Sexual Development in Girls: Reviewing the Tanner Stages

Sexual development in girls occurs in predictable stages. J.M. Tanner divided the visible changes of puberty into five stages and published his work back in 1962. Since that time, the stages of pubertal development in girls have become known as The Tanner Stages.

There are 5 Tanner Stages of sexual development in girls. The ability to have predictable stages of puberty is particularly useful for physicians. Physicians identify which Tanner stage a child is in as a means to determine if the child is developing appropriate physical sexual characteristics at the appropriate age. For example, a 5 year old girl with sexual characteristics of Tanner stage 2 may have precocious puberty and need further medical work up.

Certain aspects of sexual development are shared between boys and girls. These include adrenarche (also called pubarche) which is the appearance of pubic hair, and a growth spurt. There are additional stages of sexual development that are not considered in the Tanner stages. These stages of sexual development, though not in the visible Tanner stages, occur predictably in boys and girls. For example, menarche (onset of menses) in girls and nocturnal emissions (wet dreams) in boys.

The overall sexual development of girls occurs in a very specific sequence. Sexual development in girls begins with thelarche (breast development), then adrenarche (pubic hair development), then a growth spurt (quick increase in height), and finally menarche (onset of menses) occurs.

Sequence of Visible Sexual Development in Girls:

Tanner Stage 1 in Girls:

Breast- preadolescent breasts with elevation of the papilla only

Pubic hair- none

Tanner Stage 2 in Girls:

Breast- breast buds develop and areolar diameter enlarges.

Pubic hair- sparse growth of long, slightly pigmented, straight or minimally curled hair that grows primarily along the labia.

Tanner Stage 3 in Girls:

Breast- further enlargement of the breast and areola with no separation of their contours.

Pubic hair- hair becomes darker and curlier

Tanner Stage 4 in Girls:

Breast- the areola and papilla project to form a secondary mound above the level of the breast.

Pubic hair- adult type pubic hair covers an area smaller than in the adult and does not extend onto the thighs.

Tanner Stage 5 in Girls:

Breast- the breasts look like mature female breasts, the areola has recessed to the general contour of the breast.

Pubic hair- the hair is adult in quantity and type and extends on to the thighs.