Well-Child Care Toolkit

Sexual Maturity Ratings

Sexual maturity ratings (SMRs) are widely used to assess adolescents' physical development during puberty in five stages (from preadolescent to adult). Also known as Tanner stages, SMRs are a way of assessing the degree of maturation of secondary sexual characteristics. The developmental stages of the adolescent's sexual characteristics should be rated separately (i.e., one stage for pubic hair and one for breasts in females, one stage for pubic hair and one for genitals in males), because these characteristics may differ in their degree of maturity.

Sexual Maturity Ratings: Males

SMR	Pubic Hair
Stage 1	Preadolescent
Stage 2	Scanty, long, slightly pigmented, primarily at base of penis
Stage 3	Darker, coarser, starts to curl, small amount
Stage 4	Coarse, curly; resembles adult type but covers smaller area
Stage 5	Adult quantity and distribution, spread to medial surface of thighs

SMR	Genitals
	Penis	Testes
Stage 1	Preadolescent	Preadolescent
Stage 2	Slight or no enlargement	Beginning enlargement of testes and scrotum; scrotal skin reddened, texture altered
Stage 3	Longer	Further enlargement of testes and scrotum
Stage 4	Larger in breadth, glans penis develops	Testes and scrotum nearly adult
Stage 5	Adult	Adult

Sexual Maturity Ratings: Females

SMR	Pubic Hair
Stage 1	Preadolescent
Stage 2	Sparse, slightly pigmented, straight, at medial border of labia
Stage 3	Darker, beginning to curl, increased amount
Stage 4	Coarse, curly, abundant, but amount less than in adult
Stage 5	Adult feminine triangle, spread to medial surface of thighs

SMR	Breasts
Stage 1	Preadolescent; elevation of papilla only
Stage 2	Breast and papilla elevated as small mound; areola diameter increased
Stage 3	Breast and areola enlarged with no separation of their contours
Stage 4	Projection of areola and papilla to form secondary mound above the level of the breast
Stage 5	Mature; projection of papilla only, areola has recessed to the general contour of the breast

Source: Tanner JM. 1962. Growth at Adolescence (2nd ed.). Oxford, England: Blackwell Scientific Publications.