Protocol - Assessment of Pubertal Development - Female
The female participant uses the Tanner staging drawings to self-assess her breast development and pubertal hair.
Please use the appropriate male- or female-specific protocols.
From Avon Longitudinal Study of Parents and Children (ALSPAC):
We would like to assess the stage of your physical development using the drawings on the next pages. These show various stages commonly used by doctors to assess the growth and development of girls. We need to know which drawings most closely match your stage of development at the moment. Not all teenagers follow the same pattern of development. Just pick the stage that is closest, based on both the picture and the description.
The drawings below show stages of the way the breasts develop. A teenager can go through each of the five stages shown, although some teenagers skip some stages. Please look at each of the drawings. It is also important to read the descriptions.
Cross the box that is closest to your current breast stage
1 [ ]The nipple is raised a little in this stage. The rest of the breast is still flat.
2 [ ]This is the breast bud stage. In this stage the nipple is raised more than in stage 1. The breast is a small mound. The dark area around the nipple (areola) is larger than in stage 1.
3 [ ]The areola and the breast are both larger than in stage 2. The areola does not stick out away from the breast.
4 [ ]The areola and the nipple make up a mound that sticks up above the shape of the breast. (Note: This stage may not happen at all for some teenagers. Some teenagers develop from stage 3 to stage 5 with no stage 4.)
5 [ ]This is the mature adult stage. The breasts are fully developed. Only the nipple sticks out in this stage. The areola has moved back in the general shape of the breast.
The drawings below show different amounts of female pubic hair. A teenager can go through each of the five stages shown. Please look at each of the drawings. It is also important to read the descriptions.
Cross the box that is the closest to the amount of pubic hair you have.
1 [ ]There is no pubic hair
2 [ ]There is a little long, lightly coloured hair. This hair may be straight or a little curly.
3 [ ]The hair is darker in this stage. It is coarser and more curled. It has spread out and thinly covers a bigger area.
4 [ ]The hair is now as dark, curly, and coarse as that of an adult woman. However, the area that the hair covers is not as large as that of an adult woman. The hair has not spread out to the legs.
5 [ ]The hair is like that of an adult woman. It also covers the same area as that of an adult woman. The hair usually forms a triangular pattern as it spreads out to the legs.
NOTE: Your pubic hair stage may or may not be the same as your stage of breast development.
Protocol Name from Source:
Avon Longitudinal Study of Parents and Children (ALSPAC). Growing and Changing (8), Female Teenage Questionnaire
Personnel and Training Required
Paper and pencil
|Specialized requirements for biospecimen collection||No|
|Average time of greater than 15 minutes in an unaffected individual||No|
Mode of Administration
Child, Adolescent, Adult
Females aged 6-20 years
The Avon Longitudinal Study of Parents and Children (ALSPAC) provides Tanner stage drawings that have been widely used for decades with adolescent males and females to determine their own perceptions of pubertal development.
|Common Data Elements (CDE)||Person Puberty Development Assessment||3007416||CDE Browser|
|Logical Observation Identifiers Names and Codes (LOINC)||Assess pubertal dev female proto||62644-0||LOINC|
Process and Review
The Expert Review Panel #5 (ERP 5) reviewed the measures in the Reproductive Health domain.
Guidance from ERP 5 includes:
· No significant changes to measure
Back-compatible: no changes to Data Dictionary.
University of Bristol. Department of Social Medicine. (n.d.). Avon Longitudinal Study of Parents and Children (ALSPAC). Growing and Changing (8), Male Teenager Questionnaire. Oakfield Grove, Bristol, UK: Author. Questions B1-B5 and C1-C5.
Certification for the Spanish translation can be found here.
Jenner, M. R., Kelch, R. P., Kaplan, S. L., & Grümbach, M. M. (1972). Hormonal changes in puberty. IV. Plasma estradiol, LH, and FSH in prepubertal children, pubertal females, and in precocious puberty, premature thelarche, hypogonadism, and in a child with a feminizing ovarian tumor. Journal of Clinical Endocrinology and Metabolism, 34(3), 521-530.
Maliqueo, M., Sir-Peterman, T., Perez, V., Echiburu, B., Ladron de Guevara, A., Galvez, C., Crisosto, N., & Azziz, R. (2009). Adrenal function during childhood and puberty in daughters of women with Polycystic Ovary Syndrome. Journal of Clinical Endocrinology and Metabolism, 94, 3282-3288.
Marshall, W., & Tanner, J. (1969). Variations in the pattern of pubertal changes in girls. Archives of Disease in Childhood, 44, 291-303.
Sizonenko, P. C., Burr, I. M., Kaplan, S. L., & Grümbach, M. M. (1970). Hormonal changes in puberty. II. Correlation of serum luteinizing hormone and follicle stimulating hormone with stages of puberty and bone age in normal girls. Pediatric Research, 4(1), 35-45.
|Variable Name||Variable ID||Variable Description||Version||dbGaP Mapping|
|PX100101_Female_Breast_Development_Stage||PX100101010000||Cross the box that is closest to your current breast stage.||Variable Mapping|
|PX100101_Female_Pubic_Hair_Development_Stage||PX100101020000||Cross the box that is closest to your current pubic hair stage.||Variable Mapping|
Assessment of Pubertal Development
April 11, 2017
Separate male- and female-specific protocols to assess stage of puberty. Stage of puberty can be assessed by pubic hair, female breast development, and the size and shape of the male testes.
The purpose of these protocols is to assess stage of puberty.
Reproductive health, puberty, breast development, testes development, Tanner staging, Avon Longitudinal Study of Parents and Children, ALSPAC