Delayed Sexual Development
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Delayed Sexual Development

(Delayed Puberty; Delayed Sexual Maturation)

En Español (Spanish Version)

Definition

Girls normally enter puberty between the ages of 8-14, while the onset for boys is between the ages of 9-14. When there is a delay in puberty, it is called delayed sexual development.

For girls, delayed sexual development is defined as an absence of breast development by the age of 13, or an absence of menstruation for five years or more after initial breast development. Delayed sexual development for boys means their testicles don’t enlarge by age 14, or their sex organs don’t completely develop five years after they started to develop.

Causes

Delayed sexual development can be caused by chronic disease, abnormal chromosomes, or other factors. It can also be a variation of normal puberty, called constitutional delay. In this case, some adolescents simply take longer to develop than their peers, but eventually catch up. To understand the reason for the delay, it is necessary to look at potential causes including:

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Risk Factors

Both premature and delayed puberty can run in families. Certain long-term diseases can also increase the risk of delayed sexual development. Increased lead exposure has also been associated with delayed sexual development.

Symptoms

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

Diagnosis

The doctor will ask about your child’s symptoms and medical history, and perform a physical exam. An assessment of your child's pubertal milestones and growth will be performed. An x-ray of the left wrist bone may be taken 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

Treatment

The treatment of delayed sexual development depends upon the cause. For adolescents who are otherwise healthy and just developing later than their peers, often there is no treatment other than continued monitoring. For those who have a chronic underlying disease, treatment is aimed at the specific condition. Once the condition is treated, puberty typically proceeds. Treatments include:

Sex Hormone Replacement

Sex hormones are prescribed to those with chromosomal abnormalities, like Turner syndrome or Klinefelter syndrome, to help begin sexual development. Hormones may also be prescribed to teens who are severely delayed or overly stressed by their lack of development.

Letrozole

This drug can increase the height in boys with constitutional delay of puberty.

Psychological Support

Psychological support or counseling may be suggested for adolescents who are struggling with the delay in their development.

Surgery

Girls with Turner syndrome may have their ovaries surgically removed because of a risk of malignancy. If a tumor is found in the head, the doctor may remove the tumor.

Ongoing Monitoring

The doctor will continue to monitor your child’s height, weight, and sexual development to chart his or her progress and to see if any treatment given has been effective.

Prevention

Most causes of delayed sexual development cannot be prevented. To help reduce the chances of your child experiencing delayed puberty, you can make sure they are kept as healthy as possible. This includes making sure they are eating well and getting all the nutrients they need to meet their needs, and also making sure any underlying illnesses are treated.

RESOURCES:

The American Academy of Family Physicians
http://www.aafp.org

American Academy of Pediatrics
http://www.aap.org

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca

Caring for Kids
http://www.caringforkids.cps.ca/

References:

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.

Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. Am Fam Physician . Available at: http://www.aafp.org/afp/990700ap/209.html . Accessed July 5, 2005.

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 March 2008 by David Juan, 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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