Healthy sexuality includes an understanding of how the body works, and how to take care of it. When youth understand their sexual development they can build the confidence and motivation to enhance their health and the skills to avoid negative outcomes.


Puberty is part of sexual development. It is the process of a child growing and maturing into an adult. Puberty is sometimes called adolescence and people going through puberty are sometimes called adolescents.


Puberty changes are triggered by the increase in the production of sex hormones that are sent around the body. When this starts is different for everyone; it can start as early as age 8 and go until age 20. Everyone is unique and will follow the timeline set by their own body. These changes happen slowly and take several years to complete.



Why does it all have to be so hard? I have enough on my plate right now after leaving home and now problems down there! I’m just not sure that everything is normal. I know I’m circumcised so I guess that may affect my size. What is the right size penis anyway? I’m going to have to talk to someone but who will even listen?



Still no period! I know I’m not pregnant ‘cause I haven’t had sex in six months. So what’s going on? I’ve been getting my periods since I was 12, so you’d think that they would come regularly by now. One of the girls at the shelter said that stress and even not eating well can affect your period, so I guess that could be the reason. But what if there’s something really wrong with me?




Talking about anatomy, physiology and sexual development in terms of people, parts and processes is more inclusive, accurate and clear than separating information about puberty based on assigned sex (female and male) or gender identity (girl and boy). It also helps make sure that all youth are included in the discussion, including trans, non-binary and intersex youth. The language used on this page might serve as example of inclusive language scripts fro parents and professionals.



When people think about puberty, they often focus on the changes that happen to the body. Although these are the easiest to recognize, puberty also has social and emotional changes. Social and emotional changes are often the changes that youth need the most help understanding and the most support coping with.


These changes are triggered by both physical development of the brain and body as well as changes in the socio-cultural expectations. For example, the mood swings might be caused by hormone changes, but they are also affected by the expectations from parents and changes in friendships.

The emotional and social changes youth experience during puberty tend to be intertwined and include:


  • Want more independence
  • Having stronger feelings of wanting to feel liked and fit in
  • Friendships become more important
  • Friends and friendship groups may change
  • Peers and media have greater influence on values and behaviors
  • Sometimes feeling lonely and confused
  • Thinking more about appearance
  • Becoming more self-conscious
  • Mood swings
  • Starting to have sexual thoughts and feelings
  • May get crushes and become interested in having a romantic partner (boyfriend, girlfriend)
  • Expectations from and about parents and school may change
  • Thinking more about the future




There are myths related to gender stereotypes about who is affected by emotional changes more. For example, it is a myth that girls in puberty think more about their appearance and that boys want more independence. It is important to challenge these gender stereotypes and replace the myths with accurate information such as “different people may experience these changes in different ways”.



Because of the connection between mind and body, social and emotional health is supported by healthy living choices such as getting enough rest, good nutrition, regular exercise, avoiding substance use and adequate hydration.


In addition, it is important for youth to be taught skills related to support healthy:


  • Self care and living skills
  • Self-esteem and body image
  • Relationships, communication and boundaries
  • Values and identity development
  • Management of emotions
  • Risk taking
  • Connections to community and health supports




Although media reinforces the idea of “teen angst”, it is important to know that depression is a medical condition and is not a normal part of puberty. Adolescence is often when symptoms of mental illness begin to appear, so if a youth is showing signs of depression, anxiety or psychosis, it is important to support them to access health care. Early intervention tends to result in improved health outcomes for those living with mental illness.



Physical changes often impact the social and emotional well-being of youth so healthy management is important. As with the social and emotional changes of puberty, most of the physical changes happen to everyone, regardless of their assigned sex. These changes include:


  • Growing taller
  • Having temporary period of increased awkwardness/clumsiness
  • Voice changes
  • Skin and hair getting oily
  • Pimples, blackheads, acne
  • Increase in the amount and courseness of body hair (legs, underarms, chest, back)
  • Genital hair growth (pubic hair)
  • Increase in sweating, especially feet and armpits
  • Changes to body odor
  • Breasts changes (may include swelling, tenderness, temporary or permanent development)






Hormone fluctuations cause everyone to have some breast changes during puberty. For youth assigned male at birth, these changes are typically temporary. For those assigned female, some of the changes are temporary (tenderness, hardness under the areola) while breast size and shape changes are lasting. Both during and after development, it can be common for one breast to be a different size or shape from the other.

People assigned male at birth will generally experience these changes in puberty:

  • Increase in the amount and coarseness of facial hair
  • Widening of shoulders
  • Sperm production
  • Penis and testicle growth
  • Increase in erections, including unexpected erections
  • Ejaculation of Sperm
  • Wet dreams


People assigned female at birth will usually experience these puberty changes:

  • Lasting breast development
  • Hip widening
  • Increase in vaginal fluid
  • Vaginal development
  • Ovulation
  • Menstruation

Some physical changes don’t happen to everyone, but are based on a person’s reproductive anatomy.






Youth who identify as a gender other than their assigned sex may find some puberty changes especially challenging.

Before puberty, children’s bodies don’t have publicly visible differences based on assigned sex. Puberty changes can make gender expression and self-acceptance more challenging for some trans or non-binary youth. Some youth who are transgender may benefit from medical interventions that can delay puberty changes. Transitioning can be more difficult after the physical changes of puberty have occured.

All youth, including trans, non binary and gender creative youth need support accessing the services they need to feel great about, and take care of, their body.


Managing the physical changes of puberty tends to be about understanding anatomy and physiology, acquiring hygiene skills and learning about one’s own body.

Self-care and Screenings:


As the body matures, it becomes more important for youth to get to know what is normal for all parts of their body and where to go if they notice changes. This includes getting to know what their breasts and genitals look like and checking them regularly. It is important to see a health care provider if a person notices any sores, lumps, rash, irritation, unusual discharge, foul smell in any part of the body, including the genitals, if it hurts or bleeds to pee or if they are feeling pain or are having other concerning symptoms.


Yearly check-ups continue to be an important part of healthy development throughout life. Puberty is a good time for parents and professionals to teach youth about:


  • How to find health care services like a doctor, counselor, optometrist and dentist.
  • When and how to make an appointment.
  • How to prepare for a health care appointment.
  • How to ask questions and remember information at a health care appointment.

For ideas and suggestions on how to talk to a health care provider about sexual health, see:





Having a complete health-check up at least once a year is an important part of getting and staying healthy. This can be a challenge for youth who have barriers to accessing health care or are uncomfortable talking to health care providers. One way you can reduce barriers to health care is to help youth get access to a copy of their provincial and other health insurance cards and encourage them to carry it with them at all times. Howe else can you support youth to feel more comfortable using health care services?


When youth see a health care provider regularly, such as every year, the health care provider can support them in understanding current screening guidelines. This is especially true for youth who are sexually active. Sexually active youth may need to have pelvic exams and STI screenings.






Cancer screening guidelines and recommendations have changes significantly in recent years. It is now recommended that a person have their first Cervical Screening (pap test) at age 25 or 3 years after first sexual activity (oral, anal, vaginal sex or genital touching by another person) whichever comes later. For testicular and breast self-exams, youth are simply encouraged to get to know what their testicles and breasts look and feel like, reporting any changes to a health care provider.

Skin, Hair and Body Odor Changes:


Increased sweat and oil production as well as changing hormones can cause changes in body odor. It can also result in blocked pores on the face and body that can lead to pimples, zits and acne and can make the hair look very oily. For adolescents to look and feel their best, it is important that they:


  • Maintain healthy living choices such as managing stress, getting enough rest, good nutrition, regular exercise, adequate hydration and avoiding substance use.
  • Wash their face, feet, and armpits every day with mild soap and water.
  • Wash the genitals and genital area, anal area (bum crack) every day with unscented mild soap and water. People do not need to wash inside of their vaginas. If a person has an uncircumcised penis, once the foreskin is able to be gently pulled back, the person does that to gently wash the glans (head of the penis). It is important not to force back the foreskin.
  • Wear clean underwear and socks daily. Many people in puberty also notice they need to wear a clean shirt and pants daily too.
  • Wash pillowcases, hat and hair accessories often.
  • Was their hair regularly. This means something different for everyone. Some people wash their hair every day or 2. For some people, daily hair washing would be too much can cause their hair to brittle.
  • Remember that using harsh cleansers or washing the face and hair too often, can actually lead to more oil production or damage to the hair and skin.
  • Talk to a health care provider if they are having severe symptoms, like bad acne. There are many medical interventions that can help.


Some people use antiperspirant or deodorant to deal with armpit sweat and smell. Some people do not. They may use baking soda, cornstarch or just wash their armpits regularly.


Increased body hair is managed differently by different people, families, cultures and faiths. For example, in some cultures, body hair is removed regularly; in others, body hair is left in place. Body hair removal is not needed for hygiene or health reasons. If a youth chooses to remove body hair, it is important that they learn safe ways to do so. This is especially true for pubic hair removal.

Penis & Testicular Changes:


During puberty, testicles grow and begin to make to sperm. Sperm is a sex cell that, when joined with an egg, can create a pregnancy. Sperm is stored in the epididymis, a tube-like structure at the back of the testicles.


Around the same time, the penis starts to grow and gets more erections.Many people wonder about penis size, partly because media tends to exaggerate both penis size and the importance of penis size. It is important that youth know that penis size is not related to the ability to receive or give sexual pleasure or create a pregnancy. The penis continues to develop throughout puberty. In adulthood, the average penis size is around 5″ when erect. Penises come in many shapes and sizes. Everyone is different, so a penis that is larger or smaller is still normal. Using pills, creams, or devices to enlarge the penis can cause serious harm and are not recommended for anyone, especially youth.


An erection is when the penis fills with blood and becomes hard. This allows for some types of sex. Sometimes erections happen when a person has a sexy thought or feeling, or the genital area is touched. Sometimes erections happen unexpectedly, like at school or during sports. Baggy clothes, sitting down and wearing appropriate sports equipment can all help hide an erection. Staying calm and thinking about other things can help the erection go away more quickly.


Sometimes when a person has an erection, if they masturbate, they may ejaculate. Ejaculation is when semen is released from the penis. Semen is made when the sperm from the epididymis is joined with special fluids from the prostate and seminal vesicles. Semen is a sticky, whitish fluid. About a teaspoon of semen is ejaculated.


People often get erections at night when they are sleeping. Many people have an erection when they wake up and will have to wait for the erection to go away before they can urinate (pee). Sometimes people ejaculate when they are sleeping. This is called a nocturnal emission or having a wet dream. If someone has a wet dream, it is important to wash bedding or pajamas the next day if semen got onto them. Learning how to do laundry can help with managing wet dreams.






Circumcision is when the foreskin is removed from the penis. Some people are circumcised, others are not. Circumcision is a personal choice that parents make and is generally not considered medically necessary for health or hygiene. Circumcision is an important part of traditional practice or ceremony of some cultures and faiths.

Vaginal, Uterine and Ovary Changes:


When puberty starts, the vagina can start to make more vaginal fluid or vaginal discharge. This normal body process helps the body keep the vagina clean and healthy. Vaginal fluid can be clear or whitish; slippery, sticky or even a bit creamy. The amount and consistency changes slightly throughout the month. Significant changes in color, smell, amount or texture can be the sign of a problem, so if a person notices that, it is important for them to talk to a health care provider. When a person is having a sexy thought or feeling, vaginal fluid increases.


People are born with all the eggs (ova) they will ever have. These are stored in the ovaries. During puberty, hormones trigger the ovaries to mature a few of the eggs. While this is happening, the lining of the uterus builds up with blood and tissue. Once mature, the ovaries release one or more mature eggs into the fallopian tube. This is called ovulation. If that egg is fertilized by a sperm, the fertilized egg would travel to the uterus and implant into the built up lining. If that egg is not fertilized, it dissolves in the fallopian tube, triggering the lining to shed from the uterus through the vagina. This is called having a period, or menstruation.


This whole process is called the menstrual cycle. People usually start their first menstrual cycle sometime between the ages of 8 and 16. The time it takes to go through the cycle is measured from the first day of the period to the first day of the next period. This usually takes between 20 and 40 days. The period part of the menstrual cycle usually lasts 3-7 days. People go through the menstrual cycle and get periods until they are about age 45-55. Then, they stop getting periods and are in menopause.


Having a first period is a sign that a person is now releasing mature eggs and is a reminder that the body is now capable of becoming pregnant. Getting other signs of puberty, like increased vaginal discharge, breast changes and pubic hair growth, usually shows that the person is getting close to having their first period. These other signs are a good reminder for the person to start carrying a pad in preparation.






A youth can get pregnant before their first period. If someone is sexually active around the time of their first ovulation and a sperm fertilizes that first egg, it could result in a pregnancy instead of a first period. Some people ovulate a month or two before their first period.




Youth may worry that they will get their period at school or that when they get their period, blood will suddenly come rushing out. It can be helpful to let youth know that periods usually start slow, with their first sign being a small smear of blood on toilet tissue or underwear. They need to know where and how to get menstrual products, how to use them, what to do if they don’t have one handy and to not flush them down the toilet. It is important to always use unscented menstrual products..

Having a period is a normal healthy part of growing up.

Most people feel and act the same when they have their period as when they don’t have their period. People can exercise, shower/bathe, and go to school when they have their period. If they use a tampon or menstrual cup instead of a pad, they can swim during their period. Someone can choose what menstrual supplies they feel most comfortable with.

  • Pads and pantyliners are absorbent items that are applied to underwear and catch menstrual fluid as it leaves the vagina. They can be disposable or reusable and need to be changed often to avoid leaks and unpleasant smell.
  • Tampons are absorbent items that are inserted into the vagina to absorb menstrual fluid before it leaves the vagina. These items may come with or without an applicator. To avoid a potentially serious infection called Toxic Shock Syndrome (TSS), tampons need to be changed frequently, as directed on the package (usually at least every 4 hours in a day; some tampons can be left for up to 8 hours at night). If a person has an intact hymen, using a tampon for the first time can be a bit tricky. It can take patience to gently stretch the hymen enough with the tampon applicator to allow for insertion.
  • Menstrual cups- are special plastic or silicone cups that are inserted into the vagina and catch menstrual fluid as it leaves the uterus through the cervix. These are usually reusable. These can be left in safely for up to 12 hours. At that time, or before if full, the person carefully removes the cup, drops the contents into the toilet, washes the cup and re-inserts it. There may be some disposable menstrual cups available in some areas.

Some people have minor body changes before or during their period, like light cramping, mild headaches, tender breasts or a bit of bloating. Stress, diet, weight loss or gain, birth control and pregnancy can all affect the menstrual cycle as well. Healthy living strategies like getting enough rest, stress management and regular exercise can reduce uncomfortable symptoms of periods. For some people, periods can be painful and more difficult to manage. Difficult periods can be a sign of a problem.


Reasons to talk to a healthcare provider include:


  • Severe headaches or nausea
  • Periods that last more than 7 days
  • Changing a pad or tampon every 1 to 2 hours or have lots of blood clots
  • Bleeding between periods
  • Missing a period when sexually active or missing several periods when not sexually active
  • First period before age 8 or not having a period by age 16






Some youth use over the counter pain medication to manage menstrual cramps. It is very important to help youth understand that is it important to use any medication exactly as instructed by a health care professional or on the package. Over the counter pain medications are not always effective for some people. If a pain medication does not work at the recommended dose, increasing the dose does not tend to work either and can cause serious health risks.


Beyond the Basics: a resource for educators on sexuality and sexual health.


Alberta Health Services – Teaching Sexual Health:  www.teachingsexualhealth.ca


KidsHealth from Nemours:  www.kidshealth.org