Appendix H: Canadian Guidelines on Sexually Transmitted Infections – Tanner scale of sexual maturity

Section VII

Appendix H: Tanner Scale of Sexual Maturity

Sexual-maturity ratings have replaced the traditional indicators of growth status such as height, weight and skinfold thickness. Sexual maturity ratings have proven useful in assessing growth and development during adolescence.

Classification of patients may be done as part of a general physical examination and does not require any special procedures.

The scale of development is based on secondary sexual characteristics. The ratings range from stage 1, which represents the prepubertal child, to stage 5, which represents the adult.

Boys: Genital Development

  • Stage 1: Preadolescent. Testes, scrotum and penis are about the same size and proportion as in early childhood.
  • Stage 2: Enlargement of scrotum and testes. Skin of scrotum reddens and changes in texture. Little or no enlargement of penis.
  • Stage 3: Enlargement of penis, at first mainly in length. Further growth of testes and scrotum.
  • Stage 4: Increased size of penis, with growth in breadth and development of glans. Testes and scrotum larger. Scrotal skin darkened.
  • Stage 5: Genitalia are adult in size and shape.

Girls: Breast Development

  • Stage 1: Preadolescent. Elevation of papilla only.
  • Stage 2: Breast bud stage. Elevation of breast and papilla as small mound. Enlargement of diameter of areola.
  • Stage 3: Further enlargement and elevation of the breast and areola, with no separation of their contours.
  • Stage 4: Projection of areola and papilla to form a secondary mound above the level of the breast.
  • Stage 5: Mature stage. Projection of papilla only, owing to recession of the areola to the general contour of the breast.

Both Sexes: Pubic Hair

  • Stage 1: Preadolescent. Vellus over pubis is not developed further than that over abdominal wall (i.e., no pubic hair).
  • Stage 2: Sparse growth of long, slightly pigmented downy hair, straight or slightly curled, chiefly at base of penis and along labia.
  • Stage 3: Hair is considerably darker, coarser and more curled. It spreads sparsely over the junction of pubis.
  • Stage 4: Hair is adult in type, but area covered is still considerably smaller than in adult. No spread to medial surface of thighs.
  • Stage 5: Hair is adult in quantity and type, with distribution of horizontal (or classic “feminine” in females) pattern. Spread to medial surface of thighs but not up linea alba or elsewhere above base of inverse triangle (spread up linea alba occurs late and is rated Stage 6).
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