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WHAT TO EXPECT WHEN YOU'RE ADOLESCENT

NOT YOUR MOTHER'S GYNECOLOGIST

You're a New Kind of Girl—You Deserve a New Kind of Medicine

Casey,1 fifteen, a slender redhead with a sprinkle of freckles on her nose, was sitting next to my desk, twisting a strand of long, straight hair when I walked into my office. I could tell she was nervous.

"Hi, I'm Dr. Ashton," I said, sitting down at my desk. Since this was Casey's first visit, we were meeting in my cheerful office, not in an exam room. (After all, do you want to meet your doctor for the very first time in an exam room with your clothes off? I wouldn't either. So my patients meet me in their clothes, at my desk.) Casey looked startled when I introduced myself. "Really? No way," she burst out. Then she blushed. "Sorry, it's just… you don't look like a doctor." I laughed. I hear this all the time. Is it my blond hair? My leopard-print skirt and Tory Burch boots? Lucky for me, I didn't have to check my fashion sense at the door when they were handing out degrees at Columbia Med School. Or my sense of humor, either.

And it's a good thing, too. Without a sincere appreciation for a witty comment or the latest color in Uggs, my job wouldn't be nearly so much fun. I love the humor, the sass, the street sense, and the totally exhilarating energy of my teenage patients. Although I do treat adult women, too (often the mothers of my teen patients), I spend most of my time every day talking with, laughing with, and treating girls from their early teens to early twenties. That's what Casey and I did—talk and laugh. After a good chuckle over her confusion, we found ourselves talking about pretty much everything— why she'd come (bad cramps), her overall health (pretty good), and her life in general (crazy busy, with dance team practice, SAT prep courses, college visits, and a long-time boyfriend). The more we talked about her incredibly full life, the more Casey reminded me of something—the single most important thing I've learned from my patients. It's this:

It is much, much harder to be a teenage girl now than ever before.

Yeah, I know, the lonely-zitty-anxious-harassed teen years have never exactly been an all-expense-paid vacation to Hawaii. But it's tougher today than ever. Even tougher than when I was a teen (and that wasn't so long ago—really!). And also tougher, at least in some ways, than when your parents were teens. Sure, you've got your iPod, your cell phone, your computer. You can text your best friend about tomorrow's math test and check your new crush's Facebook page at the same time with one hand tied behind your back. You're smarter, more sophisticated, and way more connected than your parents were (or are). But you're also under phenomenal pressure—academic, social, physical, and sexual.

"You're supposed to get perfect grades, but even straight A's aren't enough to get you into a good college," Casey told me. "You're supposed to volunteer, play sports, and be a genius at something, like violin or math." Don't forget being pretty, popular, and fun. And talk about social pressure— who knows what your so-called friends might be texting about you at any given moment? Sure, social pressure's been around forever. But today it's nonstop, always-on, 24-7.

I asked Casey if she was sexually active. "No," she said. "But at school there's definitely pressure to dress sexy and act like you're having sex." Where does all this extra sexual pressure come from? Everywhere. One study showed that teens today may be exposed to twice as much sexual content on TV as they were even ten years ago. Another shows that the more sexy shows a teen watches, the more likely she is at risk of getting pregnant. Then there's music, movies, videos, and social networking sites— not to mention the fact that it just takes one click of the mouse for someone to e-mail a naked picture of you to a thousand of your closest friends.

On top of all that social pressure, there's this physical fact of life. Not only are girls dressing older and acting older but their bodies actually are older, in some ways, than they used to be. Just a decade or so ago doctors wouldn't have expected your breasts to start developing until age ten. Now we know that your breasts might start budding as early as age seven or eight.2 Meanwhile, if you're white, you're likely to get your first period about three months earlier than girls did forty years ago, and if you're black, it will come a good five to six months earlier than it did in the late 1960s. And two centuries ago girls hit puberty a good four or more years later than they do now.

We don't really understand all the reasons for the shift, but we do know that better nutrition and general health play a big role.

So with all this added pressure on you, are you getting lots of new information and new resources to help you deal with it all? Or a new level of respect for handling stress that previous generations just didn't face?

Yeah, right. In your dreams.

That's why I wrote the book. A new kind of teen—that's you—needs a new kind of doctor. That's me.

R-E-S-P-E-C-T

The way health, sex, and physical information is handled by schools, teachers, doctors, and even some parents, you'd think today's girls were living in a time warp. Sex ed is still taught exactly the way it was thirty years ago (often it's all-abstinence-all-the-time). Most parents still have a tough time talking with their daughters about their bodies: Many parents don't even know the right words for the female anatomy. (Not that I blame them—their parents never talked to them about their bodies.) Even doctors don't seem to want to talk straight with girls. Old-school doctors always seem to fall into two groups: the "Just-Say-No" group (as in "Can we talk about safe sex?" "No.") and the "Free Love" group ("Whatever you do is beautiful. Just use condoms.").

Come on, people! This is the information age!

If you ask me, both these approaches are disrespectful to girls. I believe in giving you all the information you need, at the right age, so you can make smart choices for your body and your emotional health. That doesn't mean I'd tell you it's OK to have sex at a young age: In fact, I'll tell you all the medical reasons why that's not a good idea. But I'll also expect you to use your own best judgment and I'll treat you accordingly, with respect for the choices you make.

To make those choices, you need the very latest research and information presented in a straight-up way. That's why I wrote this book. I'm not going to take sides or preach one school of thought over another. You're smart. You know how to get information and you know how to think. I'm going to give you the right information at the right time and let you make the choices that are right for you.

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