Puberty describes the transition from a child’s body to an adult’s body capable of reproduction. During this phase, the body undergoes physical, hormonal, and emotional changes.

Are there differences between ASD individuals vs. N-ASD peers?

The physical changes (hormonal shifts, growth spurts, sexual maturation) occur in a similar timeline for ASD and non-ASD individuals. Emotional fluctuations, self-consciousness and identity exploration are also common in both groups.

Although they mostly move through a similar development along the biological changes, autistic individuals may experience slower cognitive and social maturation than physical development compared to their non-ASD peers. This can cause a delay in awareness of pubertal and sexual changes happening to them.

To sum up, the biological process of puberty is essentially the same for autistic and non-autistic individuals, but autistic individuals often face additional sensory, social, emotional and

safety-related challenges that require more explicit teaching, structured support, and sensitivity to their unique needs.

What are the specific challenges?

● Sensory processing

Adjustments to new bodily sensations (sweating, hair growth, breast development) are often less tolerable. Sensory sensitivities can make these changes overwhelming, for example, discomfort with body odour, new textures of body hair or wearing bras or menstrual pads.

● Social and emotional understanding

Difficulty interpreting social cues can lead to confusion about flirting, dating, and appropriate boundaries. They may miss informal peer learning and rely more on explicit teaching.

● Emotional regulation

Co-occurring conditions (anxiety, depression, ADHD) can intensify mood swings. Difficulties with identifying emotions make self-regulation harder.

● Gender Identity and orientation

Research suggests autistic individuals may be more likely to identify as queer, which can add another layer of complexity during puberty.

What happens to the body?

Here is a non-exhaustive list of the physical changes that male and female individuals have in common:

● Growth spurt

● Enlargement of testicles and penis/labia of the vulva, darkening of the skin in the genital area

● Growth of pubic, underarm, body and facial hair

● Voice crack (boys) and becoming deeper

● Increased oil production in the skin, pimples and maybe acne

● More sweating and more pungent body odour

Specific changes for female individuals:

● First menstruation (Menarche)

● Breast development

Specific changes for male individuals:

● Sperm production and first ejaculation

● Frequent erections

What happens on an emotional level?

● Mood swings

● Stronger emotions and sensitivity

● Desire for more independence and privacy

● Greater self-consciousness about body and appearance

● Developing a stronger sense of identity

● Interest in romantic relationships and attraction to others

● Increased importance of friendships and peer approval

● Occasional conflict with parents or caregivers as independence grows

● Curiosity about sexuality and relationships

● Beginning to think more abstractly and critically (more adult-like thinking patterns)

Although most individuals will face similar changes, they may occur at different timings, be present, and be experienced very differently from person to person.

Menstruation

What is the menstrual cycle?

The menstrual cycle is a hormone-regulated process that begins at puberty and continues until menopause, preparing the body for possible pregnancy. Each cycle starts on the first day of menstruation and usually lasts 21–35 days, though cycles up to 40 days can occur during puberty. Cycle length is measured from the first day of one period to the day before the next. Menstruation is the shedding of the uterine lining (endometrium), which builds up to support a fertilised egg. If fertilisation does not occur, the lining, blood, and unfertilized egg are expelled through the vagina, typically over 3–7 days. Pregnancy is possible during ovulation, when an egg is released and can be fertilised for about 12–24 hours. Ovulation usually occurs near the midpoint of the cycle, with most people ovulating about 14 days before their period begins (Cleveland Clinic, 2022b; cf. Kumar & Singh, 2025; Cleveland Clinic, 2022a; Cleveland Clinic, 2022b).

When to see a doctor:

A health care provider should be consulted if menstruation becomes suddenly irregular or stops (outside of puberty or perimenopause), if there is severe pain or very heavy bleeding (requiring product changes every hour), unusual discharge, periods lasting longer than seven days, symptoms of toxic shock syndrome such as fever, shivers, or vomiting (cf. Cleveland Clinic, 2023), if menstruation has not started by age 16 or if pain medication doesn’t help with the pain.

Menstrual Products:

– Pads: Disposable menstrual pads are designed to absorb the period fluid and to provide adequate protection. The pad is attached to the underwear with an adhesive strip on the back so that the soft, absorbent side is facing up towards the vulva. The pad needs to be changed regularly (every 4-6 hours) and disposed of the used ones in a rubbish bin.

– Tampons: Tampons are single-use intravaginal products that absorb the period fluid. They come with a string for easy removal. Tampons are available in different sizes and absorption levels, with or without an applicator.

• Application: Wash hands before getting into a comfortable position (squatting, lying down, standing or with one leg raised). Remove the tampon from its packaging and pull out the small string. Insert the tampon into the vagina, aiming towards your lower back. The string must remain outside. The tampon is in place when you can no longer feel it. Wash your hands after inserting the tampon and change it regularly (about every 4 hours). To remove the tampon, gently pull on the string, wrap it in paper and dispose of it in the rubbish bin.

• Menstrual cups: The menstrual cup is a flexible receptacle (made of natural rubber or medical-grade silicone) that is inserted into the vagina to collect menstrual fluid. It can be reused with each menstrual cycle and for several years.

• Application: Wash your hands and get into a comfortable position (e.g., squatting or with one leg up). Fold the cup flat and carefully insert it into the vagina. Once in place, it must not be uncomfortable. To remove it, squeeze the bottom tip to release the seal and gently pull the cup out. Empty the contents and wash the cup with lukewarm water before inserting it back into the vagina. To sterilise it, the menstrual cup should be boiled with hot water at the end of the period.

• Period underwear: Period underwear, also called menstrual underwear, resembles conventional underpants but features an absorbent, leak-proof layer. They come in different styles, a variety of fabrics and absorbencies. It is recommended to wear them for a maximum of 12 hours (depending on the flow) and to soak them in cold water afterwards before putting them in the laundry. Menstrual underwear should not be tumble-dried.