Article
Tanner Stages
The Tanner (Sexual Maturity Rating, SMR) stages classify physical development during puberty for breasts/genitalia and pubic hair (P1–P5; in females often referenced as B1–B5 for breasts, PH1–PH5 for pubic hair).
Female Breast (B) Stages
- B1: Prepubertal, no glandular tissue.
- B2: Breast bud; small mound, areolar enlargement (thelarche onset). See thelarche.
- B3: Enlargement of breast and areola; no contour separation.
- B4: Areola and nipple form secondary mound above breast contour.
- B5: Mature breast; recession of secondary mound (variable).
Female Pubic Hair (PH) Stages
- PH1: Vellus hair only (prepubertal).
- PH2: Sparse, lightly pigmented hair along labia.
- PH3: Darker, coarser, curling hair spreading over mons.
- PH4: Adult-type hair, less lateral spread.
- PH5: Adult distribution, inverse triangle, possible medial thigh spread.
Utility
- Standardizes assessment of pubertal progression.
- Guides evaluation for disorders (precocious vs delayed puberty).
- Correlates with growth velocity and bone maturation.
Limitations
- Inter-observer variability.
- Staging intervals are not equal in time; overlap common.
- Breast staging complicated by adiposity (lipomastia) vs glandular tissue.