Puberty

 

Puberty is defined as “the condition of being or the period of becoming first capable of reproducing sexually that is brought on by the production of sex hormones and the maturing of the reproductive organs” (Merriam-Webster.com, 2017). In girls, sexual maturity is defined by regular menstruation and the development of breast tissue and averagely occurs after the age of ten years; however it can occur earlier in some girls. Puberty, if it occurs in the normal range, is barely medicalised however the contraceptive element and sexual health sides continue to be heavily monitored to deter deviance. However, the focus of this piece will be on the medicalisation of puberty, more specifically that of precocious puberty and gonadotropin-releasing hormone agonists treatment, hereafter referred to as GnRHas.

Case Study: Early Puberty, Medicalisation, and the Ideology of Normality by Peter Hayes

 

Case study overview:

The case study chosen to best illustrate the ways in which Illich’s theories of medicalisation can be applied to puberty is the Early Puberty, Medicalisation and Ideology of Normality, written by Peter Hayes. The case study focuses on the medicalisation of deviant bodies, specifically that of girls experiencing early or precocious puberty and the way in which it is treated in order to be normalised. Firstly, precocious puberty is used to describe puberty which happens before the age of eight years and can occur in any child; however, Hayes’s work concentrates mostly on the effects felt by girls who undergo the recommended GnRHas treatment.

GnRHas treatment is prescribed to young girls experiencing precocious puberty between the ages of eight years and eleven years and is used to halt the further development of breast tissue, halt menstruation and delays the production of sex hormones. The use of GnRHas is first recommended in the work of Comite, Cutler, Rivier, et al. (1981) who believed that the use of GnRHas allowed girls experiencing precocious puberty extra time to grow before height could be stunted by achieving sexually maturity, as well as making argument that it would also prevent “adverse psychosocial effects” (Comite et al., 1981: 1546). However, as Hayes goes onto explain, the use of GnRHas was criticised very early on due to the failure to recognise the possible side-effects to the drug and the suggested need for height therapy was weak at best.

The medicalisation of female height has existed since the 1940’s wherein taller girls were given oestrogen to reduce their final height (Lee & Howell, 2006). This need to medicalise height, it can be argued, can be attributed to nothing more than creating cosmetic norms for the female body and the medicinal management of puberty in girls further illustrates Illich’s theory that medicine creates norms and is often used to supress deviant bodies. Furthermore, the links between GnRHas treatment and increased final height in girls has been heavily criticised due to the lack of strong supportive evidence despite numerous trials and in 1992 two small randomised control trials reported no significant difference in final height between girls treated with GnRHas and those who were not experiencing signs of puberty between 7.5 years and 8.5 years (Bouvattier et al., 1999; Cassio, Cacciari, Balsamo, et al., 1999). However, despite the lack of supporting evidence, medical professionals boasted of the success in treating final height with GnRHas, this in turn feeds into the theory of disease mongering where in medical professionals exaggerate the risks of non-threatening diseases or bodily processes, such as puberty, and creates a need for medicalisation of these natural processes.

In addition to this, once the failure to increase final height was acknowledged, the marketing of GnRHas focused instead on the adverse psychological effects that young girls (and their parents) who experience precocious puberty can be at risk of developing if left untreated. This is yet another act of scare mongering encouraged by the medicalisation of a natural process and feeds into the ‘risk society’ theory, which ultimately leads to further medicalisation and medical surveillance of young girls. The argument made for using GnRHas to treat adverse psychological effects centres around how young girls will feel if they are more developed than their peers, identifying girls who experience precocious puberty as having deviant bodies. Alongside this, it is implied that girls who develop earlier are more likely to engage in sexual activity younger as well as develop other unfavourable behavioural traits (Hayes, 2015). Much of the reasoning behind prescribing GnRHas plays on parental anxiety, further by cross sectional correlations between early puberty and a younger age of sexual activity, coupled with the increased risk of sexual abuse, and an increased incidence of drug taking and drinking (Kim & Lee, 2012). In direct contrast to these proposed risks to girls experiencing precocious puberty (and suggested early sexual debut) , “Sexually precocious males are often perceived as more mature, attractive, and smart, and are often given more leadership roles than later developing boys” (Brown et al., 2013: 108) It can be argued that these deviations in attitudes towards the early sexualisation of boys compared to girls feeds into social norms of female sexuality, clearly showing a negative bias towards the sexualisation of women.

Furthermore, Hayes’s study debates the use of GnRHas to treat these adverse psychological effects as there is limited evidence to support the claims that medicating these girls is better than educating them. Psychosocial aspects of developments in girls concerning sexuality and development should not be a strong indicator for the need of GnRHas as the support and care each child receives differs from family to family (Roberts, 2013). By continuing to medicalise precocious puberty and female sexuality, female bodies remain “deviant” and so the cycle continues.