Arrested development: The girl who was left untouched by adolescence

Charleen* thought her mother was overreacting when she brought her to see me, because at 17, Charleen was yet to experience menarche (first menstrual period).

The lanky teen was too busy playing basketball and swimming for the school team to give it a thought. Moreover, she was happy that she never had to miss a tournament because of periods.

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

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

Eventually, Charleen was comfortable enough to get onto the examination bed. A thorough examination revealed that Charleen’s mother probably had a good reason to be duly concerned.

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 10 years. Her breasts were prepubescent, she had no underarm or pubic hair and she had maintained narrow, boyish hips.

This was the start of a long journey for Charlene and her mother. Further tests 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 failed to assure normal development of female sexual characteristics.

Charleen was never going to experience menses, pregnancy, childbirth or breastfeeding, but at 17, few girls are too concerned about having babies.

Even though she was an only child and her mother a widow, Charleen was not duly bothered by her incapacity to continue the family line. She was quite happy to skip the whole hulabaloo of menstrual periods that she had witnessed in 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 an early age, while pregnant with Charleen, she had remained focused on raising her daughter and empowering herself economically at the detriment of expanding her own immediate family.

She had banked on many grandchildren to fill the gap.Fate had dealt her a nasty blow. Her dream of becoming a happy grandmother had been shattered irreversibly.

She blamed herself for Charleen’s predicament, thinking that it could have resulted from something she did or didn’t do during 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 17, 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 to create an embryo carried by a surrogate mother.
However, for Charleen’s future parenting consideration to be realised, Kenya 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. Without it, parents seeking a baby through surrogacy can easily be accused of a crime.

The surrogate mother will not be spared, 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.

Our legislators, still have time in this term to do right by couples who need assisted reproduction. The ball is in their court!

* Name withheld to protect identity

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Normal growth

After age eight and most commonly around age 10 to 11, young girls begin to develop breasts, although this is not yet accompanied by other signs of puberty.

After that, the growth spurt begins and the girls get markedly taller and shed off any residue baby weight. While they mostly retain their childlike innocence, they become more fashion-conscious, more aware of the world and more responsive to their environment.

Feeling like little adults, they seek more independence within the sheltered environment of childhood, find their personalities, gain a deeper appreciation of friendship and begin to appreciate gender differences.

By teenage, the more obvious signs of sexual maturation set in and most girls start menstruating between 12 and 15, although it is no longer uncommon to find a menstruating pre-teen.