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Figure 24-44 Tanner's Stages of Development. Genital development in boys. Numbers indicate sex maturity ratings.

Stage Characteristics 1 2

Prepubertal; testes, scrotum, and penis are about the same size and proportion as in early childhood

Enlargement of the testes and scrotum; reddening and coarsening of scrotal skin; little change in size of penis

Enlargement of penis, which occurs mainly in length; further growth of testes and scrotum

Further enlargement of penis with growth in width and length; enlargement of glans penis; darkening of scrotal skin

Adult genitalia

The Tanner sex maturity ratings for pubic hair development in boys and girls are illustrated and summarized in Figure 24-45.

The Tanner sex maturity ratings for girls are based on the growth of pubic hair and the development of the breasts. Five stages are observed for each. The examiner should record two ratings: one for the breasts and one for the pubic hair. The sex maturity ratings for breast development in girls are illustrated and summarized in Figure 24-46.

Figure 24-45 Tanner's Stages of Development. Pubic hair development. Numbers indicate sex maturity ratings. A, Development in boys. B, Development in girls.

Stage Characteristics

1 Prepuberal; no true pubic hair

2 Sparse growth of slightly pigmented, downy hair; only slightly curled; hair mainly at base of penis or along labia

3 Increase in hair, which is becoming coarser, curled, and darker

4 Adult-type hair, but limited in area; no spread to medial surface of thighs

5 Adult-type hair with spread to thighs

Figure 24-46 Tanner's Stages of Development. Breast development in girls. Numbers indicate sex maturity ratings.

Stage Characteristics 1 2 3

Prepubertal; elevation of papilla only

Breast bud stage: elevation of breast and papilla as a small mound; enlargement of diameter of areola Further enlargement of breast and areola with no separation of contours Areola projected above level of breast as a secondary mound

Mature stage: recession of areola mound to the general contour of the breast; projection of papilla only

*This stage is absent in approximately 25% of girls. Conversely, this stage may persist throughout life.

1 1

1 1 1

T Apex strength spurt

Height spurt

10.5-16

13.5-17.5

Penis

10.5-14.5

12.5-16.5

Testis

9.5-13.5

13.5-17

G. rating

2 3

1 1

1 1 1

Age (years)

Age (years)

Figure 24-47 Developmental sequence in boys. ''G. rating,'' genital rating.

A summary of the developmental sequence for boys is diagrammed in Figure 24-47; a summary for girls is diagrammed in Figure 24-48.

The youngster should be given a gown to avoid embarrassment in front of a parent. Inspect the external genitalia. Is pubic hair present? What are the sex maturity ratings? Are any lesions present? Is there evidence of sexual abuse? Palpate the testes. Is an inguinal hernia present?

Pelvic examinations are not routine in this age group unless clinically indicated and should be performed by an experienced examiner. Vaginal bleeding in girls younger than 9 years of age is a result of infection from foreign objects in more than 66% of cases. Trauma accounts for an additional 16%.

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