ARRESTED DEVELOPMENT

Being a pre-teen is a great period in a child’s life. They are growing up and gaining independence within a sheltered environment. The young ones are finding their personalities, gaining a deeper appreciation of friendships and beginning to appreciate the gender differences.

Alongside the important feeling of being a little ‘adult’ who can go for chaperoned school trips and church camporees, the young girls begin to have a sneak peek of what awaits them in womanhood. Thelache comes knocking around this time. This is the beginning of the development of breasts in the young female, which is not yet accompanied by other signs of puberty. This happens after eight years of age but most commonly around 10 to 11 years.

The female growth spurt begins and the young girls will markedly start getting taller and shed off any residual baby weight they may still be harbouring. They become more fashion-conscious, more aware of their world and more responsive to their environment. However, unlike their teenage counterparts, they but would mostly retain their childlike innocence.

All these changes herald the impending teenage when the more obvious signs of sexual maturation set in. Most adolescents will start their menstrual periods between 12 and 15 years but it is no longer uncommon to find a menstruating pre-teen.

The story was quite different for Charleen*. She thought her single mom was overreacting when she brought her to my office because at seventeen, Charleen was yet to experience menarche (first menstrual period). Charleen, a lanky teen, was too busy playing basketball for and swimming for her school teams to give it a thought. She was just happy never to miss a tournament because of periods.

She stood at five feet and eight inches and weighed 69kg. Casually dressed in jeans and a tee-shirt, she easily fit in with her agemates at the mall without raising an eye. But her mother was convinced that all was not well in Charleen’s development.

Like every teenager visiting a gynaecologist for the first time, it took a while to get her at ease before she opened up. Since she did not find anything wrong with her delayed menses, she seized the moment to point out that her mother was probably the one in need of a consultation.

Eventually, Charleen was at comfortable enough to get onto the examination couch willingly. A thorough examination revealed that Charleen’s mother probably had a good reason to be duly concerned in this particular case.

Underneath her teenage gear was the body of a pre-teen. She was absolutely untouched by adolescent development, save for the enviable height. In her world, time had frozen at ten years. Her breasts were prepubescent, she had no axillary or pubic hair and she had maintained the narrow, boyish hips.

This was the start of a long journey for the small family. Further tests done revealed that though genetically, Charleen was a classic female bearing the XX chromosomes, a developmental anomaly had left her without the upper third of the vagina, the uterus and fallopian tubes. She had very small rudimentary ovaries that had obviously failed to assure normal development of female sexual characteristics.

Charleen was never going to experience menses, pregnancy, childbirth or breastfeeding. At seventeen, few girls are too concerned about having babies. She was not duly bothered by her incapacity to produce an heir to her small family. She was quite happy to skip the whole hulabaloo of menstrual periods as witnessed among her peers.

Her mother on the other hand was distraught. She could not comprehend how she had been robbed of an opportunity to become a grandmother. Having lost her husband at a very early age, while pregnant with Charleen, she had remained focused on raising her and empowering herself economically at the detriment of ever expanding her own immediate family. She had banked on many grandchildren to fill that gap.

Fate had dealt her a nasty blow. She felt that her dream as a happy grandmother had been shattered irreversibly. She bitterly blamed herself for Charleen’s predicament, thinking that this could have resulted from improperly caring for her pregnancy. It took months of intense counselling to accept that there was nothing she could have done to change how Charleen was. She needed to be strong for her daughter when the magnitude of her condition finally set in.

Exposure to toxins very early in the pregnancy, infections and chromosomal ‘accidents’ in the forming baby are some of the possible causes that may have resulted in Charleen’s state.  At seventeen years of age, Charleen needed a way forward that was safe and acceptable to her. She would need hormone replacement therapy to protect her bones from early onset osteoporosis and to protect her from cardiovascular diseases.

New advances in the field of fertility have provided hope for young women like Charleen. She can be a mother through the use of donor eggs and her spouse’s sperm, carried by a surrogate mother. This would probably help save her mother’s dream.

However, for Charleen’s future parenting consideration to be realized, our country needs to urgently address the gap in legislation on assisted reproductive technologies. An attempt at legislation died with the last parliament, leaving everybody involved vulnerable.

The parents seeking a baby through surrogacy can easily be accused of a crime. The surrogate mother will not be spared either while the specialist doctors performing the procedures are instantly turned into criminals. This has been well demonstrated in the recent case in a Mombasa court citing child trafficking.

We have four years to go. Over to our legislators, the ball is in your court!