vii Age of onset of pubertal characteristics is important for medical, social, and public health reasons. In the last 20 years there has been a renewed ­ interest worldwide in pubertal data due to many countries finding that, contrary to earlier studies, the age of pubertal markers was continuing to decline, though at a much slower rate than in the first half of the 20th century. In addition, it is now recognized that important racial and ethnic differences exist as well. Knowing how to accura­tely assess sexual maturity markers is an important ­ clinical skill. Secular changes in ages of onset of pubertal mark- ers have profound public health implications. Just as rising ages may indicate harmful social or envi- ronmental conditions including inadequate nutri- tion, lowering ages may not indicate ideal health but may reflect undesirable factors. For example, many recent studies have demonstrated the associa- tion between the epidemic of overweight and obese girls and earlier pubertal onset and menarche. Questions about interactions between overweight and puberty in boys await more studies for clarity. Endocrine disrupters are increasingly found to be associated with early and late puberty depending on the chemical and sex of the child. Many other fac- tors, including prenatal conditions, are also being studied for their associations with pubertal age. Observation of the development of genital and sex- ual hair growth in children is an essential part of their physical examination. Accurate staging of the physical changes of sexual development provides an important basis for the diagnosis and management of certain clinical problems that may arise as the child grows and matures. In addition, counseling of patients and families regarding the expected ­ timing and sequence of pubertal development depends on accurate physical assessment and understanding of the stages of development. This manual is a combination and revision from those developed for the Pediatric Research in Office Settings (PROS) puberty study on girls in 19951 and for the PROS puberty study on boys in 2005.2 It will assist you in learning how to assign the stages of the physical changes of pubertal development using the systems described by Marshall and Tanner3,4 as well as correct techniques for breast palpation and testicu- lar measurement. Because gynecomastia is common among and of concern to adolescent boys, assessing breast tissue is important for boys as well as girls. Photographs The 2 “classic” sets of photographs of the 5 male and female sexual maturity stages in medical litera- ture are those of Tanner5 and van Wieringen et al.6 This manual uses these classic photographs as well as many taken for this book. Drawings for each genital and pubic hair stage with further explanatory detail are also included to supplement the ­ photographs. Foreword
Previous Page Next Page