Umm Fulaanah: Doctor, please help me examine this girl. About 8 months ago, I noticed that her breasts were a bit bigger than usual. But I dismissed it because she has always been a robust child, just like her mother. Smiles. Then, last night I saw blood stain on her underwear. Could this be menstruation?
Dr. Fuleen: Hmmm… How old is Fulaanah again?
Umm Fulaanah: She’s 6 years old.
Dr. Fuleen: Maa shaa Allaah! Okay. How much was the blood? Did she give you any account of falling and injuring her private part?
Umm Fulaanah: No doctor.
Dr. Fuleen: Tell me more about this breast swelling. Is it painful to touch? Any discharge? Have you noticed some hair growing around her genitals or armpits?
Umm Fuleen: It’s not that big and it’s not painful at all. No discharge either. Yeah, I also saw a few strands of hair on her pubic area and armpits while bathing her.
Dr. Fuleen: I’m sorry to ask this sensitive question… But did she mention about anyone touching her in a sexual way?
Umm Fulaanah: Nothing like that doc. I keep a close watch on my children and she never mentioned anything like that.
Dr. Fuleen: OK. I’ll have to examine her carefully from head to toe. Can I go ahead?
Umm Fulaanah: Of course, please do.
*10 minutes later*
Dr. Fuleeen: Ummu, I’m sorry to inform you that Fulaanah has a condition called PRECOCIOUS PUBERTY. This is when a child begin to mature into an adult at an earlier age than his/her peers – less than 8 for girls and less than 9 for boys.
Umm Fulaanah: SubhaanaLlaah! Tell me more doc. Is there a treatment for this?
Dr. Fuleen. Actually, the good news is that the condition can be managed. But first, we need to run some blood tests and scans to rule out the cause of the condition. In most cases, it is due to the production of “sex hormones” from the brain earlier than usual. Other rare causes include tumour of the ovaries, adrenal gland or brain, which could be producing large amounts of hormones.
Umm Fulaanah: Now you’re scaring me doc! You mean she could have a brain tumour?
Dr. Fuleen: No ma’am. That’s very unlikely. Like I said, most cases are due to early onset of sex hormone production which is normal at age 8-9 but just coming too early in Fulaanah. The treatment is mainly to give some medications which will suppress these hormones and delay puberty until the appropriate age.
Umm Fulaanah: I see. What about the bleeding? Are you saying it is menses? Can it be delayed too?
Dr. Fuleen: Yes ma. The menses can be suppressed. The treatment will also allow her to keep growing taller like her mates. One of the complications of precocious puberty is short stature, because the sex hormones allow the bones to develop too fast and stop growing earlier than normal.
Umm Fulaanah: So when can she start the treatment?
Dr. Fuleen: She should start as soon as we complete the tests. A team of specialists will be involved in her case. There are two options for the medication – monthly injections or an implant into the skin that can stay up to a year. The latter is more convenient than the former, but more expensive. We also need to follow up with her and offer lots of emotional and psychological support. She needs more protection now than before, to guard her against sexual harassment, etc.
Umm Fulaanah: Okay doc. Thanks so much for your time. Ermm.. One more thing… I hope this will not affect her reproductive system or fertility later on?
Dr. Fuleen: Very unlikely. Once we stop the treatment, puberty should resume within the next one to two years. As long as the test results show no secondary underlying problem, she will be fine and lead a normal life in shaa Allaah.
Umm Fulaanah: Alright doc. JazaakiLlaah khairan…
PS: Fulaanah was treated successfully and she’s doing fine now.
Precocious puberty is not a licence for sexual debut. Let the girl enjoy and complete her childhood!