Maturity Staging

👫PUBERTAL DEVELOPMENT👫

📌 DEVELOPMENT OF 2° SEXUAL CHARACTERS:
👩 In Females:
✔ T (Thelarche) ➡ P (Pubarche) ➡ M (Menarche)
▶ Thelarche - Breast enlargement
▶ Pubarche - Development of pubic hair
▶ Menarche - Onset of menstrual cycles
👨 In Males:
✔ T (Thelarche) ➡ P (Pubarche) ➡ A (Adrenarche)
▶ Thelarche - Testicular enlargement
▶ Pubarche - Penile enlargement
▶ Adrenarche - Features of maleness

📌 TANNER STAGING OF THELARCHE IN FEMALES:
🔰 Stage 1 - prepubertal elevation of papilla only
🔰 Stage 2 - elavation of breast tissue & papilla as a small mound, enlagement of areola
🔰 Stage 3 - further enlargement of breast & areola
🔰 Stage 4 - projection of areola & papilla to form a secondary mound
🔰 Stage 5 - secondary mound disappears, adult breast with typical contours develops

📌 STAGING OF PUBARCHE IN FEMALES:
🔰 Stage 1 - no sexually stimulated pubic hair present, some non-sexual hair maybe seen in the genital area
🔰 Stage 2 - appearance of coarse, long, crinkly hair along labia majora
🔰 Stage 3 - coarse, curly hair extending onto mons pubis
🔰 Stage 4 - adult hair in thickness & texture, extending laterally onto mons pubis giving the vulva an inverted triangular appearance
🔰 Stage 5 - hair may extend further laterally onto inner aspects of thighs & perineum
👉 Axillary hair appears a little later in sequence.
👉 Secondary hair growth is under control of adrenal cortex.

📌 SEXUAL MATURITY RATING (SMR):
👩 In females:
💃 Stage 1 -
● prepubertal,
● no terminal hair
💃 Stage 2 -
● appearance of breast bud;
● sparse straight hair along the labia majora
💃 Stage 3 -
● generalised breast enlargement (extending beyond the areola);
● pigmented, coarse pubic hair, begins to curl
💃 Stage 4 -
● nipple & areola form a second mound over breast;
● hair increases in amount & spread over entire mons
💃 Stage 5 -
● mature adult type breast, nipple projects & areola recedes;
● adult type pubic hair in triangle shaped area, spreading over to medial thighs
👨 In males:
🏃 Stage 1 -
● testicular size <2.5cm, vol. <3ml;
● prepubertal
🏃 Stage 2 -
● testicular size 2.5-3.2cm, vol. reaching 4ml, reddening of scrotum;
● scanty hair at penile base
🏃 Stage 3 -
● testicular size 3.3-4.0cm, further increase in vol. to 10ml
● increase in length of penile shaft
● hair begins to curl & darken
🏃 Stage 4 -
● testicular size 4.1-4.5cm, vol. 16ml
● increase in girth of penis & glans, darkening of scrotum
● coarse, abundant & curly hair, less than in adult
🏃 Stage 5 -
● testicular size >4.5cm, vol. 25ml
● adult size scrotum & penis
● adult type hair, spreading over to medial thighs

📚 References:
📖 Shaw's TB of Gynaecology, 15th Edition
📖 Ghai Essential Pediatrics, 8th Edition