Puberty

Definition: It is the period of life having a physiological changes proceeds over an average 4-5 years after initiated during which-

• Sex character develop
• Sex organ mature
• Reproductive capacity attained- maturation of hypothalamus, pituitary and gonads

Adolescence - Includes the physiologic, social, behavioral & personal independence leading to the development of adult identity. It is broader term than puberty.

Theories of Pubertal Initiation:
The exact cause of the initiation of pubertal changes is not fully understood

• Gonadostat theory
• Critical weight & body fat mass
• Onset of adrenal activity
• Sleep mechanism
• Central nervous system maturation

Pubertal Changes:
The sequence of events occurring at the time of puberty:

• Thelarche (breast development)- breast bud appears at age 9-11, sign of ovarian production & completed over 3 years.
• Adrenarche (maturation of adrenal gland)- production of 17 ketosteroids, DHEA & DHEAS, development of pubic (pubarche) and axillary hairs, follows after thelarche but can be first sign in 20% of girls.
• Growth spurt- 3 phases; 5cm/year of minimum growth velocity, 8.5cm/year of peak height velocity & stage of decrease velocity.
• Menarche (spontaneous first menstrual flow)
• Anatomical maturation of the genital tract
• Behavioral changes and psychic maturation

Pubertal Stages: Tanner's Classification:
Tanner's staging is a system based on the orderly, progressive development of breast (thelarche) & pubic hair in females.

Stages of pubic hair growth	Stages of breast development
No pubic hair.	No breast tissue (elevation of papilla only).	Stage  1
Sparse, long pigmented hair along the labia major.	Breast bud.	Stage  2
Darkening, coarsening, curling of hair which extends upwards and laterally.	Enlargement of breast and areola without separation.	Stage  3
Hair of adult consistency limited to the mons.	Areola and nipple form a mound on top of underlying breast tissue.	Stage  4
Hairs spread to the medial aspect of the thighs.	Adult configuration with areola and breast having smooth contour.	Stage 5

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Factors Affecting the Age of Menarche:
Age of menarche varies from society to society and in Egypt, it usually occurs around 12.5 years. Many factors can affect the age of menarche such as:

• Socio-economic factors
• Environmental factors
• Racial & geographical factors
• Medial & endocrinological diseases- blindness, deafness, epilepsy, obesity & diabetes (all accelerates puberty development)