Delayed Sexual Development
(Delayed Puberty; Delayed Sexual Maturation)
DefinitionGirls 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.
CausesThis condition can be caused by:
- Constitutional delay—some children simply take longer than their peers; they will catch up at some point
- Chromosomal abnormalities:
- Kallmann syndrome
- Hypopituitarism caused by infection, trauma , and central nervous system lesions
Risk FactorsFactors that may increase the chance of delayed puberty include:
- Family history
- Underlying disease:
- Other factors:
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SymptomsOne common symptom for both boys and girls is shortness in height. Other symptoms by gender include:
- Symptoms in boys:
- Lack of testicular enlargement by age 14
- Lack of pubertal maturation by age 14
- Sex organs that don’t completely develop within 5 years after they started to develop
- Symptoms in girls:
- Lack of breast development by age 13
- No breast tissue or pubic hair by the age of 14
- Lack of menstruation for five years or more after initial breast development
- Failure to menstruate by age 15-16
DiagnosisYou will be asked about your child’s symptoms and medical history. A physical exam will be done. Your child's milestones and growth record will be reviewed. An x-ray of the left wrist bones may be taken. This will help to assess if bone development is normal for your child’s age. Your child's hormone levels may be tested. This can be done with blood tests.Images may be taken of your child's bodily structures. This can be done with:
- MRI scan
- Pelvic ultrasound (female)
- Skull x-ray
TreatmentThere is often no treatment for those who are healthy and just starting later than their peers. They will continue to be monitored.Other treatment depends on the cause. For those who have a chronic underlying disease, treatment is aimed at the specific condition. After the condition is treated, puberty often begins on its own.For others treatments may include:
Sex Hormone ReplacementSex hormones will help begin sexual development. They may be given to those with chromosomal abnormalities. This can include Turner syndrome or Klinefelter syndrome. Hormones may also be given to teens who are severely delayed or overly stressed by their lack of development.Other medications may be added to sex hormone replacement medications. They may help increase height in children and young adults with constitutional delay of puberty.
Psychological SupportCounseling may be suggested for adolescents who are struggling with the delay. This may help the child cope with social pressures.
Ongoing MonitoringYour child’s height, weight, and sexual development will continued to be monitored. This will help determine if any treatment has been effective.
PreventionMost causes of delayed sexual development cannot be prevented. To help reduce the chance, make sure your child maintains a healthy lifestyle. This includes making sure your child is eating well and getting nutrients. Make sure any underlying illness is treated.
Family Doctor—The American Academy of Family Physicians
Healthy Children—American Academy of Pediatrics
About Kids Health—The Hospital for Sick Children
Caring for Kids—Canadian Paediatric Society
Blondell RD, Foster MB, et al. Disorders of puberty. Am Fam Physician. 1999;60(1):209-218.
Delayed puberty. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx. Updated May 11, 2013. Accessed June 4, 2014.
Delayed puberty. Nemours Kid's Health website. Available at: http://kidshealth.org/teen/sexual%5Fhealth/changing%5Fbody/delayed%5Fpuberty.html. Updated August 2011. Accessed June 4, 2014.
Female delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 15, 2013. Accessed June 4, 2014.
Male delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 7, 2012. Accessed June 4, 2014.
- Reviewer: Kari Kassir, MD
- Review Date: 01/2015
- Update Date: 06/04/2014
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