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Delayed Sexual Development

(Delayed Puberty; Delayed Sexual Maturation)

Definition

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:
  • Lack of breast development by the age of 13 or
  • Lack of menstruation for five years or more after initial breast development
Delayed sexual development for boys is defined as:
  • Testicles that don’t enlarge by age 14.
  • Sex organs that don’t completely develop within five years after they started to develop.

Causes

This condition can be caused by:
  • Constitutional delay—some children simply take longer than their peers; they will at some point catch up
  • Chronic disease
  • Abnormal chromosomes
  • Other factors
To understand the reason for the delay, it is necessary to look at potential causes including:
Complications From Cystic Fibrosis
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Risk Factors

Factors that may increase the chance of delayed puberty include:
  • Family history
  • Having certain long-term diseases

Symptoms

One common symptom for both boys and girls is shortness in height. Other symptoms by sex 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. A physical exam will be done. Your doctor will review your child's milestones and growth record. 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

Treatment

There 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. Once the condition is treated, puberty often proceeds on its own.
For others treatments may include:

Sex Hormone Replacement

Sex hormones will help begin sexual development. They may be given to those with chromosomal abnormalities. This can include Turner 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. They may help increase height in boys with constitutional delay of puberty.

Psychological Support

Counseling may be suggested for adolescents who are struggling with the delay. This may help the child cope with social pressures.

Ongoing Monitoring

The doctor will continue to monitor your child’s height, weight, and sexual development. This will help determine if any treatment has been effective.

Prevention

Most causes of delayed sexual development cannot be prevented. To help reduce the chance, make sure your child is kept as healthy as possible. This includes making sure they are eating well and getting all the nutrients they need. Make sure any underlying illness is treated.

RESOURCES

The American Academy of Family Physicians http://familydoctor.org/

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

CANADIAN RESOURCES

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

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

References

Delayed puberty. Nemours Kidshealth website. Available at: http://kidshealth.org/teen/sexual%5Fhealth/changing%5Fbody/delayed%5Fpuberty.html . Accessed August 17, 2012.

Delayed Puberty. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx . Accessed August 17, 2012.

Female delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 22, 2012. Accessed August 17, 2012.

Male delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 7, 2012. Accessed August 17, 2012.

Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. Am Fam Physician . Available at: http://www.aafp.org/afp/990700ap/209.html . Accessed August 17, 2012.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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