Delayed Sexual Development
(Delayed Puberty; Delayed Sexual Maturation)
Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. When this stage is late, it is called delayed sexual development.
For girls, delayed sexual development is defined as:
- Absence of breast development by the age of 13 or
- Absence of menstruation for five years or more after initial breast development
- Testicles that don’t enlarge by age 14 or
- Sex organs that don’t completely develop five years after they started to develop
This condition can be caused by:
- Chronic disease
- Abnormal chromosomes
- Constitutional delay—a variation of normal puberty (some simply take longer than their peers; they will at some point catch up)
- Other factors
To understand the reason for the delay, it is necessary to look at potential causes including:
- Underlying disease:
Complications From Cystic Fibrosis
Factors that increase the chance of delayed puberty include:
- Delayed puberty can run in families
- Certain long-term diseases
- Increased lead exposure]]>
One common symptom for both boys and girls is shortness in height. Other symptoms include:
Symptoms in boys:
- Lack of testicular enlargement by age 13 ½
- Lack of pubic hair by age 15
- Genital enlargement that takes more than five years from start to completion
Symptoms in girls:
- Lack of breast development by age 13
- Lack of pubic hair by age 14
- Failure to menstruate by age 16
- Time lag of more than five years from breast development to first period
The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. An assessment of your child's milestones and growth will be done. An x-ray]]> of the left wrist bone may be taken. This will help to assess if bone growth is normal for your child’s age.
Depending on these results, other tests may be ordered, including:
- Chromosome studies
- Hormonal levels: FSH, LH, and estradiol in girls; testosterone in boys
- GnRH stimulation test
- ]]>MRI scan]]> of head and pituitary gland to exclude tumors or lesions
- Additional tests (eg, T4, insulin-like growth factor or IGF-1, IGFBP-3, TSH, prolactin)
- Assessment of nutritional state
- Family history of pubertal delay
- Pelvic ultrasound (female)
- Skull x-ray
- Test of smell and vision
The treatment depends on the cause.
There is often no treatment for those who are healthy and just starting later than their peers. They will continue to be monitored.
For those who have a chronic underlying disease, treatment is aimed at the specific condition. Once the condition is treated, puberty often proceeds on its own.
For others treatments may include:
Sex Hormone Replacement
Sex hormones are given to those with chromosomal abnormalities. This can include Turner or Klinefelter syndrome. The hormones will help begin sexual development. Hormones may also be given to teens who are severely delayed or overly stressed by their lack of development.
This drug can increase the height in boys with constitutional delay of puberty.
Counseling may be suggested for adolescents who are struggling with the delay.
If a tumor is found in the head, the doctor may remove the tumor.
The doctor will continue to monitor your child’s height, weight, and sexual development. This will help determine if any treatment has been effective.
The American Academy of Family Physicians
American Academy of Pediatrics
About Kids Health
Caring for Kids
Ben-Haroush A, Goldberg-Stern H, Phillip M, de Vries L. GnRH agonist treatment in girls with precocious puberty does not compromise post-pubertal uterine size. Hum Reprod. 2007;22:895-900.
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Hero M, Wickman S, Dunkel L. Treatment with the aromatase inhibitor letrozole during adolescence increases near-final height in boys with constitutional delay of puberty. Clin Endocrinol . 2006;64:510-513.
Louis GMB, Gray LE, Jr, Marcus M, et al: Environmental factors and puberty timing: expert panel research needs. Pediatrics. 2008;121:S192-S207.
The Merck Manual . 2nd ed. Merck website. Available at: http://www.merck.com/mmhe/print/sec23/ch271/ch271b.html . Accessed July 4, 2005.
Sedlmeyer IL, Palmort MR. Delayed puberty: analysis of a large case series from an academic center. J Clin Endocrinol Metab . 2002;87:1613-1620.
Richmond EJ, Rogol AD. Male pubertal development and the role of androgen therapy. Nat Clin Pract Endocrinol Metab. 2007;3:338-344
Last reviewed January 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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