Há associação entre a maturação sexual feminina precoce e a exposição a condições de vulnerabilidade como o início sexual precoce, incidência de DST, gravidez e violência sexual na adolescência?

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2008.Introdução: As adolescentes têm sido estimuladas a postergar a função reprodutiva para quando se tornarem independentes, devendo priorizar os estudos e a qualificação profissional. Enquanto isso, a menarca, que é um sinal biológico do amadurecimento da função sexual, vem ocorrendo progressivamente mais cedo, assim como a iniciação sexual. A ocorrência da menarca não está diretamente relacionada à maturidade psicoemocional e social. A maturação sexual em idades cada vez mais precoces parece estar relacionada à maior exposição das adolescentes a diversas condições de vulnerabilidade, entre elas, o despreparo para a iniciação sexual, a suscetibilidade às DST, a gravidez não planejada e a violência sexual. Métodos: Foram atendidas 201 adolescentes no ambulatório de ginecologia de uma unidade básica de saúde do Distrito Federal, onde responderam a um questionário durante as consultas. Para calcular a associação, foram consideradas a menarca como variável independente; DST, a idade da primeira relação sexual, da primeira gravidez e a ocorrência de violência sexual entre as variáveis dependentes. Aplicados os testes estatísticos de coeficiente de correlação de Pearson e Mann-Whittney para avaliar a associação entre as variáveis e o p-valor para avaliar a significância. Resultados: A média da idade da menarca foi menor entre as adolescentes que engravidaram (Pearson= 0,32527) e p= 0,0004 e viveram situações de violência sexual p= 0,0008. Em relação à idade da menarca e da 1ª relação sexual, a correlação de Pearson foi de 0,38371 e o p= 0,0001, indicando que há associação entre as duas variáveis. Quanto às DST, a associação não teve significância estatística. Conclusão: Os resultados deste estudo demonstram que há associação entre a idade da maturação sexual e da menarca com a idade de iniciação sexual, com a incidência de gravidez e com a vivência de violência sexual, podendo ser considerada como mais um fator de vulnerabilidade na adolescência. ________________________________________________________________________________________ ABSTRACTIntroduction: The teenagers have been encouraged to postpone the reproductive function for when they become independent and should prioritize the studies and professional qualification. Meanwhile, the menarche, which is a sign of maturity of biological sexual function, is occurring progressively earlier, as well as sexual initiation. The occurrence of menarche is not directly related to psicoemocional and social maturity. The sexual maturity at ever earlier ages seems to be related to increased exposure of adolescents to various conditions of vulnerability, including the unpreparedness for sexual initiation, the susceptibility to STDs, pregnancy and sexual violence not planned. Methods: There were 201 teenagers attended the clinic of gynecology a basic health unit of the Federal District, where he answered a questionnaire during the consultations. To calculate the association, were considered the menarche as independent variable; DST, age of first sexual intercourse, the first pregnancy and the occurrence of sexual violence between the dependent variable. Applied statistical tests of Pearson's correlation coefficient and Mann-Whittney to assess the association between the variables and p-value for assessing the significance. Results: The average age of menarche was lower among adolescents who became pregnant (Pearson = 0.32527) p = 0.0004 and lived situations of sexual violence p = 0.0008. In the age of menarche and 1 st sexual relationship, the correlation of Pearson was 0.38371 eop = 0.0001, indicating that association between the two variables. As for STDs, the association was not statistically significant. Conclusion: The results of this study show that there are association between the age of sexual maturation and menarche at the age of sexual initiation, with the incidence of pregnancy and with the experience of sexual violence and may be regarded as another factor of vulnerability in adolescence

Increased Vulnerability to Pregnancy and Sexual Violence in Adolescents with Precocious Menstruation

This cross-sectional, observational, and descriptive study was conducted to evaluate the association between age at menarche in the adolescent population and the age at sexual initiation, age at first pregnancy, and experience of sexual violence in the adolescent population visiting a primary health unit in Brazil. We recruited 201 female adolescents who visited the gynecology outpatient clinic of a Basic Health Unit in the Federal District of Brazil. These adolescents answered a questionnaire with regard to sexual and reproductive health during doctor’s appointments. To calculate the association, we recorded data for age at menarche, age at first sexual intercourse, age at first pregnancy, and experience of sexual violence. Pearson and Mann–Whitney correlation coefficient statistical tests were performed to evaluate the association between these variables. Mean age at menarche was lower among adolescents who became pregnant (p=0.0004) and those who experienced sexual violence (p=0.0008). Further, there was a strong association between age at menarche and age at first sexual intercourse (p<0.0001). This study also demonstrated that the earlier the age at menarche, the earlier was the age at sexual initiation and age at first unintended pregnancy and the greater was the risk of experiencing sexual violence. Early menarche may be considered a vulnerability factor during adolescence