia majora in girls. Sex hormones, especially androgens, stimulate the growth and differentiation of bone tissue, promote the closure of growth zones, and enhance muscle development. In these processes, the protein-anabolic effect of sex hormones is manifested. The relationship between the various systems regulating puberty is shown in Fig. 1.

Puberty begins earlier in girls than in boys. During this period, urinary excretion of estrogens and gonadotropins increases noticeably in girls, and androgens in boys. Recently, in all countries, the timing of the onset of puberty has shifted to an earlier period. Thus, according to the observations of V.S. Gruzdev dating back to 1894, menstruation began at 15 years 8 months; Currently (1965) they usually begin at 13-14 years of age. In boys, the date of puberty is determined by the first ejaculations. The beginning and duration of the pubertal period depend on family (constitutional) characteristics, body structure and environmental conditions (nutrition, climate, living conditions, etc.). Puberty begins in girls from 8-11 and usually lasts until 17 years, in boys - from 10-13 and up to 19 years.

During puberty, a hypertensive reaction and a hypotonic state, pulse lability, acrocyanosis, Trousseau spots, orthostatic albuminuria, spontaneous hypoglycemia, and sometimes mental disorders may be observed. The degree of puberty is judged by secondary sexual characteristics - hair growth on the pubis (11-13 years) and in the axillary region (12-15 years), in girls, in addition, by the timing of the onset of menstruation and the development of the mammary glands (10-15 years) , as well as using radiographs of the hand and distal ends of the forearm bones. The onset of puberty corresponds to ossification of the sesamoid bone, then synostosis appears in the first metacarpal bone and terminal phalanges; At the end of puberty, complete synostosis of the epiphyses of the radius and ulna occurs. It is necessary to be careful when assessing the degree of puberty in boys based on the size of the external genitalia, since their growth is often somewhat delayed.

Precocious puberty(pubertas praecox) can be true or false. When true, there is a relationship between the hypothalamic-pituitary region, the gonads and the adrenal glands. There are constitutional (essential) and cerebral forms of true puberty.

The constitutional form is almost always observed in girls and is apparently due to family predisposition. Secondary sexual characteristics appear early, even from birth, but more often at 7-8 years, and menstruation - at 8-10 years. Menstruation is ovulatory. In boys, secondary sexual characteristics can appear as early as 9-11 years of age, less often earlier. There is macrogenitosomia (premature enlargement of the external genitalia). At 12-13 years of age, puberty ends.

Initially, children with precocious puberty are ahead of their peers in physical development. However, later, due to the closure of growth zones, some of them develop short stature and disproportion - the lower limbs are relatively short in relation to the body (Fig. 2). The mental development of such children is often consistent with their age, and if it lags behind, then by approximately 2 years. In girls, urinary excretion of follicle-stimulating hormone and estrogen reaches puberty levels. The content of 17-ketosteropds in daily urine exceeds the age norm. With tumors of the adrenal gland and gonads, the level of hormone excretion is significantly higher. A vaginal smear confirms a normal menstrual cycle.

The prognosis for the constitutional form of premature puberty is favorable. There is no treatment.

In the cerebral form of true puberty, there are lesions in the hypothalamic region (tumors, hemorrhages, congenital brain defects, encephalitis) or a tumor of the pineal gland. Currently, most researchers believe that even with tumors of the pineal gland, premature sexual development is caused by secondary changes in the hypothalamus due to internal hydrocephalus. Children experience early and rapid development of genital organs and secondary sexual characteristics. Mature Graafian follicles and the corpus luteum appear in the ovaries. Interstitial cells form in the testes and spermatogenesis occurs. The content of gonadotropins, estrogens, and 17-ketosteroids in the urine corresponds to the pubertal period.

Precocious puberty is also observed with multiple fibrous dysplasia, in which there are changes in the skeletal system, skin pigmentation and increased activity of the thyroid gland.

False puberty (pseudopubertas praecox) occurs with pathological changes in the adrenal glands, ovaries or testicles. Ovulation and spermatogenesis are absent. After removal of the tumor, the development of secondary sexual characteristics is possible.

Delayed puberty(pubertas tarda) is characterized by late development of the genital organs and glands, as well as the appearance of secondary sexual characteristics. In boys it is diagnosed at 20-22 years old, in girls at 18-20 years old. Most often it occurs under the influence of a constitutional (family) factor, less often due to insufficient hygienic conditions and nutritional reasons. Delayed puberty is sometimes observed up to 15-16 years of age. At the same time, physical and often mental development lags behind. The differentiation of the skeletal system also lags behind, usually by 2-4 years. In the coming years, most children will reach the same age level as their peers in sexual development.

Assessment of puberty must be carried out on the basis of a number of signs and especially radiological data on the differentiation of the skeletal system. Correspondence of ossification processes to actual age, as a rule, excludes delays in puberty.

Variations in Puberty. Premature development of the mammary glands (premature thelarche) in girls may be the only sign of deviation. The absence of secondary sexual characteristics, estrogenic changes in the vaginal smear and enlargement of the internal and external genitalia makes it possible to distinguish this process from true puberty. It is believed that premature telarche is based on an increased reaction of mammary gland tissue to estrogens. In the future, this reaction may disappear. No treatment required.

Boys often experience pubertal gynecomastia (see), expressed more often on the left and disappearing without treatment. Treatment with male sex hormones is contraindicated.

Premature secondary hair growth (premature pubarche) develops on the pubis, in the armpits without other signs of virilization and is more often observed in girls. Only from 10-12 years of age is it combined with enlargement of the mammary glands, external and internal genital organs. Later, children develop normally. Urinary excretion of 17-ketosteroids corresponds to the age norm or slightly exceeds it. Children with precocious puberty require medical supervision and should be examined periodically.

During puberty, sometimes there is an enlargement of the thyroid gland of the II and III degrees without dysfunction. In this case, no treatment is carried out. Often, especially in boys, acromegaloid phenomena (also physiological) develop. There may be a predominance of masculine or feminine principles. The prognosis is favorable. During the same period, the so-called pseudo-Freulich type of obesity is sometimes noted, somewhat similar in appearance to obesity in adipose-genital dystrophy (see). At the same time, the distribution of fat is uniform with some predominance in the chest, abdomen and thighs. Arms and legs are often shortened. Body length and bone differentiation correspond to actual age. Hypogenitalism is absent or slightly expressed. The excretion of 17-ketosteroids and 17-hydroxycorticosteroids in urine is normal. The basal metabolism is reduced or normal. Puberty occurs at normal times or is somewhat delayed. No drug treatment is required.

During puberty, girls with symptoms of basophilism (the basophilic cells of the pituitary gland function intensely) experience female-type obesity, and stripes appear on the hips, buttocks, and breasts. Blood pressure is often elevated. However, sexual development is not impaired or even accelerated. Menstruation occurs on time, and the cycle is preserved. The prognosis, as with the types of obesity described above, is favorable.

Pubertal exhaustion is observed mainly in girls. The first symptoms: lack of appetite, abdominal pain, belching and vomiting, often repeated. The skin is dry, wrinkled. Bradycardia, muffled heart sounds, arterial hypotension, and amenorrhea are noted. Unlike pituitary cachexia, there is no atrophy of the mammary glands and hair loss. The basal metabolism is reduced. The function of the thyroid gland is not impaired. The content of 17-ketosteroids in the urine is reduced, and after the administration of ACTH it reaches normal levels. Follicle-stimulating hormone in urine is often absent or reduced. The prognosis is usually favorable. Treatment requires careful care, aminazine, protein-anabolic steroids. Methandrostenolone (or Nerobol) 5 mg per day, Nerobolil intramuscularly 25-50 mg once a week (4-6 injections).

Diagnosis, prescription of medications, especially hormones, as well as prognosis of diseases and conditions during puberty must be approached with caution.

Rice. 2. Girl 2.5 years old: early sexual and physical development (height 110 cm).

The logical conclusion of sexual intercourse is orgasm. At this time, the man not only receives pleasure, but also ejects semen, which, once in the woman’s vagina, provokes the development of a new life. There are a number of problems that a man, with age or under the influence of certain factors, begins to experience during ejaculation. One of these problems is delayed ejaculation.

Causes of delayed ejaculation

If there are problems with ejaculation, a man experiences sexual arousal and has an erection sufficient for sexual intercourse, but even intense stimulation of the penis does not lead to the release of seminal fluid for a long time. Delayed ejaculation is often accompanied by difficulties in obtaining orgasm, as well as psychological dissatisfaction of partners.

Long ejaculation -This is a fairly rare phenomenon, it occurs in 1 man in a thousand.

Some women may note that, in general, the situation is not so bad, because sexual intercourse lasts longer than usual, and this is in any case better than premature ejaculation. Problems with ejaculation of this type also lead to problems with conception, but women who do not want to become mothers also like this state of affairs, which cannot be said about men.

Delayed orgasm in men can be caused by a huge number of reasons, including:

• injuries to the scrotum and penis;
• sexual infections;
• prostatitis;
• urethritis;
• BPH;
• urethral strictures;
• previous operations on the prostate gland;
• renal failure;
• diseases of the endocrine system.

Prolonged sexual intercourse in a man may be associated with neurological problems, for example, a recent stroke, diabetes, Parkinson's disease, multiple sclerosis and spinal cord diseases. If ejaculation is constantly delayed, the problem may be hidden in physiological aspects, that is, the partner may have a penis that is too small or the woman may have a vagina that is too wide.

Delayed ejaculation in men can be caused by psychological factors, such as fear of not satisfying a partner, interpersonal problems (lack of sexual desire between partners), and the presence of complexes. Quite often, delayed orgasm occurs in people who have an “autosexual” orientation, that is, they experience greater satisfaction from masturbation than from traditional sexual intercourse.

Prolonged sexual intercourse can provoke the use of certain medications. This side effect occurs after regular use of antidepressants, antipsychotics, antihypertensive and diuretic drugs. A similar result is observed with drug and alcohol abuse.

Only a qualified specialist can determine exactly why ejaculation may be delayed, based on a thorough examination and test results. Do not try to diagnose yourself, you will only worsen the situation and subsequently complicate the work of doctors.

Classification of delayed ejaculation

Delayed ejaculation even has several types. Depending on the degree of violation, a distinction is made between anejaculation - in which ejaculation does not occur for more than 20 minutes, while partners are forced to stop sexual intercourse, and relative anejaculation, characterized by the absence of ejaculation during sexual intercourse, but its achievement during masturbation. There is also retrograde ejaculation, a man receives pleasure during sexual intercourse, but the release of semen does not occur in the usual way. Sperm enters the bladder instead of the opening of the genital organ. This method of ejaculation is also called “dry orgasm.” In general, it is not dangerous for men, but it is impossible to conceive a child without treatment.

The pathology can be primary in nature, that is, occur from the beginning of sexual activity, or secondary, that is, occur after a certain period of life. Depending on the circumstances, doctors distinguish between permanent and situational dysfunction. In the first case, ejaculation is always delayed, regardless of the situation, and in the second, pathology occurs depending on certain conditions.

Each form of sexual dysfunction has its own characteristics and requires an individual approach to treatment.How to speed up ejaculation,The doctor will tell you, having studied in detail your medical history and other features of your body.

Symptoms of delay

The main symptom of dysfunction is, as the name suggests, delayed ejaculation. In this case, a man can fully ejaculate outside of sexual contact, that is, through petting and masturbation. The consequences of this condition are not critical, because such a phenomenon does not threaten the lives of partners, but it definitely requires correction. Delayed ejaculation in rare cases can cause a man discomfort in the lower abdomen. There are no additional symptoms such as itching, burning or redness.

It should be noted that a man who is unable to cum quickly tends to blame the woman for the situation, ignoring the problem with his health. This moment only intensifies mutual reproaches and claims. As a result, both partners develop hostility towards each other, and accordingly the family is destroyed. If a man in such a situation does not come to his senses in time, this will happen again in a new relationship, and will last until he consults a doctor.

Treatment for delayed ejaculation

Before a doctor prescribes a course of therapy, he is obliged to conduct a diagnosis, that is, determine the reason that caused such an unusual state of sexual function. After listening to the patient’s complaints, the urologist or andrologist will conduct a rectal examination of the prostate, ultrasound of the penis and scrotal organs. In order to exclude infections, prostate juice will be taken for analysis. To assess the hormonal state of a man, an androgen profile study (testosterone level, GSPS) will be performed. If there are prerequisites for pathology, consultation with a neurologist, endocrinologist and cardiologist is required. If physiological abnormalities are not found, a psychosexual examination of the patient will be performed.

The approach to treatment is chosen by the doctor individually, depending on the cause of the pathology and the detected disorders. Therapy can consist of several stages; treatment usually begins with medications and physical procedures. If they do not bring results, the patient is sent to a surgeon for corrective surgery..

Some doctors say that the situation can be corrected by choosing the right position for sex or by determining the tactics of action. Therapy consisting of the following stages helps best:

1. Ejaculation, which is caused by masturbation alone.
2. Inducing ejaculation by masturbation in the presence of a partner, but without her participation.
3. Inducing ejaculation by stimulating the partner.
4. Stimulation of the penis by the partner, which leads to complete readiness for ejaculation, and then rapid insertion of the penis into the vagina.

According to doctors, after a man ejaculates several times into the vagina, the pathology and associated psycho-emotional problems disappear and the man completely restores full ejaculatory function.

Medicines and drugs

In the treatment of delayed ejaculation, there is not one drug, but several at once, because the drugs must comprehensively remove not only the cause, but the possible consequences of prolonged absence of therapy. Most often, doctors prescribe:

• dopaminergic drugs;
• dopamine reuptake inhibitors;
• drugs alpha-2 antagonists, alpha-1 agonists, calcium channel blockers;
• antagonists of 5-H serotonin receptors.

If retrograde ejaculation is present, the patient may be prescribed medications such as: Ephedrine sulfate, Midodrine, Brompheniramine maleate or Desipramine. Although all of the above medications are available in pharmacies without a prescription, purchasing them at your own discretion is strictly prohibited. The duration and regimen of administration must be indicated by the doctor on an individual basis.

If the cause of the pathology is congenital anomalies or defects that develop as a result of injuries and surgical interventions, then the only treatment is surgical. If you experience pain during ejaculation or when it is delayed, be sure to seek treatment for concomitant diseases, these can be prostatitis, urethritis and sexually transmitted diseases.

To summarize, we can say that the prognosis for the treatment of delayed ejaculation will be positive only with timely comprehensive treatment. There is no prevention that allows you to avoid such a situation, and there is no folk remedy that would help correct the pathology. Only a qualified andrologist or urologist can help you gain full virility and conceive children.

We can talk about delayed ejaculation, “when it is impossible to finish,” in cases where ejaculation occurs only after a very long period from the beginning of sexual intercourse, despite the desire to speed it up. This period can last for an hour or more. Throughout this time, the erection may be completely normal or its intensity may fluctuate slightly. A man can experience sexual arousal and have a full erection, but stimulation of the penis does not lead to ejaculation. Delayed ejaculation is much less common than accelerated ejaculation. The disorder may be permanent or may occur from time to time. Delayed ejaculation occurs in 2 out of 1000 men. Moreover, about 75% of men with delayed ejaculation can achieve it through masturbation. It is necessary to distinguish normal delayed ejaculation from pathological one. In the first case, this disorder is a consequence of characteristics inherited from the parents that manifest themselves during the normal process of puberty. Pathophysiological factors include injuries, diseases, surgical interventions, hormonal disorders, and the use of certain medications that affect the normal process of zyakulation. Anejaculation is an extreme form of delayed ejaculation, in which the latter does not occur for such a long time that the patient and his partner stop sexual intercourse. All variants of ejaculation disorders can be divided into two categories:

1. absolute inability to achieve ejaculation
2. relative anejaculation, when ejaculation is absent during sexual intercourse, but is present during masturbation during petting or during sleep.

What reasons influence delayed ejaculation?

1. Psychogenic causes - delayed ejaculation caused by psychological disorders. One of the most common reasons for prolongation of sexual intercourse in a man is the formation of an inadequate erotic stereotype, which does not coincide with the sensations characteristic of sexual intercourse. In some cases, with high sexual excitability, the method of masturbation was formed as a result of receiving a release from random mechanical or emotional influences not related to the genitals. Subsequently, there is a desire to repeat the orgasm from this stimulus and the formation of dependence on it. Conventional intimate relationships could not provide the desired scenario needed to achieve ejaculation. On the contrary, with reduced excitability of the ejaculatory center, masturbation was carried out against the background of the need to further increase stimulation. With the onset of sexual activity, it turned out that the mechanical effect on the genitals during intimacy was “too weak.” As a result, arousal did not increase to the level necessary to obtain sexual release. However, sexual fantasies that include desired actions can cause ejaculation without any problems.
2. Nutritional reasons - alcohol abuse. With chronic alcoholism, there is a decrease in the excitability of the ejaculation center in the lumbar spinal cord. In chronic alcoholics, functional factors associated with marital conflicts and suspicions of the wife of infidelity may be superimposed on organic causes.
3. Malformations of the bladder neck - Müllerian cyst, Wolffian duct anomalies.
4. Iatrogenic: caused by organ dysfunction after surgery on the prostate or bladder and caused by postoperative neurological problems - proctocolectomy, abdominal aneurysmectomy, aortic lymphadenectomy.
5. Neurogenic causes - diabetic neuropathy, Parkinson's disease, multiple sclerosis, spinal cord injury.
6. Infectious causes - urethritis, tuberculosis of the genitourinary system.
7. Endocrine causes - hypogonadism, hypothyroidism.
8. Medicinal causes - taking diuretics, antidepressants and serotonin reuptake inhibitors.

What are the psychogenic causes of delayed ejaculation?

A common psychological reason is the unconscious suppression of ejaculation by the man himself, when he fears the woman is pregnant or when he considers sex a “dirty and shameful” activity. In some cases, there may be a fear of not satisfying a woman, an unconscious fear of “sexual insufficiency,” which leads to an involuntary prolongation of intimacy until ejaculation disappears. For some men, moral and ethical considerations may influence the duration of sexual intercourse. The reason for the delay may also be the insufficient erotic attractiveness of the partner, to whom the man does not experience pronounced sexual attraction, or imbalances in the structure of the genital organs (the vagina is too wide compared to the size of the penis), which reduces mechanical stimulation during frictions. Delayed ejaculation is also noted as a consequence of fairly deep conflicts associated with the partner’s personality (for example, sexual trauma, which is a specific inhibitor and is associated with the real or perceived infidelity of the partner), as well as in the presence of deviant inclinations, for example, homosexual, sadistic, masochistic, etc. ., which are also a specific brake. In addition, there is the concept of “autosexual” orientation, when a man with delayed ejaculation notes much more pronounced arousal and satisfaction from masturbation than during normal sexual intercourse. The most common form (about two-thirds of all cases) is primary ejaculatory failure, in which the patient has never been able to ejaculate into the vagina. Secondary failure is called in cases where a man who previously ejaculated normally loses the ability to ejaculate intravaginally or achieves this extremely rarely. In both cases, ejaculation can usually be induced through masturbation (in about 85% of our patients) or stimulation from a partner (in about 50% of our patients), but outside of sexual intercourse.

What is the diagnosis of this pathology?

The task of diagnosis is to identify possible physiological and psychological causes of the disease. Anamnesis, especially medical history, the fact of taking pharmacological drugs, as well as examination data of the external genitalia are of key importance. In the absence of obvious causes, a thorough psychosexual examination is indicated.

This questionnaire is designed to help your doctor understand how you are feeling. Consider each statement carefully and in the right column, select the answer that most closely matches how you felt last week. Circle the number corresponding to the answer you chose (ignore the meaning of these numbers). Don't think too long about each statement, as your first reaction will always be more correct. Each statement corresponds to 4 answer options, reflecting gradations of symptom severity and coded according to the increasing severity of the symptom from 0 (absence) to 3 (maximum severity). The total score is calculated separately for the anxiety subscale and for the depression subscale. Odd-numbered items (1,3,5,7,9,11 and 13) constitute the anxiety subscale, even-numbered items (2,4,6,8,10,12,14) constitute the depression subscale. Fill out the questionnaire, calculate the score and bring it to the doctor.

Fill out the scale, count the points and bring it with you to your doctor's appointment.

What is the treatment for delayed ejaculation?

It is carried out on the basis of the reasons that influenced this violation. Here it is important to distinguish a clearly defined sexual disorder from episodes that occur from time to time, when a man is unable to achieve intravaginal ejaculation or when he needs prolonged sexual intercourse and long frictions for it to occur. Occasional difficulties with ejaculation are not a sign of sexual dysfunction and are often caused by fatigue, tension, ill health, too frequent intercourse, or exposure to alcohol or medications. In addition, a man may be unable to ejaculate if he has no special feelings for his partner (for example, if he performs sexual intercourse simply because he feels it is expected of him).

1. Sexual education includes clarification of the characteristics of orgasmic function, ridding the patient of existing myths, teaching stimulating techniques, trigger moments of orgasm. Treatment is aimed at eliminating ejaculation problems and is designed to help the couple adapt their behavior to existing difficulties. Success here depends, first of all, on the partner’s willingness to cooperate, on her ability to rebuild intimate relationships in such a way as to eliminate or compensate for factors that impede ejaculation.
2. Reducing the effect of expecting failure is achieved by prohibiting ejaculation during masturbation; sexual activity should only be with a sexual partner.
3. The patient should be focused on genital stimulation and, if possible, enhance it.
4. Sometimes it is recommended to resort to anal stimulation; such patients often benefit from prostate massage.
5. For emotional disorders, drug and physiotherapeutic therapy is carried out.
6. Neurological disorders are successfully corrected by electrical stimulation.
7. Psychogenic disorders are eliminated with the involvement of a partner. Treatment of incompetent ejaculation is based on an in-depth analysis of the underlying psychological factors in combination with exercises to focus sensation.

What is the sex technique for delayed ejaculation?

It consists of several successive stages:

• ejaculation caused by masturbation alone;
• ejaculation caused by masturbation in the presence of a partner;
• ejaculation caused by manual stimulation from the partner;
• vigorous stimulation of the penis by the partner, carried out until ejaculation is inevitable, and then rapid insertion of the penis into the vagina.

In most cases, after a man has ejaculated into the vagina once or twice, the suppression of this act or the fear associated with it completely disappears. In some cases, if these procedures fail, ejaculation (induced by manual stimulation) on the woman's vulva may help. After a man gets used to the sight of his sperm on his partner’s vulva, he can perform intravaginal ejaculation much more easily.

What drugs are used for delayed ejaculation?

The basis of drug therapy for delayed ejaculation is the effect on the central dopaminergic and antiserotonergic mechanisms.

• Dopaminergic drugs are used for delayed ejaculation caused by taking antidepressants.
• Dopamine reuptake inhibitors are effective in 66% of antidepressant-induced withdrawal cases.
• drugs alpha-2 antagonists, alpha-1 agonists, calcium channel blockers (achiv with yohimbe), are used to prevent delayed ejaculation 1.5 hours before sexual intercourse in cases of clomipramine-induced anorgasmia.
• 5-HT1A receptor agonists eliminate slow ejaculation in 8 out of 10 patients, if this disorder is caused by anxiety disorders.
• antagonists of 5-H serotonin receptors may be recommended for continuous or intermittent use.

What physiotherapeutic techniques are used for delayed ejaculation?

• Therapy using special artificial color emitters acting directly through the eyes is called the visual color stimulation method. In this case, a complex effect of four factors is carried out: color, rhythm, modulation of light signals and the level of illumination of the light field. The human eye serves as a receiver for drug-free and non-invasive correction of the regulatory structures of the brain (hypothalamus, pineal gland, pituitary gland), and through them the neuroendocrine, immune and other systems.
• Electrosleep therapy. It has a sedative effect due to inhibition of the activity of the reticular formation and activation of serotonergic neurons. Transcranial electrical stimulation operates on the same principle.
• To eliminate pathological dominant relationships in the central nervous system, it is necessary to create a new, stronger focus of excitation, i.e. new dominant. The most effective method is galvanization of the reflex collar zone according to Shcherbak. It is possible to use electrophoresis with vitamins and other medicinal substances using the orbital or endonasal technique.
• It is advisable to influence reflex zones with physical factors. Laser puncture or electroacupuncture is performed. In acupuncture, the first stage is 1-3 courses of 60-minute procedures (inhibitory method) - general strengthening, relieving neurosis. The second stage is 1-2 courses of acupuncture on local points for 5 minutes (exciting method), and on general points (inhibitory method) 60 minutes.
• Baths. The aromatic substances contained in pine baths have a sedative effect by influencing the olfactory nerve. Iodine and bromine, capable of penetrating the blood-brain barrier, have a sedative and tranquilizing effect directly at the level of the central parts of the nervous system.

• SMT on the reflexogenic zones of the spinal centers of erection and ejaculation. Taking into account the leading role of disorders of the neuro-reflex centers of the spinal cord, the effect is carried out at the level of the SI-SV segments, which ensures activation of blood circulation in this area and an increase in efferent and autonomic impulses in response to the involvement of sensitive conductors.
• Rectal electrical stimulation. A special electrode is inserted into the rectum and anal stimulation is performed. The mechanism of therapeutic action consists of:
  • - emptying the prostate of stagnant secretions and its decay products;
  • - improving lymph and blood circulation in this organ;
  • - increasing the tone of muscle tissue;
  • - stimulation of metabolic processes.
• Ultrasound therapy. Ultrasound has a trophic, anti-inflammatory effect by stimulating reparative regeneration, activating microcirculation in the area of ​​influence and increasing the activity of cellular lysosomal enzymes. They act on the sacral spinal segments in a continuous manner.
• Galvanization of the panty area is used to improve the trophism of the spinal segments and restore damaged neuro-reflex connections.
• Peloid therapy. The use of mud applications on the panty area causes local hyperemia and stimulates repair processes. Irritation of skin thermomechanoreceptors causes the formation of reflex reactions in the segmental and subcortical structures of the brain, which are closed on the effectors corresponding to the reflex zone. A combination with treatment with rectal mud tampons is possible.
• Ultratone therapy. The effect is applied to the spine and perineum, moving the electrode with longitudinal and circular movements along the spine D8-L2, then along the perineum and along the inner perineum of the two third thighs.

What problems arise in a married couple when ejaculation is delayed?

Delayed ejaculation in normal marital relationships may initially even favor the achievement of sexual satisfaction in the wife, who, with prolonged sexual intercourse, can experience orgasm several times. Failure to ejaculate can be a source of sexual pleasure because it makes prolonged sexual intercourse possible. Some patients report that they are able to maintain an erection for 1-2 hours to the great satisfaction of their partners, many of whom admire it. However, when a woman discovers that her partner is incapable of intravaginal ejaculation (complete intercourse in the vagina), her reaction often changes. The relationship becomes burdensome for both the woman and the man, despite the man's desire, they cannot achieve orgasm at a certain time. The circumstances are even worse in conflictual relationships between spouses, when they no longer attract each other erotically. She begins to feel that her partner does not find her attractive enough, that he does not get pleasure, or that he is “delaying” the onset of orgasm out of selfishness. If sexual partners want to have children, then failure to ejaculate can cause even greater distress and even mutual accusations and quarrels that can destroy the most beautiful relationships. The situation can become dramatic when a woman experiences sexual indifference to a man, and instead of sexual pleasure, she develops an aversion to sexual intercourse with him. If a woman, at the insistence of her partner, is forced to have intercourse with him, then it is difficult for her to endure intercourse for too long, and she usually shows impatience about this. This causes subsequent conflicts and further delays the onset of ejaculation. Thus, a vicious circle is created, which worsens both life together and the condition associated with delayed ejaculation.

What is retrograde ejaculation?

This ejaculation disorder is characterized by the release of seminal fluid into the bladder. The diagnosis of retrograde ejaculation is established when sperm are detected during a urine test after sexual intercourse.

What are the reasons for the lack of ejaculation after sexual intercourse?

• congenital malformations of the posterior urethra and bladder neck, urethral valves, congenital anomalies of the bladder triangle, bladder exstrophy.
• acquired disorders of the normal structure: urethral strictures, sclerosis of the bladder neck.
• Iatrogenic disorders: transurethral resection of the prostate, bladder neck incision, transvesical adenomectomy, sympathectomy, colorectal or anal surgery.
• neurological causes: spinal cord injury, multiple sclerosis, diabetic neuropathy.
• pharmacological causes: antihypertensive drugs, alpha blockers, antipsychotics and all antidepressants that lead to partial paralysis of the bladder neck.
• idiopathic causes: in cases where the etiological factor could not be determined.

What treatments are used for retrograde ejaculation?

Drug therapy can be effective in the absence of anatomical and neurological disorders. The following drugs are commonly used: ephedrine sulfate, midodrine, brompheniramine maleate, imipramine. If the cause of retrograde ejaculation is congenital, acquired or iatrogenic changes in the bladder neck, sometimes special surgical correction techniques are used.

When does painful ejaculation occur?

Painful ejaculation or one-orgasmia occurs with many problems: the presence of prostate adenoma, infections, exacerbation of chronic prostatitis, chronic pelvic pain syndrome, colliculitis, obstruction of the ejaculatory ducts. Also found when taking antidepressants, alpha blockers.

The material was prepared by urologist-andrologist, physiotherapist, dermatovenerologist Oleg Viktorovich Akimov.

©2017 copyright (c) doctor Akimov O.V.

Delayed ejaculation what to do?

Delayed ejaculation manifests itself in difficulties with ejaculation during sexual intercourse, and in some cases even in its absence. A man needs a lot of time to achieve pleasure and this should not be regarded as an advantage, because if this occurs regularly, then we are talking about a serious problem. Treatment of this disorder, as well as the speed of recovery, depends on the reasons that contributed to the disorder of sexual life.

What you need to know about delayed ejaculation?

Sexual intercourse that lasts too long can cause discomfort for both the man and his partner. This is not always something to be proud of, because it may be a dysfunction of the reproductive system, which in the future will lead to more serious problems, such as impotence.

How does the ejaculation process itself develop?

This process consists of three stages. First, there is an increase in excitement, after which the sensations intensify to a peak, when orgasm should occur. The third stage is the onset of ejaculation.

What does the term “delayed ejaculation” mean?

Delayed ejaculation is a condition in which during sexual intercourse a man cannot achieve satisfaction for a long time and ejaculation does not occur.

A man has a desire to complete sexual intercourse, but cannot, because the ejaculation reflex is suppressed in the body.

Important! When ejaculation is delayed, there are no problems with erection, only problems with the release of seminal fluid are observed.

It is worth noting that any stimulation of the penis does not lead to ejaculation. Moreover, such a violation can be observed periodically or constantly.

In this case, the man never manages to cum. That is why this sexual disorder has several manifestations: when it is possible to achieve ejaculation after a long time, and when it is not possible to achieve ejaculation at all.

Causes of sexual dysfunction in men

Problems with ejaculation occasionally occur in all men, because the process of achieving orgasm can be influenced by various factors. Stress or physical strain can even cause a lack of potency, so if this situation occurs several times and does not recur, you should not immediately seek treatment. If delayed ejaculation occurs periodically or constantly, then you should go to the hospital. Let's consider the reasons for the occurrence of such a violation.

Physiological factors include:

• serious diseases of the body, such as diabetes, inflammation or prostate adenoma, various spinal injuries, Parkinson's disease, diseases of the cardiovascular system;
• endocrine diseases such as hypothyroidism;
• neurological diseases;
• congenital malformations of the organs of the reproductive system, including the bladder neck;
• complications after prostate or bladder surgery in the form of nerve damage;
• infectious diseases of the genitourinary system that arose as a result of sexually transmitted infections;
• prostate surgery;
• hormonal disorders;
• regular suppression of ejaculation during sexual intercourse for greater satisfaction of the partner;
• too turbulent sex life.

Very often, doctors are faced with the fact that after examination they cannot find the cause of ejaculation disorders in men. After all, delayed ejaculation often occurs as a result of psychological reasons.

And here, conventional treatment with medications will not work; only a psychologist needs to identify the cause of this condition. This may be certain stereotypes of sex education or a discrepancy between expectations and fantasies of reality.

Important! When you frequently achieve orgasm through masturbation without the participation of the genitals, a certain signal is generated in the brain that you can get pleasant sensations much faster. That is why ordinary intimate relationships can no longer provide the same level of excitement, and ejaculation is delayed.

Psychological reasons include:

• stress and depression;
• worries and complexes about one’s inability in bed;
• discord in relationships with your partner, frequent quarrels;
• religious restrictions on sex;
• disappointment in a partner when forming a certain ideal in the imagination.

Often, the first unsuccessful sexual contact can lead to the development of such problems, which either a partner who can be satisfied or highly qualified specialists will help you get rid of.

There are also problems with late ejaculation in men who began their sex life under certain prohibitions (for example, religious ones) and therefore experience a feeling of fear. Or, on the contrary, such problems appear in men who are frivolous about their sexual life and often change their partners, and therefore require longer stimulation.

In addition to problems at the psychological level and physiological problems, taking various medications can cause problems with ejaculation, for example, taking antidepressants and diuretics.

Drinking alcohol in large doses can also affect the quality of your sex life and increase the time it takes to achieve orgasm.

Diagnosis of problems

When is the best time to see a doctor?

You should go to a doctor for treatment if delayed ejaculation causes discomfort in sexual relations or if accompanying symptoms appear that indicate the presence of a disease of the genitourinary system.

Sometimes, in order to determine the cause of problems in bed that a man has, it is enough for a doctor to perform an external examination of the genitals and collect all the necessary tests, such as:

• smear analysis to determine urogenital infections;
• A blood test to determine testosterone levels, which may indicate the presence of endocrine disease, heart disease, or diabetes. And also to identify inflammatory processes in the body;
• urine test to determine genitourinary infections.

But sometimes doctors have difficulty finding the cause of the development of that disorder. In this case, the man needs to undergo many additional examination procedures.

How is prolonged ejaculation treated?

Treatment methods

Treatment depends on the reasons for delayed ejaculation.

Let's look at the most common methods:

• deviation caused by emotional or physiological disorders is treated with medications and physiotherapeutic procedures;
• if delayed ejaculation occurs as a result of psychological reasons, the man and his partner should attend consultations with a sexologist who provides training in stimulation methods, helps get rid of complexes, and helps the couple choose appropriate behavior in sex. The man is also prescribed a set of exercises that help focus his sensations;
• neurological disorders are treated by electrical stimulation.

Treatment with medications helps to get rid of all ejaculation disorders:

• dopaminergic drugs and dopamine reuptake inhibitors are used when delayed ejaculation occurs as a result of taking antidepressants;
• to prevent delayed ejaculation, alpha 2 antagonists and alpha 1 agonists are prescribed one and a half hours before sexual intercourse;
• if the ejaculation disorder is caused by psychological disorders, for example, fear and anxiety, 5-HT1A receptor agonists or 5-H serotonin receptor antagonists will help. These drugs can be used for a long time.

Physiotherapeutic methods are divided into two groups: sedative and trophostimulating.

Let's consider the procedures of the first treatment method:

1. Use of color radiation. This procedure helps, without the use of drugs, to influence the brain and nervous system through the visual perception of colors, light levels and modulation of light signals.
2. Electrosleep therapy helps reduce the activity of the reticulatory formation by activating serotonergic neurons.
3. Laser puncture, electroacupuncture and acupuncture are methods of physical impact on certain areas. They have a general strengthening effect and relieve neurosis.
4. Pine baths have a sedative effect on the central nervous system.

Trophostimulating methods include:

1. Rectal electrical stimulation is performed through the anus using an electrode. This procedure helps to get rid of stagnant secretions in the prostate, improve blood circulation in this organ and increase muscle tone.
2. Ultrasound therapy helps get rid of inflammation.
3. Peloid therapy (treatment using mud).
4. Ultratone therapy. The essence of the procedure is to affect the spine and groin area

To reduce the likelihood of delayed ejaculation, you need to lead a healthy lifestyle, do not abuse alcohol or smoke, play sports, and also promptly treat any diseases of the genitourinary system, in particular prostate diseases.

If a single ejaculation disorder occurs, you should not dwell on the failure, because this can become a reason for the development of a serious deviation in your sexual life.

Delayed ejaculation

Delayed ejaculation is a sexual dysfunction in men, characterized by difficulty in ejaculating. With delayed ejaculation, a man experiences sufficient sexual arousal and has a full erection, but stimulation of the penis does not lead to the desired release of seminal fluid for a long time after the start of sexual intercourse. Delayed ejaculation is accompanied by difficulties in achieving orgasm, physical and psychological dissatisfaction of partners. To find out the reasons for delayed ejaculation, a man may need to consult an andrologist, sexologist, psychotherapist, neurologist, endocrinologist; conducting ultrasound of the penis and scrotal organs, tests for sexually transmitted infections and hormones. The treatment algorithm for delayed ejaculation depends on the causes of the disorder and may include drug therapy, psychotherapy, and physical therapy.

Delayed ejaculation

Delayed ejaculation is an unconscious suppression of the ejaculation reflex, accompanied by a late release of seminal fluid or a complete absence of ejaculation in a man, despite the desire and desire of sexual partners to speed up this moment. Among other forms of ejaculation disorders (premature ejaculation, retrograde ejaculation, painful ejaculation), delayed ejaculation and anejaculation are much less common. According to statistics, delayed ejaculation affects 1-2 men out of 1000. Delayed ejaculation, as a sexual dysfunction, should be distinguished from the conscious, controlled inhibition of ejaculation practiced by some men. Due to the multifactorial nature of the problem of ejaculation disorders, its solution may lie in the area of ​​sexology, psychotherapy, andrology and urology, neurology, and endocrinology.

Causes of delayed ejaculation

Delayed ejaculation can be caused by psychological and organic reasons. In many cases, there is a combination of several factors, which requires the man to be examined by various specialists.

The organic basis for delayed ejaculation can be congenital defects and injuries of the scrotum and penis, genital infections, prostatitis, urethritis, prostate adenoma, urethral strictures, previous operations on the prostate gland (adenomectomy, transurethral resection of the prostate). In addition to diseases of the male genital organs, delayed ejaculation can be associated with neurological problems (stroke, diabetic neuropathy, Parkinson's disease, spinal cord diseases) and hormonal disorders (hypothyroidism, hypogonadism, etc.). Nerve damage, as a factor in impaired ejaculation, occurs after surgical interventions on the abdominal cavity and pelvic organs: proctosigmoidectomy, total cystectomy, resection of an abdominal aortic aneurysm, retroperitoneal and para-aortic lymphadenectomy, etc.

A factor inhibiting ejaculation may be a disproportion in the structure of the genital organs of sexual partners (a small penis in a man, a too wide vagina in a woman), accompanied by a decrease in mechanical stimulation of the penis during friction.

Psychological factors that cause delayed ejaculation may include depression, emotional stress, problems in interpersonal relationships between sexual partners, various kinds of sexual trauma, complexes and restrictions, and insufficient sexual attractiveness of the partner. In some cases, delayed ejaculation during normal sexual intercourse is observed in persons suffering from deviant sexual inclinations (homosexual, sadistic, masochistic, etc.). Men who have an “autosexual” orientation may suffer from delayed ejaculation, that is, they experience greater satisfaction from masturbation than from traditional sexual intercourse.

It should be borne in mind that delayed ejaculation can be a side effect of certain types of medications taken by a man (antidepressants, antipsychotics, antihypertensives, diuretics), as well as alcohol and drugs. In addition to the above-mentioned pathophysiological and psychogenic factors, the time of ejaculation is influenced by many other reasons - the man’s age, his sexual experience, the frequency and regularity of sexual intercourse, relationships with his partner, etc. In some cases, delayed ejaculation is a consequence of sexual fatigue associated with excessive sexual activity men and is temporary, transient in nature.

Classification of delayed ejaculation

Depending on the degree of the disorder, a distinction is made between delayed ejaculation and anejaculation, its extreme form in which ejaculation does not occur for such a long period that sexual partners are forced to stop sexual intercourse and further sexual stimulation. In addition to the absolute inability to achieve ejaculation, there is also relative anejaculation, characterized by the absence of ejaculation during sexual intercourse, but its achievement during petting, masturbation, etc.

Delayed ejaculation can be primary (accompanying a man from the moment of sexual activity) and secondary, acquired (occurring after a certain period of normal sexual life). Depending on the circumstances and frequency of repetition, a distinction is made between constant (independent of the situation and recurring regularly) and situational delayed ejaculation (occurring from time to time under certain conditions).

Symptoms of delayed ejaculation

The main objective sign of delayed ejaculation is prolongation of sexual intercourse against the wishes of partners and the desire to bring the moment of ejaculation and orgasm closer in a man. Moreover, 75% of men suffering from the impossibility of intravaginal ejaculation can speed up or achieve ejaculation through masturbation, and 50% through other types of stimulation with the participation of a partner, but outside of sexual intercourse. Standard criteria for the duration of sexual intercourse are very conditional and variable. However, delayed ejaculation is generally considered to be the absence of ejaculation for more than minutes after the start of sexual intercourse, if this causes physical and psychological discomfort in sexual partners.

At the beginning of a sexual relationship, delayed ejaculation may be perceived by the partner as a desirable moment, since increasing the duration of sexual intercourse allows her to experience several orgasms. Meanwhile, further awareness of the fact that a man cannot complete sexual intercourse replaces a positive reaction with a negative one, as the partner begins to feel sexually unattractive and unwanted in the eyes of her partner. If a couple strives to conceive a child, delayed ejaculation and anejaculation can become a reason for serious conflicts and even a break in the relationship.

A man suffering from delayed ejaculation is often inclined to see the cause of his problems in a particular woman, and not in himself, which increases mutual reproaches and complaints. As a result, both partners develop a hostile attitude, both towards sexual intercourse and towards each other.

Diagnosis of delayed ejaculation

The main task of diagnosis is to identify the causes of delayed ejaculation. To do this, if ejaculation is impaired, a man needs to consult a urologist, andrologist or andrologist-sexologist. After clarifying the medical history and examining the external genitalia, the specialist will decide on the appointment of tests, diagnostic studies and additional consultations.

To identify organic causes of delayed ejaculation, it is necessary to conduct a rectal examination, ultrasound of the penis and organs of the scrotum and prostate gland. In order to exclude STDs, prostate secretions, urethral smears are examined using PCR and bacterial culture. As part of the assessment of hormonal status, a study of the androgen profile (total and free testosterone, GSPS) is indicated. If there is evidence indicating concomitant pathology, a man suffering from delayed ejaculation should be consulted by specialized specialists - a neurologist, endocrinologist, cardiologist, etc. In the absence of organic and psychological causes, a psychosexual examination of the patient is necessary.

Treatment for delayed ejaculation

The approach to treating delayed ejaculation is always individual and depends on the identified disorders. It may include drug therapy for the underlying disease, psychotherapy, physical therapy, and treatment for alcohol or drug addiction. If ejaculation is delayed due to medication, the dosage of the drugs is adjusted or replaced.

If the delay in ejaculation is caused by psychogenic reasons, most likely the patient will need the help of a psychotherapist or sex therapist. To eliminate interpersonal problems, it is necessary to involve a partner in the treatment process. For pharmacotherapy of delayed ejaculation, dopaminergic (amantadine), antiserotonergic (cyproheptadine) drugs, calcium channel blockers (yohimbine), etc. are used. In addition to the main therapy for delayed ejaculation, acupuncture, laser puncture, electroacupuncture, peloid therapy, therapeutic baths (pine, iodine-bromine) are successfully used. , rising shower. To correct the neuroendocrine regulation of ejaculation, physiotherapy methods are used: transcranial electrical stimulation, electrosleep, galvanization of the collar and panty area, endonasal electrophoresis, rectal electrical stimulation, SMT, ultrasound therapy.

The success of treatment for delayed ejaculation largely depends on the willingness of both partners to cooperate with specialists and find harmony in sexual relations.

The period of puberty in girls is quite long - about ten years. It is characterized by the presence of several stages in the development of a girl’s puberty.

The onset of puberty occurs at the age of eight to nine years, which is characterized by accelerated growth in girls.

The appearance of further signs of puberty - enlargement of the mammary glands, growth of pubic hair - begins at approximately ten to twelve years of age.

On average, two years after the above external transformations, the first menstruation appears.

The final stage of puberty in girls is considered to be the age that occurs four to six years after the onset of the first menstrual bleeding. Typically, this occurs between the ages of seventeen and eighteen.

However, there are groups of girls who, due to their developmental characteristics, may begin puberty at the age of nine years. This means not only the accelerated growth of the body and its limbs, but the formation of secondary sexual characteristics - the development of mammary glands and so on. It happens that absolutely healthy girls begin to enter puberty at the age of seven or eight years, which is associated with the genetic characteristics of their development.

Also, the onset of puberty in some categories of girls may be delayed until thirteen to fifteen years of age. At the same time, girls are healthy and developing normally, and such delays in maturation are caused by hereditary factors.

Onset of puberty in girls

The onset of puberty occurs at the age of eight to nine years. This stage is characterized by a strong jump in the growth of girls, which can reach about ten centimeters per year. It happens that girls at this time are ahead of their male peers in height.

During this period of puberty, the skeletal system, muscular system and nerve endings grow at different rates. Therefore, outwardly, girls who have entered puberty may appear clumsy and awkward, somewhat angular.

Often, such changes in the figure cause girls suffering and fear that they will remain forever like funny grasshoppers. Parents need to reassure girls by telling them that their figures will soon undergo positive transformations.

Later, around the age of eleven to thirteen, secondary sexual characteristics begin to change rapidly - the mammary glands grow, the waist decreases, body shapes become rounded, and so on.

Age of puberty in girls

The age of puberty in girls is as follows:

1. The onset of puberty occurs around eleven to thirteen years of age.
2. The end of puberty occurs at the age of seventeen to eighteen years.

There are several categories of teenagers who do not mature at the same rate. Some girls begin to enter puberty earlier and, accordingly, end puberty earlier. Such teenagers are called accelerators. In them, the onset of puberty in the form of enlarged mammary glands is observed at the age of nine – ten to eleven years. And the growth spurt occurs approximately a year before. Accordingly, the appearance of the first menstruation in the above girls occurs at ten to eleven years.

In another category of adolescents, the onset of puberty is delayed until thirteen - fourteen - fifteen years. This manifests itself in growth retardation and the formation of secondary sexual characteristics. The first menstruation appears in these categories of girls at thirteen, fourteen or fifteen years. Accordingly, puberty ends at a later age, at eighteen years. Such teenagers are called retardants, that is, they are slow in their development, which is absolutely normal and genetically determined.

However, certain developmental anomalies and hormonal disorders occur in girls, which cause delayed puberty and the appearance of menstruation. Therefore, if there are no signs of puberty at fourteen to fifteen years of age and menstruation has not begun by the age of fifteen, it is recommended to show the girl to a gynecologist and endocrinologist.

Signs of puberty in girls

Signs of puberty in girls include the following:

• A sharp growth spurt - a girl can grow up to ten centimeters per year. At the same time, girls grow faster than their male peers. Differences in height are equalized at the age of seventeen to eighteen years, that is, by the end of puberty in girls. At this time, girls stop growing, while boys continue to grow.
• Changes in the figure of a teenage girl in the initial stage of puberty - an increase in the length of the limbs compared to the length of the body. Because of this, a change in the proportions of the body occurs, which leads to a visual impression of its awkwardness.
• Subsequently, secondary female sexual characteristics begin to form. First of all, the mammary glands begin to enlarge. Then, after some time, smooth pubic hair appears on the pubic area. After a short time, pubic hair begins to change in structure - it becomes wavy. The next changes in the girl’s body concern the appearance of axillary hair.
• The labia minora and labia majora increase in size.
• Soon the first menstruation occurs - menarche.
• Changes in the girl's appearance continue - the volume of her hips increases, her waist becomes thinner, her shoulders narrower, and her figure acquires rounded, smooth outlines characteristic of the female body.
• The amount of hair on the girl’s arms and legs increases, and they become darker.
• Hormonal changes occur in the girl’s body, as a result of which the appearance of her skin and hair changes. The activation of the sebaceous glands located in the skin begins. Therefore, the skin and hair take on an oilier appearance; The girl's face, neck and back begin to become covered with red pimples and blackheads.
• The overall percentage of body fat in a girl increases, and fat deposits are noticed mainly in the pelvic area, on the abdomen and thighs.

Stages of puberty in girls

The stages of puberty in girls are correlated with the appearance of each sign of puberty.

• A sharp jump in growth - in a normally developing girl, this increase in height occurs at approximately eleven years of age. If before this period, at approximately seven to eight years old, girls gain in height by five to six centimeters per year, then the entry into puberty is marked by a growth of eight to ten centimeters per year. At this time, the child grows out of recently purchased clothes and shoes so quickly that it surprises not only his parents, but also the girl herself.

At this time, the annual weight gain reaches four to nine kilograms, although before this period the usual weight gain averaged two and a half to three and a half kilograms.

An increase in growth affects the child’s appetite and the amount of food eaten, because such transformations require an increased flow of energy and building materials.

• Such changes can appear earlier, at about nine years of age in girls who develop earlier than their peers.
• Subsequently, the size of the pelvis and hips increases, which refers to the formation of secondary sexual characteristics. It happens that such changes occur at the age of nine years.
• Further changes in the girl’s body are manifested in the enlargement of the mammary glands. First of all, the nipple and areola around the nipple are enlarged. After six months to a year, the mammary glands become like small cones. At this time, it is not recommended to use a bra, which can stop the formation of mammary glands.
• Approximately, around the beginning of the first menstruation, the entire mammary gland increases in size and becomes round in shape, like the mammary glands of adult women. This usually occurs during the first period. It is at this time that it is worth putting on the first bras, which will facilitate the girl’s movement.
• At the age of twelve to thirteen, the formation of secondary sexual characteristics continues: hair grows in the pubic area and a waist is formed, characteristic of the structure of the female body. Primary sexual characteristics also develop - an increase in the external genitalia (labia minora and majora) occurs.
• Various skin changes occur due to the activation of sebum secretion. Such “innovations” are due to the process of hormonal and physical changes in the girl’s body. An increase in the amount of sebum provokes the appearance of red pimples on a girl’s skin and blackheads, and also causes increased oiliness in the hair.

Such changes do not at all please older girls, who are very worried about the deterioration in appearance that has occurred. Parents need to consult with hairdressers and cosmetologists about purchasing special shampoos and cosmetics for the skin, with the help of which they can maintain good condition of the skin of the body and hair, as well as maintain the external attractiveness of the girl. It would be a good idea to undergo special skin cleansing cosmetic procedures in a cosmetologist’s office. In addition, an older girl must be taught the rules of careful personal hygiene so as not to provoke deterioration of the condition of her skin and hair.

• The appearance of the first menstruation, called menarche. This fact means that the girl is already sexually mature, that is, capable of reproductive function. At first - for two years - the menstrual cycle is most often unsteady. This is manifested in an unknown rhythm of bleeding, as well as in its strength and duration. After menstruation becomes cyclical, we can say that the girl is ready to conceive and give birth to a child (but only from a physiological point of view, and not psychological and social).

As noted above, in the first two years, menstruation in girls has an undefined cycle, that is, deviations of a different nature appear. These features are not a violation of the girl’s normal development, but are considered fluctuations that do not go beyond the normal physiological stages of puberty. First of all, this concerns irregularities in the regularity of the menstrual cycle, which has two phases. During the period when menstrual bleeding has just begun, the primary eggs may not mature to the end, and therefore the separation of mature eggs from the ovaries does not occur. In this case, the formation of the corpus luteum either does not occur at all, or is underdeveloped, which does not stimulate the production of increased levels of progesterone in the girl’s blood.

The first phase of the menstrual cycle leads to increased growth of the uterine mucosa (endometrium), which occurs under the influence of estrogens. This provokes the appearance of uncomfortable and prolonged uterine bleeding, called juvenile bleeding. Approximately five to ten percent of girls experience similar manifestations.

Sometimes, periods may not occur every month, but at intervals of two to three months. Other disturbances in the cyclicity of menstruation may also occur, but such deviations, as already mentioned, disappear after a couple of years.

It is very important to prepare the girl for periodic bleeding before her period appears. It is necessary to tell the girl about hormonal changes in her body, that her body is already ready for reproductive functions. Such a conversation can be conducted by the girl’s mother and/or gynecologist. It is worth preparing the girl to accept the fact that menstruation is a common occurrence in a woman’s life. But if the bleeding is accompanied by pain and other unpleasant sensations that can disturb the girl and cause her inconvenience, you should definitely consult with a gynecologist.

It is also necessary to have a conversation with the girl about the dangers of early sexual activity and possible pregnancy in this case, which leads to tragic consequences at this age.

• Since the onset of menstruation, a girl’s height does not increase at an accelerated pace. At this age, on average, by the age of thirteen, the growth rate is reduced to one and a half to two and a half centimeters per year.
• At the age of fourteen to sixteen, a girl’s figure begins to take on feminine contours - in addition to the already grown breasts and thinning waist, the hips begin to round, the pelvis begins to grow, the shape of the legs changes, and so on. Hair appears in the armpit area. Menstruation becomes rhythmic. The development of the skeletal system and bone growth stops.

To maintain a girl's hygiene, it is necessary to teach her how to use a razor for women to shave hair in the armpit area. Pubic hair should not be removed, since at this age it is not at all necessary.

Early puberty in girls

Early sexual development is considered to be the appearance of secondary sexual characteristics and the appearance of menstruation (in some cases) in girls around ten years of age. Such manifestations in development, which are slightly ahead of the norm, are not considered a deviation or violation. Therefore, we can say that for some girls a slight advance in development is a variant of the norm. Such developmental features are observed in accelerated girls, who differ from their peers in early physical, sexual, psychological and emotional development.

Early puberty in girls should not worry parents. But in these cases, it is recommended to conduct special conversations that can explain to the girl the changes in her own body and teach her personal hygiene skills.

Premature puberty in girls

Precocious puberty is characterized by the appearance of a full set of secondary sexual characteristics (or some of them) in girls under eight years of age. Sometimes at this age the appearance of menarche - the first menstruation - is observed. There are several forms of premature puberty in girls:

1. True premature sexual development. This form of premature development is considered cerebral, that is, arising due to processes occurring in the brain. The early onset of puberty is caused by the early onset of activity of the hypothalamus or adenohypophysis, which are responsible for reproductive functions. The activity of these glands stimulates the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Activation of LH leads to the production of estrogen in the girl’s body, which leads to changes in her body due to puberty. The activity of FSH leads to the onset of growth and maturation of follicles in the ovaries.

True premature puberty has a number of features:

• isosexual in nature, that is, correlated with the female sex genetically and by gonadal characteristics;
• complete in its manifestations, that is, it is characterized by the presence of thelarche (growth of the mammary glands), adrenarche (appearance of pubic and axillary hair) and an acceleration in the rate of body growth.
• completed, that is, characterized by the premature appearance of menarche.

The causes of the cerebral form of true precocious puberty can be infections that were suffered by a girl under the age of one year. Such manifestations are also caused by organic damage to the brain, which puts pressure on the hypothalamus, as well as certain problems that arose during maternal pregnancy.

There is not only a cerebral form of true precocious puberty, but also a constitutional form. The latter form of deviation in puberty is more rare and is hereditary.

False precocious puberty

This type of premature maturation occurs due to the increased secretion of estrogens in the adrenal glands or ovaries. The use of drugs containing estrogens or gonadotropic hormones in the treatment of girls also provokes the appearance of false puberty.

The false type of premature development is characterized, like the true one, by the accelerated rate of growth of the girl. But false development is always incomplete, which is manifested in the absence of premature menarche. Also, false development can occur in both isosexual and heterosexual types.

Characteristics of the false isosexual type of development (female type):

• fast growth rate;
• mammary glands enlarge;
• hair growth occurs in the pubis, groin areas and armpits.

Characteristics of the false heterosexual type of development (male type):

• up to the age of eight, the clitoris enlarges, which begins to resemble the shape of a penis;
• hair shafts appear in the area of ​​the upper lip and chin;
• bones grow faster than in girls developing according to the isosexual type;
• the fat layer is distributed according to the male type.

It should be noted that the heterosexual type of development is quite rare and is caused by hormonal disorders in the body of girls who were administered androgen hormone drugs. If a timely visit to specialists occurs, deviations in the girl’s development can be reversed into a feminine direction. The use of the correct treatment method, which is carried out over a long period of time, can completely restore the correct sexual development of the girl. The mammary glands will form in due time, the menstrual cycle will be established on time. In the future, the reproductive functions of the cured girl will be preserved, she will be able to conceive and bear a child well, and also give birth normally. If treatment is neglected, then female-type development in such girls will not occur at all.

Incomplete precocious sexual development

This type of premature puberty is caused by the appearance of an excess of gonadotropic hormones in the girl’s body. A strong increase in estrogen can also lead to similar deviations in sexual development.

Characteristics of incomplete precocious puberty:

• not accompanied by accelerated growth rates;
• only the mammary glands are formed, without the appearance of other secondary sexual characteristics;
• Only hair growth appears in the groin, pubic and armpit areas without the formation of other secondary sexual characteristics.

Diseases of various types that provoke the appearance of premature sexual development. Such diseases include:

• the occurrence of follicular ovarian cysts,
• presence of ovarian tumors,
• the appearance of primary hypothyroidism,
• McCune-Albright syndrome,
• Russell-Silver syndrome.

Such diseases are characterized by the appearance of bloody discharge that resembles menstrual bleeding. But secondary sexual characteristics do not develop.

Movies about girls' puberty

It is recommended to watch films about girls’ puberty together with their mother or another adult woman who can explain to the girl any incomprehensible or confusing moments. Parents are recommended to watch the film themselves before watching it together with their child to make sure it is beneficial and does not contain footage or information that, in the opinion of mom or dad, is premature for their daughter. You should start watching such films at the age when the first signs of puberty appear in a girl, as well as when she develops an interest in such issues.

Films about girls' puberty are represented by the following documentaries and cartoons:

• A film about the formation and protection of the reproductive functions of girls “When a girl grows up...”, which won the main prize in the “Applied Animation” category at the Open Suzdal Festival in the city of Suzdal in 2003. The film was created with the support of the Russian Ministry of Health and the pharmaceutical company Gedeon-Richter.
• Documentary "Girl Power" from the Discovery Channel.
• Documentary film produced in Great Britain in 1998 “The Human Body. Puberty."
• Documentary film created in 2008, “About Sex - Puberty.”

A mandatory period of development for any boy is the age of puberty. If the teenager himself may not realize the importance of changes in his own body, then parents must clearly understand the responsibility of this period and be prepared for it.

Stages of Boy Development

Many parents believe that puberty in boys and their sexual development are equivalent concepts. In fact, this is a misunderstanding of the two terms, because in order to develop secondary sexual characteristics, the boy’s body must prepare, and this process is not that fast.

Doctors believe that puberty is the end of a boy's overall sexual development. There are the following stages of development, which have their own characteristic features:

1. Intrauterine. The beginning of this stage occurs at 12-16 weeks of intrauterine stay of the fetus, when its future gender is finally formed, that is, it is already clear who will be born - a boy or a girl. In the male fetus, it is during this period of intrauterine life that the scrotum and penis are formed. Before birth, the fetal testicles are located in the abdominal cavity, and descend into the scrotum after birth.
2. Childhood (age 9-11 years). External signs of puberty are just beginning to form, but during this period the pituitary gland, a gland that regulates many physiological processes, is already actively functioning. Parents consider the age of 9-11 years insignificant, but it is during this period that the boy needs to be told what pregnancy is, how children are made, and what sexual characteristics distinguish a girl from a boy.
3. Age 13-14 years. This is a very important period of sexual development, since it is now that the sex gonads begin to become active, the boy’s growth accelerates sharply, which means that androgen hormones are actively produced in the body. It is these hormones that lead to the development of secondary sexual characteristics - growth of the penis, enlargement of the testicles.
4. Age 17-18 years. For most teenagers, it is during this period that all stages of puberty are completed, but some boys can continue to grow until they are 20-22 years old - this is considered the norm. This age implies special attention to the teenager from the parents - it is necessary to explain to him the basic rules of social behavior of a man, teach him to take care of his appearance, and gradually instill a sense of responsibility for both his future and the future of the family as a whole.

Note:All stages of sexual development are very important and boys should never be left alone with their thoughts. Parents should take an active part in the development of a man, instill some important rules and social norms, explain the changes occurring in him physiologically .

Characteristic signs of puberty in boys

Active maturation in boys begins at 12-13 years old, but this is not a dogma! Some doctors believe that if boys experience early puberty, they will have a stronger sexual constitution in the future. Naturally, we are talking about natural manifestations, and not pathological ones, when the physiological process in question, which occurs at an early age, is caused by some kind of disease.

What will indicate puberty in boys:

1. At 11 years old (the age is indicated approximately, it all depends on the individual characteristics of the body) the boy's penis begins to enlarge– this is not noticeable, the growth of the penis is smooth. The average length of a boy's penis is 4 centimeters, but by the age of 14 he will be 7 cm long, and by the age of 18 - 10 cm. Parents should understand that these figures are not a standard and can vary significantly, so focus on they are not worth it.
2. Testicular development. They become somewhat larger and look absolutely proportional to the growing penis. Parents should remember that in men one testicle is always slightly smaller than the other, so do not be surprised by the disproportion.
3. Hair growth in the pubic area. In boys, by the age of 15-16 years, hair growth in this area is distinguished by a clear diamond shape, and by the age of 17-18 years, the development of hair on the lower extremities ends. In the armpit area, hair begins to grow at the age of fourteen; this process usually ends by the age of 17. The sign of puberty described in this paragraph is also very individual - millions of men live with “bare” legs and are absolutely healthy and happy.
4. Voice timbre correction. This is the so-called “voice breaking”, which begins at the age of 13-14, and the process of forming a constant timbre is completed at the age of 17.
5. Beard and mustache growth. The first vellus mustache appears in boys at the age of 15-16, but the beard begins its active growth only from the age of eighteen. But again, these figures are very conditional, because a lot depends on genetics and heredity. For example, it is well known that representatives of Caucasian nationalities can begin to develop both a mustache and a beard as early as 14 years of age.
6. Engorgement of the nipples. If in girls this symptom is intensely expressed, then in boys this change generally goes unnoticed. Doctors cannot indicate the specific age of a boy when nipple engorgement begins.
7. Maturation of germ cells. Spermatozoa in a boy are formed at the age of 14-15, but their development occurs gradually and continues almost throughout his life. At least during the period of male reproductive activity, they continue to form.
8. Pollutions. This is the name for the process of spontaneous ejaculation, which most often occurs at night. Parents should prepare the boy for wet dreams, talk about them and explain why it happens and what it means.

Separately, it is worth noting that as a boy reaches puberty, his appearance also changes - his shoulders become wide, but his pelvis remains narrow, and intensive growth of muscle mass and bones is noted. Parents often notice that the boy’s height has increased rapidly, by several centimeters at once.

During active puberty, quite a lot of sex hormones are released, so there is a change in the structure of the skin and the functioning of the sebaceous glands. The sebaceous glands produce sebum too actively, and this leads to the formation of pimples and blackheads. This sign of puberty often provokes the development of complexes in boys, so parents should be attentive to their own child, provide him with psychological support - success in a man’s life and the ability to believe in himself depend on this.

Possible deviations during puberty

The period of development of boys under consideration may also occur with some deviations.

Late puberty

In general, doctors' opinions about the age of boys when they should go through puberty differ greatly. But if a boy has no pubic hair at the age of 15, and the testicles do not enlarge until the age of 13, then experts talk about deviations in puberty.

Most often, this disorder of puberty in boys is provoked by:

• congenital chromosome abnormalities;
• endocrine diseases, which can be congenital or acquired;
• disruption of the gastrointestinal tract caused by severe pathologies;
• diseases of the vascular system and heart;
• with complications.

Questions about late puberty in boys should be asked to an endocrinologist - he will be able to find out the cause of this condition and take the necessary measures, if necessary - for example, hormone therapy. But statistically, boys still catch up and eventually reach puberty. However, in a situation of late puberty, parents should be tactful, talk to the child, justifying their attitudes (for example, “this happens” - provide the boy with articles on late puberty, some competent materials), and provide him with maximum attention.

If we are talking about some pathological reasons for the boy’s late puberty, then he will be given a full examination and medications will be prescribed. If there are genetic abnormalities, it is unlikely that it will be possible to correct the situation, but hormones prescribed by a specialist can speed up the process of puberty.

Early puberty in boys

Doctors make this diagnosis if secondary sexual characteristics begin to appear in a boy at the age of 10 years. Moreover, early puberty in boys most often has completely natural causes - for example, if his father had the same deviation, then it is inherited by his child.

If we consider the pathological etiology of early puberty in boys, then we will talk about endocrine disorders. If a boy develops a truly masculine appearance, then the genitals remain unchanged (that is, there is no enlargement of the testicles and penis), then this condition will be called false early puberty. This can be caused by a benign neoplasm located in the testicle or adrenal gland, and it is in these organs that the male hormones androgens are produced. In this case, the boy’s gonads will remain at the same level of development, but his appearance will change greatly.

If the doctor suspects a pathological etiology of early puberty in a boy, then a full examination will be prescribed - an examination of the pelvis and adrenal glands is carried out using a device, a brain examination is carried out using, and blood tests are collected to determine. Treatment of early puberty in boys involves the prescription of medications that can stop the production of sex hormones; in many cases, it is enough just to neutralize their effect on the body. If a tumor of the adrenal gland or testicle is diagnosed, it is advisable to undergo surgical treatment, after which the physiological processes of puberty are normalized.

Puberty of boys is a natural process for which parents, first of all, need to be prepared. Only they can provide psychological support to the child during this difficult period. Of course, you shouldn’t “overload” a teenager with information and constantly bring him into frank conversation - this will irritate the boy. But you will have to talk to him, or, as a last resort, provide him with already selected material that explains to the boy in an accessible language all the changes that occur in his body during puberty.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category