This is a conversation I had with a nurse on my HMO's message board. Do you think she's being reasonable, from the point of view of one who does not unconditionally trust the medical profession?

Personally, I get the feeling that she's being inflexible, subscribing to the viewpoint that all women should menstruate. For example, when she said "Hopefully, she will start menstruating on her own and she won't have to make this decision", I read that as "and she won't have the option of making this decision".

It's not related to castration, although I think there are similarities.

---

happousai:

I know a 16-year old girl, who has never menstruated before. Her

mother is concerned and wants her to go to a doctor to have it

checked out. But she doesn't want to, because she's afraid that the

doctor will make her start menstruating.

She thinks menstruation is gross, and says she doesn't want to have

kids, so why should she go through the trouble of menstruating.

Should she go see the doctor? What can she expect to happen if she

sees the doctor?

KPBetsRNC:

Hi happousai- There can be any number of reasons for the delay in

menarche (starting periods). If hormone tests and anatomical review

show no problems, she just may be delayed in starting her cycles,

and there is nothing to worry about. But if a problem is discovered,

it could be corrected sooner rather than later.

happousai:

But if she goes to see the doctor, would he view her amnorrhea as a

problem to be corrected?

Because she would prefer that she never menstruates.

KPBetsRNC:

Hi happousai- It would only be considered a problem if they found a

problem causing this. She may just be a "late bloomer", but it's

worth investigating. If she "never" menstruates, she may have

difficulty getting pregnant in the future. I know that's not a

concern for her now, but wouldn't she like to know if there might be

something wrong? Does anyone else have experiences to share?

happousai:

> If she "never" menstruates, she may have difficulty getting

> pregnant in the future.

She does not intend to get pregnant in the future. I consider her to

be a very bright girl. Although she is only 16 years old, she is

already attending university. So, I place much confidence in her

stating that she never wishes to have children.

> I know that's not a concern for her now, but wouldn't she like to

> know if there might be something wrong?

Well, she recognizes that primary amnorrhea may be a symptom of some

problem with adverse health implications (such as osteoperosis). If

she has such a problem that can cause adverse health risks (other

than infertility), then she wants to get that fixed.

But she is not willing to go to the doctor unless she's sure the

doctor would not force her to menstruate. It's fine if he has to

correct a problem that would impact her health, but she doesn't want

him to make her menstruate just because it's normal for women to

menstruate. (She tells me that just because something is normal,

doesn't mean it's good. For example, if she were normal, she would

enduring high school right now instead of going to university.)

All the literature that I and her have read online regarding primary

amenorrhea talks about what the doctor will do to make menstruation

start, which is exactly what she doesn't want! She is very surprised

that apparently, not menstruating is not even mentioned as an option

in those webpages. So she is afraid if she goes to the doctor, he

will try to make her start menstruating against her will.

Oh, another complication here: Her mother doesn't trust her decision

to never get pregnant, and wants her to have normal periods.

...So, the question boils down to: If she goes to the doctor to have

her primary amenorrhea checked out, can she be assured that he will

not force her to menstruate, even though she's a minor and her

mother wants her to menstruate, and even though the standard

treatment for primary amenorrhea is to try to induce normal

menstruation?

KPBetsRNC:

Hi happousai- As bright as this girl is, her maturity level is not

at the point where she can make the decision now that she will not

want children in the future. I know "bright" 40 year olds who make

that decision and regret it later. However, it's good to hear that

she does not want children at this point in her life. The fact that

she thinks menstruation is "gross" gives away her maturity level.

Unless the 16 year old has her medical degree, she should not be

allowed to make medical decisions for herself, without first

consulting with a Dr. Research doesn't take the place of medical

testing. Of course, no one can force her to take medication if it is

recommended. But I would think it would make sense to rule out a

worse-case scenario before avoiding a Dr. altogether. And the answer

is-- I cannot assure anything.... only make recommendations.

Hopefully, she will start menstruating on her own and she won't have

to make this decision. I hope everything goes well for her.

Along simular lines, we have the case of boys who do not initiate puberty. "Standard" practice calls for regular testosterone shots if puberty doesn't start by a certain age, usually 16.

So again, a 16 year old boy fails to initiate puberty. The boy decides he does not want puberty. Can he refuse testosterone shots or will they be administered against his will?

In our current culture, which permits infant circumcision, I think most boys will be forced to take the testosterone shots "for your own good, your too young to make a decision not to be a mature adult", and the 16 year old girl WILL be forced by parents and doctors to initiate menstruation. Yes.

I can indeed see the girl waiting until she is age 18 or 21, depending on what state she lives in, getting a lawyer to write a stiff letter to the doctor threatening a malpractice suit if he initiates menstruation against her will, before taking that letter and herself to a doctor for an exam.

The desire to menstruate is a subjective experience and can not be judged without getting into sticky philosophical entanglements. Medically speaking, it would be best for her to go to a doctor and see if there is a problem that needs attending in order for her to maintain a lifestyle she desires.

No doctor can 'force" a person to receive medical treatment. The difficulties concerning forced treatment, if there were to be a problem, would come from the parents. Is this 16 year old empancipated? If so, she has every right to refuse any treatment. And even if she is not empancipated, she is 16, which makes it difficult for her parents to control her medical issues. We can thank the abortion laws for this.

Also, as far as this RN is concerned, she is pretty open minded for someone who may only have an ADN degree. Few nurses are interested in reading post modern discourse, and as such, should be judged no more for her POV than should your friend be judged for her POV. Nurses are people, too. She does not make treatment decisions. Nor does the doctor, ultimately, Only the patient can make medical decisions that will affect his or her life.

happousai (imported) wrote: Thu Apr 24, 2003 1:14 am I know a 16-year old girl, who has never menstruated before. Her mother is concerned and wants her to go to a doctor to have itit checked out. But she doesn't want to, because she's afraid that the doctor will make her start menstruating. She thinks menstruation is gross, and says she doesn't want to have kids, so why should she go through the trouble of menstruating.

Most of us aren't lucky enough to be able to decide what parts of puberty we want or don't want to endure. I applaud this girl for expressing her views against being forced to menstruate.

However, she should be checked by a doctor for the assurance that she does not have any life threatening condition. If her ovaries or uterus are just too under developed to support menstruation and child bearing, with no other medical problems present, she should be allowed to refuse treatment. She might have a malignancy which could be life threatening and require surgery. If so, that would permanently eliminate the problem of menstruation.

Any child should be allowed to make the decision, when they are old enough, concerning corrective treatment for sexual abnormalities which are not life threatening.

"

sassafras (imported) wrote: Thu Apr 24, 2003 3:47 am No doctor can 'force" a person to receive medical treatment.

"

A doctor can force someone to have medical treatment if the patient is considered unfit to make the right decision for herself. The doctor cannot say that the patient is unfit, only a psychiatrist, psychologist or a counsellor can make that judgement. (This only refers to UK law, I have no idea about the laws of other countries concerning the topic.)

Although this does not seem to apply to this case. If she does need to see a psych professional, she must be able to show she understands the consequences of not having the treatment, to show she is willing to live with those consequences, and be to express why she is willing to take the risks when treatment is offered. Or she can just say its a religious thing... Jesus forbids health - heath is of the devil - I endure poor health for salvation... hey Jesus got nailed to a cross for God's sake!

All the best,

Leon

"

sassafras (imported) wrote: Thu Apr 24, 2003 3:47 am No doctor can

Leon (imported) wrote: Thu Apr 24, 2003 6:00 am 'force" a person to receive medical treatment.

"

A doctor can force someone to have medical treatment if the patient is considered unfit to make the right decision for herself. The doctor cannot say that the patient is unfit, only a psychiatrist, psychologist or a counsellor can make that judgement. (This only refers to UK law, I have no idea about the laws of other countries concerning the topic.)

Although this does not seem to apply to this case. If she does need to see a psych professional, she must be able to show she understands the consequences of not having the treatment, to show she is willing to live with those consequences, and be to express why she is willing to take the risks when treatment is offered. Or she can just say its a religious thing... Jesus forbids health - heath is of the devil - I endure poor health for salvation... hey Jesus g

ot nailed to a cross for God's sake!

All the best,

Leon

I don't know about UK, but in the US it is very difficult to prove that a person is unfit to make decisions. She need not prove anything, the doctor must prove that she is unfit. Unless she has said "I want to kill myself," or "I want to kill someone," it is unlikely that any doctor would even begin to pursue that line of inquiry.

If she goes to a doctor and he finds nothing "wrong" but he wishes to begin a form of treatment (honestly, i dont know what type of "treatment" there is for lack of menstration which is not secondary to a disease process) , all she has to do is tell him she wishes to get a second opinion and leave.

I dont know about "treatment" for amenorrhea in depth so I'm now researching it. At first glance into information, it is obvious that at 16, a doctor wouldn't pursue treatment. Sixteen is still within the range of onset.

AND

If there is no underlying problem, pseudomentruation is a possibility, but as stated below, it is only something to consider. I can't imagine a doctor in this day and age who would force a woman to menstruate.

Forced sexualization of males is much more common.

http://www.nlm.nih.gov/medlineplus/ency ... 001218.htm

Treatment for Amenorrhea

Treatment depends on the cause of the amenorrhea.

Pituitary tumors, located in the brain, are usually treated with bromocriptine, a drug that inhibits the abnormally high prolactin secretion caused by these tumors. Surgical removal may also be necessary. Radiation therapy is usually reserved for situations in which other medical or surgical treatment regimens are not successful.

Young women with primary amenorrhea found to be caused by developmental abnormalities (which may result when the parts of the female reproductive system did not form properly before birth) may require hormonal supplementation, surgery, or both.

In any case, psychosocial support and counseling for the patient and family is necessary to address specific concerns and provide guidance regarding anticipated sexual development.

If the problem causing the amenorrhea is not correctable, then the patient and health care provider should consider the possibility of creating pseudomenstruation. This is a menstrual period that is caused by hormonal treatment rather than natural causes.

For women who do not have other reproductive abnormalities, work up for amenorrhea is delayed until after age 16.

If the condition is caused by systemic disease, treatment of the disease should allow menarche to begin.

The underlying cause could easily be AIS (Androgen Insensitivity Syndrome). I've only run into one AIS person, but except for the near total lack of body hair, and lack of menses there was no way to even begin to guess. Quite a lovely young lady.

Here's a reference: ISNA.ORG info in AIS (http://www.isna.org/faq/faq-ais.html)

http://home.earthlink.net/~imagepool/tomsig03.gif

-= MICROSOFT FREE ZONE =- (http://home.earthlink.net/~imagepool/main.html)

sassafras, I wasn't completely clear on what I actually meant. The second paragragh of what i wrote in my previous post, is not what the woman in question would have to prove, but what a counsellor would look for in her replies to his/her questions. The sort of questions that would be asked:

Do you know what is wrong with you?

Do you know how this condition, if left untreated, would effect you?

Do you know what treatment is being offered?

Are you refusing to have this treatment?

Why?

The counsellor would look for coherent answers that shows she understands what is happening, how her choice to refuse treatment would effect her and be able to give a rational answer to why she is refusing the treatment.

Once again, I doubt if she would have to see a psych professional. As you say, she isn't claiming to be suicidal.

"

sassafras (imported) wrote: Thu Apr 24, 2003 6:21 am If she goes to a doctor and he finds nothing "wrong" but he wishes to begin a form of treatment (honestly, i dont know what type of "treatment" there is for lack of menstration which is not secondary to a disease process) , all she has to do is tell him she wishes to get a second opinion and leave.

"

If the doctor recommends a psych evualation and she refuses and leaves, she could be sectioned. Once again though, this would only happen in extreme cases.

All the best,

Leon