Updated: 4/3/2020

Tanner Stages of Sexual Development

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Snapshot
  • A 6-year-old girl is brought to the pediatrician by her mother for a check-up. The girl complains that she has been teased by kids at her elementary school because she looks "older" than the other children. She has not yet experienced her first menstrual period. On physical examination, she has formed breast mounds (as seen in image) and scant pubic hair in her axillary and pubic regions. The pediatrician determines that the girl has signs of precocious puberty with Tanner stage 3 breast development and Tanner stage 2 pubic hair.
Introduction
  • Overview
    • Tanner staging is performed to assess sexual development in girls and boys, from stage 1 (pre-adolescent) to stage 5 (adult)
      • assigned independently to genitalia, pubic hair, and breasts  
  • Pathophysiology
    • average age of puberty in girls is around 10.5 years
      • average age of menarche among girls in US is 12.5 years
    • average age of puberty in boys is around 11.5 years
  • Associated conditions
    • precocious puberty
      • any sign of secondary sexual maturation in girls < 8 years of age or boys < 9 years of age
    • delayed puberty
      • no breast development or pubic hair in girls by age 13
      • no testicular enlargement in boys by age 14
    • constitutional growth delay
      • most common cause of delayed puberty
      • normal variant
        • growth curve lags but is consistent
        • children ultimately achieve target height potential
    • pathological puberty delay
      • rare
      • may be due to systemic disease (i.e., IBD), malnutrition, gonadal dysgenesis, or endocrine abnormalities (i.e., hypothyroidism and hypopituitarism)
 
 Tanner Stages of Sexual Development
Stage             
Findings in Girls
Findings in Boys
Stage 1
  • No pubic hair
  • Papillar elevation of the breasts
  • Raised nipple
  • No pubic hair
  • No penile or testicular enlargement
Stage 2
  • Pubic hair appears
  • Breast bud forms
  • Pubic hair appears
  • Testicular enlargement
Stage 3
  • Coarsening of pubic hair
  • Breast enlarges and a mound forms
  • Coarsening of pubic hair
  • Penis size and length increases
Stage 4
  • Coarse hair spreads across the pubis but still spares the thighs
  • Breast enlarges to a mound on mound with a raised areola (ring of pigmented skin around the nipple)
  • Coarse hair spreads across the pubis but still spares the thighs
  • Penis width and glans increases in size
Stage 5
  • Coarse hair spreads across the pubis and medial thigh
  • Adult breast contour develops and the areola flattens
  • Coarse hair spreads across the pubis and medial thigh
  • Penis and testis enlarge to adult size

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