Tool Kit for Teen Care, second edition

Tanner Staging

Staging Pubic Hair Development

Pubic Hair Stage 1 Pubic Hair Stage 2 Pubic Hair Stage 3 Pubic Hair Stage 4 Pubic Hair Stage 5 Prepubertal. The vellus over Sparse growth of slightly The hair is considerably The hair now resembles adult The hair is adult in type and the pubis is no further pigmented, longer but still darker, coarser, and more type. The area covered is still quantity; darker, coarse, and developed than that over the downy hair, straight or only curled. The hair spreads smaller than that in the adult, curled; and distributed in the abdominal wall, ie, no pubic slightly curled, appearing sparsely over the mons. but the hair is beginning to classic female triangle. Some hair. chiefly along the labia. spread across the mons. individuals may have hair There is no hair spread to spread to the medial thighs. the medial thighs. Staging Breast Development

Breast Stage 1 Breast Stage 2 Breast Stage 3 Breast Stage 4 Breast Stage 5 There is no development. The “breast bud” stage. The breast and areola The breast continues to The mature adult stage. Only the papilla is elevated. The areola widens, darkens further enlarge and present expand. The papilla and The secondary mound made slightly, and elevates from a rounded contour. There areola project to form a by the areola and nipple, the rest of the breast as a is no separation of contour secondary mound above the present in Stage 4, disappears. small mound. A bud of between the nipple and rest of the breast tissue. Only the papilla projects. The breast tissue is palpable areola and the rest of the diameter of the breast tissue below the nipple. breast. The breast tissue (as opposed to the height) has creates a small cone. extended to cover most of the area between the sternum and lateral chest wall.

Determining the degree of development of pubic hair and the breasts in adolescents is an essential part of the physical examination. Accurate staging provides an important basis for the management of certain clinical problems that may arise throughout puberty. In addition, counseling regarding the expected timing and sequence of pubertal development depends on recording and understanding the stages of development. The above diagrams detail the various stages of secondary sexual development using the system described by Tanner. Reprinted with permission. Herman-Giddens, ME, Bourdony CJ. Assessment of sexual maturity stages in girls. Report MA0089. Elk Grove Village (IL): American Academy of Pediatrics; 1995. Copyright © 1995 American Academy of Pediatrics.

The American College of Obstetricians and GynEcologists