Tanner scale

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Tanner scale
Synonyms Tanner stages
PurposeDefines physical measurements of development

The Tanner scale (also known as the Tanner stages or sexual maturity rating (SMR)) is a scale of physical development as children transition into adolescence and then adulthood. The scale defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitals, testicular volume, and growth of pubic hair. This scale was first quantified in 1969 by James Tanner, a British pediatrician, after a two-decade-long study following the physical changes in girls undergoing puberty. [1] [2] [3] [4]

Contents

Tanner scale
Tanner scale male intact.svg
Illustration for males
Tanner scale-female.svg
Illustration for females

Due to natural variation, individuals pass through the Tanner stages at different rates, depending in particular on the timing of puberty. Among researchers who study puberty, the Tanner scale is commonly considered the "gold standard" for assessing pubertal status when it is conducted by a trained medical examiner. [5] In HIV treatment, the Tanner scale is used to determine which regimen to follow for pediatric or adolescent patients on antiretroviral therapy (adult, adolescent, or pediatric guidelines). [6] The Tanner scale has also been used in forensics to determine aging, but its usage has decreased due to lack of reliability. [7]

Stages

Adapted from Adolescent Health Care: A Practical Guide by Lawrence Neinstein. [8]

Genitals (male)

Photos of the Tanner scale for males. Male genitalia five Tanner stages.png
Photos of the Tanner scale for males.
Tanner I
testicular volume less than 1.5 ml; small penis (prepubertal)
Tanner II
testicular volume between 1.6 and 6 ml; skin on scrotum thins, reddens and enlarges; penis length unchanged
Tanner III
testicular volume between 6 and 12 ml; scrotum enlarges further; penis begins to lengthen
Tanner IV
testicular volume between 12 and 20 ml; scrotum enlarges further and darkens; penis further increases in length and starts to increase in breadth
Tanner V
testicular volume greater than or equal to 20 ml; adult scrotum and penis

Breasts (female)

Photos of the Tanner scale for females Female breasts five Tanner stages.jpg
Photos of the Tanner scale for females
Tanner I
no glandular tissue: areola follows the skin contours of the chest (prepubertal)
Tanner II
breast bud forms, with small area of surrounding glandular tissue; areola begins to widen
Tanner III
breast begins to become more elevated, and extends beyond the borders of the areola, which continues to widen but remains in contour with surrounding breast
Tanner IV
increased breast sizing and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast
Tanner V
breast reaches final adult size; areola returns to contour of the surrounding breast, with a projecting central papilla

Pubic hair (both male and female)

Tanner I
no pubic hair at all (prepubertal)
Tanner II
small amount of long, downy hair with slight pigmentation at the base of the penis and scrotum (males) or on the labia majora (females)
Tanner III
hair becomes more coarse and curly, and begins to extend laterally
Tanner IV
adult-like hair quality, extending across pubis but sparing medial thighs
Tanner V
hair extends to medial surface of the thighs

Height

During Tanner V, females stop growing and reach their adult height. Usually, this happens in their mid teens at 14 or 15 years for females.

Males also stop growing and reach their adult height during Tanner V; usually this happens in their late teens at 16 to 17 years, [ medical citation needed ] but can be a lot later, even into the early 20's.

Tanner stage data in history

In 1970, boys reached the last Tanner stage, the postpubertal stage, on average at the age of 14.9 years and girls around the age of 14 depending on social class and the particular study. [9] In the nearly fifty years since those studies, the ages at which children are beginning puberty has only declined: "The age of puberty, especially female puberty, has been decreasing in western cultures for decades now ... for example, at the turn of the 20th century, the average age for an American girl to get her period was 16 or 17. Today, that number has decreased to 12 or 13 years." (as of 2018) [10]

Criticism

The scale has been criticized by the pornography industry for its potential to lead to false child pornography convictions, such as in the case of pornographic actress Lupe Fuentes where in 2009 United States federal authorities used it to assert that she was not an adult despite her age. Fuentes personally appeared at the trial and provided documentation that showed that the DVDs in question were legally produced. [11] [12]

Tanner, the author of the classification system, has argued that age classification using the stages of the scale misrepresents the intended use. Tanner stages do not match with chronological age, but rather maturity stages and thus are not diagnostic for age estimation. [13]

See also

Related Research Articles

<span class="mw-page-title-main">Secondary sex characteristic</span> Features that occur in an organism at sexual maturity

A secondary sex characteristic is a physical characteristic of an organism that is related to or derived from its sex, but not directly part of its reproductive system. In humans, these characteristics typically start to appear during puberty. In animals, they can start to appear at sexual maturity. In humans, secondary sex characteristics include enlarged breasts and widened hips of females, facial hair and Adam's apples on males, and pubic hair on both. In non-human animals, secondary sex characteristics include, for example, the manes of male lions, the bright facial and rump coloration of male mandrills, and horns in many goats and antelopes.

Preadolescence is a stage of human development following middle childhood and preceding adolescence. It commonly ends with the beginning of puberty. Preadolescence is commonly defined as ages 8–12 ending with the major onset of puberty. It may also be defined as simply the 2-year period before the major onset of puberty. Preadolescence can bring its own challenges and anxieties.

<span class="mw-page-title-main">Orchidometer</span> Measurement device for testicle volume

An orchidometer is a medical instrument used to measure the volume of the testicles.

Hebephilia is the strong, persistent sexual interest by adults in pubescent children who are in early adolescence, typically ages 11–14 and showing Tanner stages 2 to 3 of physical development. It differs from pedophilia, and from ephebophilia. While individuals with a sexual preference for adults may have some sexual interest in pubescent-aged individuals, researchers and clinical diagnoses have proposed that hebephilia is characterized by a sexual preference for pubescent rather than adult partners.

In medicine, precocious puberty is puberty occurring at an unusually early age. In most cases, the process is normal in every aspect except the unusually early age and simply represents a variation of normal development. There is early development of secondary sex characters and gametogenesis also starts earlier. Precocious puberty is of two types: true precocious puberty and pseudoprecocious puberty. In a minority of children with precocious puberty, the early development is triggered by a disease such as a tumor or injury of the brain. Even when there is no disease, unusually early puberty can have adverse effects on social behavior and psychological development, can reduce adult height potential, and may shift some lifelong health risks. Central precocious puberty can be treated by suppressing the pituitary hormones that induce sex steroid production. The opposite condition is delayed puberty.

Delayed puberty is when a person lacks or has incomplete development of specific sexual characteristics past the usual age of onset of puberty. The person may have no physical or hormonal signs that puberty has begun. In the United States, girls are considered to have delayed puberty if they lack breast development by age 13 or have not started menstruating by age 15. Boys are considered to have delayed puberty if they lack enlargement of the testicles by age 14. Delayed puberty affects about 2% of adolescents.

<span class="mw-page-title-main">Virilization</span> Biological development of male sex characteristics

Virilization or masculinization is the biological development of adult male characteristics in young males or females. Most of the changes of virilization are produced by androgens.

Adrenarche is an early stage in sexual maturation that happens in some higher primates, typically peaks at around 20 years of age, and is involved in the development of pubic hair, body odor, skin oiliness, axillary hair, sexual attraction/sexual desire/increased libido and mild acne. During adrenarche the adrenal glands secrete increased levels of weak adrenal androgens, including dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione (A4), but without increased cortisol levels. Adrenarche is the result of the development of a new zone of the adrenal cortex, the zona reticularis. Adrenarche is a process related to puberty, but distinct from hypothalamic–pituitary–gonadal axis maturation and function.

Pubarche refers to the first appearance of pubic hair at puberty and it also marks the beginning of puberty. It is one of the physical changes of puberty and can occur independently of complete puberty. The early stage of sexual maturation, also known as adrenarche, is marked by characteristics including the development of pubic hair, axillary hair, adult apocrine body odor, acne, and increased oiliness of hair and skin. The Encyclopedia of Child and Adolescent Health corresponds SMR2 with pubarche, defining it as the development of pubic hair that occurs at a mean age of 11.6 years in females and 12.6 years in males. It further describes that pubarche's physical manifestation is vellus hair over the labia or the base of the penis. See Table 1 for the entirety of the sexual maturity rating description.

Gonadarche refers to the earliest gonadal changes of puberty. In response to pituitary gonadotropins, the ovaries in females and the testes in males begin to grow and increase the production of the sex steroids, especially estradiol and testosterone. The ovary and testis have receptors, follicle cells and leydig cells, respectively, where gonadotropins bind to stimulate the maturation of the gonads and secretion of estrogen and testosterone. Certain disorders can result in changes to timing or nature of these processes.

<span class="mw-page-title-main">Thelarche</span> Beginning of development of the breasts in the female

Thelarche, also known as breast budding, is the onset of secondary breast development, often representing the beginning of pubertal development. It is the stage at which male and female breasts differentiate due to variance in hormone levels; however, some males have a condition in which they develop breasts, termed gynecomastia. Thelarche typically occurs between the ages of 8 and 13 years with significant variation between individuals. However, the initial growth of breast tissue occurs during fetal development.

<span class="mw-page-title-main">Testicular atrophy</span> Reduction in the size and function of the testicles

Testicular atrophy is a medical condition in which one or both testicles diminish in size and may be accompanied by reduced testicular function. Testicular atrophy is not related to the temporary shrinkage of the surrounding scrotum, which might occur in response to cold temperature.

<span class="mw-page-title-main">Male reproductive system</span> Reproductive system of the human male

The male reproductive system consists of a number of sex organs that play a role in the process of human reproduction. These organs are located on the outside of the body, and within the pelvis.

<span class="mw-page-title-main">Micropenis</span> Unusually small penis

A micropenis is an unusually small penis. A common criterion is a dorsal penile length of at least 2.5 standard deviations smaller than the mean human penis size. A micropenis is stretched penile length equal to or less than 1.9 cm in term infants, and 9.3 cm in adults. The condition is usually recognized shortly after birth. The term is most often used medically when the rest of the penis, scrotum, and perineum are without ambiguity, such as hypospadias. A microphallus describes a medical term where other sections of genitallia are different, such as hypospadias or cryptorchidism. Micropenis incidence is about 1.5 in 10,000 male newborns in North America.

<span class="mw-page-title-main">Leydig cell tumour</span> Medical condition

Leydig cell tumour, also Leydig cell tumor, (testicular) interstitial cell tumour and (testicular) interstitial cell tumor, is a member of the sex cord-stromal tumour group of ovarian and testicular cancers. It arises from Leydig cells. While the tumour can occur at any age, it occurs most often in young adults.

Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a female, the testicles in a male. In response to the signals, the gonads produce hormones that stimulate libido and the growth, function, and transformation of the brain, bones, muscle, blood, skin, hair, breasts, and sex organs. Physical growth—height and weight—accelerates in the first half of puberty and is completed when an adult body has been developed. Before puberty, the external sex organs, known as primary sexual characteristics, are sex characteristics that distinguish males and females. Puberty leads to sexual dimorphism through the development of the secondary sex characteristics, which further distinguish the sexes.

<span class="mw-page-title-main">Orchiectomy</span> Surgical removal of one or both testicles

Orchiectomy is a surgical procedure in which one or both testicles are removed. The surgery can be performed for various reasons:

Hypergonadotropic hypogonadism (HH), also known as primary or peripheral/gonadal hypogonadism or primary gonadal failure, is a condition which is characterized by hypogonadism which is due to an impaired response of the gonads to the gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and in turn a lack of sex steroid production. As compensation and the lack of negative feedback, gonadotropin levels are elevated. Individuals with HH have an intact and functioning hypothalamus and pituitary glands so they are still able to produce FSH and LH. HH may present as either congenital or acquired, but the majority of cases are of the former nature. HH can be treated with hormone replacement therapy.

Gonadotropin-releasing hormone (GnRH) insensitivity also known as Isolated gonadotropin-releasing hormone (GnRH)deficiency (IGD) is a rare autosomal recessive genetic and endocrine syndrome which is characterized by inactivating mutations of the gonadotropin-releasing hormone receptor (GnRHR) and thus an insensitivity of the receptor to gonadotropin-releasing hormone (GnRH), resulting in a partial or complete loss of the ability of the gonads to synthesize the sex hormones. The condition manifests itself as isolated hypogonadotropic hypogonadism (IHH), presenting with symptoms such as delayed, reduced, or absent puberty, low or complete lack of libido, and infertility, and is the predominant cause of IHH when it does not present alongside anosmia.

<span class="mw-page-title-main">Gynecomastia</span> Endocrine system disorder of human male breast

Gynecomastia is the abnormal non-cancerous enlargement of one or both breasts in males due to the growth of breast tissue as a result of a hormone imbalance between estrogens and androgens. Gynecomastia can cause significant psychological distress or unease.

References

  1. Tanner's stages at Who Named It?
  2. Marshall WA, Tanner JM (February 1970). "Variations in the pattern of pubertal changes in boys". Arch. Dis. Child. 45 (239): 13–23. doi:10.1136/adc.45.239.13. PMC   2020414 . PMID   5440182.
  3. Marshall WA, Tanner JM (June 1969). "Variations in pattern of pubertal changes in girls". Arch. Dis. Child. 44 (235): 291–303. doi:10.1136/adc.44.235.291. PMC   2020314 . PMID   5785179.
  4. Emmanuel, Mickey; Bokor, Brooke R. (2019), "Tanner Stages", StatPearls, StatPearls Publishing, PMID   29262142 , retrieved 2019-08-01
  5. Dorn LD, Biro FM (February 2011). "Puberty and Its Measurement: A Decade in Review". Journal of Research on Adolescence. 21 (1): 180–195. doi:10.1111/j.1532-7795.2010.00722.x.
  6. "Adolescents and Young Adults with HIV Considerations for Antiretroviral Use in Special Patient Populations Adult and Adolescent ARV". AIDSinfo. Retrieved 2019-08-01.
  7. Encyclopedia of forensic and legal medicine. Payne-James, Jason,, Byard, Roger W. (Second ed.). Amsterdam, Netherlands. 2015-09-29. ISBN   9780128000557. OCLC   924663619.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  8. Adolescent health care : a practical guide. Neinstein, Lawrence S., Neinstein, Lawrence S. (5th ed.). Philadelphia: Lippincott Williams & Wilkins. 2008. ISBN   9780781792561. OCLC   148727849.{{cite book}}: CS1 maint: others (link)
  9. Marshall, W. A.; Tanner, J. M. (1 February 1970). "Variations in the Pattern of Pubertal Changes in Boys". Archives of Disease in Childhood. 45 (239): 13–23. doi:10.1136/adc.45.239.13. PMC   2020414 . PMID   5440182.
  10. "The decreasing age of puberty". Texas A&M Health Science Center. 10 January 2018.
  11. "Lupe Fuentes Saves Man From Bogus 'Child Porn' Charge". AVN. April 16, 2010. Archived from the original on January 29, 2012. Retrieved November 9, 2013.
  12. "Adult Film Star Verifies Her Age, Saves Fan From 20 Years In Prison". Radar Online. April 21, 2010.
  13. Rosenbloom, AL; Tanner, JM (December 1998). "Misuse of Tanner puberty stages to estimate chronologic age". Pediatrics. 102 (6): 1494. doi:10.1542/peds.102.6.1494. PMID   9882230.
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