Endocrinology Book

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Female Tanner StageAka: Female Sexual Development, Female Tanner Staging

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  1. Tanner Stage 1 (Prepubertal)
    1. Height increases at basal rate: 5-6 cm/year
    2. Breast
      1. Papilla elevation only
    3. Pubic Hair
      1. Villus hair only
      2. No coarse, pigmented hair
  2. Tanner Stage 2
    1. Height increases at accelerated rate: 7-8 cm/year
    2. Breast
      1. Breast buds palpable and areolae enlarge
      2. Age 10.9 years (8.9-12.9 years)
    3. Pubic Hair
      1. Minimal coarse, pigmented hair mainly on labia
      2. Age 11.2 years (9.0-13.4 years)
    4. Modifications based on increasingly earlier Puberty
      1. White: Stage 2 changes may appear one year earlier
      2. Black: Stage 2 changes may appear two years earlier
  3. Tanner Stage 3
    1. Height increases at peak rate: 8 cm/year (age 12.5)
    2. Breast
      1. Elevation of breast contour; areolae enlarge
      2. Age 11.9 years (9.9-13.9 years)
    3. Pubic Hair
      1. Dark, coarse, curly hair spreads over mons pubis
      2. Age 11.9 years (9.6-14.1 years)
    4. Other changes
      1. Axillary hair develops (13.1 years)
      2. Acne Vulgaris develops (13.2 years)
  4. Tanner Stage 4
    1. Height increases at 7 cm/year
    2. Breast
      1. Areolae forms secondary mound on the breast
      2. Age: 12.9 years (10.5-15.3 years)
    3. Pubic Hair
      1. Hair of adult quality
      2. No spread to junction of medial thigh with perineum
      3. Age: 12.6 years (10.4-14.8 years)
  5. Tanner Stage 5
    1. No further height increases after age 16 years
    2. Breast
      1. Adult breast contour
      2. Areola recesses to general contour of breast
    3. Pubic hair
      1. Adult distribution of hair
      2. Pubic hair spreads to medial thigh
      3. Pubic hair does not extend up linea alba
  6. Other Milestones
    1. Adrenarche: Age 6 to 8 years
    2. Menarche: Age 12.7 years (10.8-14.5 years)
      1. Delayed >1 year if low body fat (e.g. athlete)
  7. Growth in Girls
    1. Peak height velocity: 11.5 years (9.7-13.3 years)
    2. Basal growth occurs up until Tanner Stage 2
      1. Basal Growth rate: 5.0 to 6.0 cm per year
    3. Pubertal Growth
      1. Girls who mature average time: 8.3 (6.1-10.4) cm/yr
      2. Girls who mature early: 9.0 (7.0-11.0) cm/yr
      3. Girls who mature late: 7.5 (5.4-9.6) cm/yr
  8. References
    1. Tanner (1985) J Pediatr 107(3):317
    2. Tanner (1966) Growth at Adolescence, Appleton

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