Editing Tanner scale

{{short description|Physical development scale of children, adolescents, and adults}}
{{Infobox diagnostic
| name = Tanner scale
| image = 
| alt = 
| caption = 
| pronounce = 
| purpose = Defines physical measurements of development
| test of = 
| synonyms = Tanner stages
}}
The '''Tanner scale''' (also known as the '''Tanner stages''' or '''sexual maturity rating''' ('''SMR''')) is a scale of [[Development of the human body|physical development]] as [[pre-pubescent]] [[children]] transition into [[adolescence]], and then [[adult|adulthood]]. The scale defines [[Measurement|physical measurements]] of development based on external [[primary sex characteristic|primary]] and [[secondary sex characteristic]]s, such as the size of the [[breast]]s, length of the [[penis]], volume of the [[testes]], and growth of [[pubic hair]]. This scale was first quantified in 1969 by [[James Mourilyan Tanner|James Tanner]], a British [[pediatrician]], after a two-decade-long study following the physical changes in girls undergoing [[puberty]].<ref>{{WhoNamedIt|synd|3082|Tanner's stages}}</ref><ref name="pmid5440182">{{cite journal |vauthors=Marshall WA, Tanner JM |title=Variations in the pattern of pubertal changes in boys|journal=Arch. Dis. Child. |volume=45 |issue=239 |pages=13–23 |date=February 1970 |pmid=5440182 |pmc=2020414 |doi= 10.1136/adc.45.239.13}}</ref><ref name="pmid5785179">{{cite journal |vauthors=Marshall WA, Tanner JM |title=Variations in pattern of pubertal changes in girls |journal=Arch. Dis. Child. |volume=44 |issue=235 |pages=291–303 |date=June 1969 |pmid=5785179 |pmc=2020314 |doi= 10.1136/adc.44.235.291}}</ref><ref>{{Citation|last1=Emmanuel|first1=Mickey|title=Tanner Stages|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK470280/|work=StatPearls|publisher=StatPearls Publishing|pmid=29262142|access-date=2019-08-01|last2=Bokor|first2=Brooke R.}}</ref>

{{Multiple image
| image1            = Tanner scale male intact.svg
| image2            = Tanner scale-female.svg
| caption1          = Illustration for males
| caption2          = Illustration for females
| width2            = 285
| align             = right
| header            = Tanner scale
}}

Due to [[Human variability|natural variation]], individuals pass through the Tanner stages at different rates, depending in particular on the timing of [[puberty]]. Among researchers who study puberty, the Tanner scale is commonly considered the "gold standard" for assessing pubertal status when it is conducted by a trained medical examiner.<ref name="Puberty and Its Measurement">{{cite journal |vauthors=Dorn LD, Biro FM |title=Puberty and Its Measurement: A Decade in Review|journal=Journal of Research on Adolescence |volume=21 |issue=1 |pages=180–195 |date=February 2011 |doi= 10.1111/j.1532-7795.2010.00722.x}}</ref> In [[HIV]] treatment, the Tanner scale is used to determine which regimen to follow for pediatric or adolescent patients on [[Management of HIV/AIDS|antiretroviral therapy]] (adult, adolescent, or pediatric guidelines).<ref>{{Cite web|url=https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/21/adolescents-and-young-adults-with-hiv|title=Adolescents and Young Adults with HIV Considerations for Antiretroviral Use in Special Patient Populations Adult and Adolescent ARV|website=AIDSinfo|language=en-US|access-date=2019-08-01}}</ref> The Tanner scale has also been used in forensics to determine aging, but its usage has decreased due to lack of reliability.<ref>{{Cite book|title=Encyclopedia of forensic and legal medicine|others=Payne-James, Jason,, Byard, Roger W.|isbn=9780128000557|edition= Second|location=Amsterdam, Netherlands|oclc=924663619|date = 2015-09-29}}</ref>

==Stages==
Adapted from ''Adolescent Health Care: A Practical Guide'' by Lawrence Neinstein.<ref>{{Cite book|title=Adolescent health care : a practical guide|date=2008|publisher=Lippincott Williams & Wilkins|others=Neinstein, Lawrence S., Neinstein, Lawrence S.|isbn=9780781792561|edition= 5th|location=Philadelphia|oclc=148727849}}</ref>

===Genitals (male)===
[[File:Male genitalia five Tanner stages.png|350px|thumb|Photos of the Tanner scale for males.]]
; Tanner I
: [[Testicle|testicular]] volume less than 1.5 [[liter|ml]]; small [[Human penis|penis]] ([[Puberty|prepubertal]]) 
; Tanner II
: testicular volume between 1.6 and 6 ml; skin on scrotum thins, reddens and enlarges; penis length unchanged 
; Tanner III
: testicular volume between 6 and 12 ml; scrotum enlarges further; penis begins to lengthen
; Tanner IV
: testicular volume between 12 and 20 ml; scrotum enlarges further and darkens; penis further increases in length and starts to increase in breadth
; Tanner V
: testicular volume greater than or equal to 20 ml; adult scrotum and penis

===Breasts (female)===
[[File:Female breasts five Tanner stages.jpg|240px|thumb|Photos of the Tanner scale for females]]
; Tanner  I
: no glandular tissue: [[areola]] follows the skin contours of the chest ([[Puberty|prepubertal]])
; Tanner II
: [[Thelarche|breast bud]] forms, with small area of surrounding glandular tissue; areola begins to widen 
; Tanner III
: breast begins to become more elevated, and extends beyond the borders of the areola, which continues to widen but remains in contour with surrounding breast
; Tanner IV
: increased breast sizing and elevation; areola and [[nipple|papilla]] form a secondary mound projecting from the contour of the surrounding breast
; Tanner V
: breast reaches final adult size; areola returns to contour of the surrounding breast, with a projecting central papilla

===Pubic hair (both male and female)===
; Tanner I
: no pubic hair at all ([[Puberty|prepubertal]])
; Tanner II
: small amount of long, downy hair with slight pigmentation at the base of the [[human penis|penis]] and [[scrotum]] (males) or on the [[labia majora]] (females) 
; Tanner III
: hair becomes more coarse and curly, and begins to extend laterally
; Tanner IV
: adult-like hair quality, extending across [[mons pubis|pubis]] but sparing medial thighs
; Tanner V
: hair extends to medial surface of the thighs

==Height==
During Tanner V, females stop growing and reach their adult height. Usually, this happens in their mid teens at 14 or 15 years for females. 

Males also stop growing and reach their adult height during Tanner V; usually this happens in their late teens at 16 to 17 years, {{medical citation needed|date=July 2023}} but can be a lot later, even into the early 20s.

==Historical data==
In 1970, boys reached the last Tanner stage, the postpubertal stage, on average at the age of 14.9 years and girls around the age of 14 depending on social class and the particular study.<ref>{{cite journal |last1=Marshall |first1=W. A. |last2=Tanner |first2=J. M. |title=Variations in the Pattern of Pubertal Changes in Boys |journal=Archives of Disease in Childhood |date=1 February 1970 |volume=45 |issue=239 |pages=13–23 |doi=10.1136/adc.45.239.13 |pmid=5440182 |pmc=2020414 }}</ref> In the nearly fifty years since those studies, the ages at which children are beginning puberty has only declined: ({{asof|2018|lc=y}}) "The age of puberty, especially female puberty, has been decreasing in western cultures for decades now [...] for example, at the turn of the 20th century, the average age for an American girl to get her period was 16 or 17. Today, that number has decreased to 12 or 13 years."<ref>{{cite web | url=https://vitalrecord.tamhsc.edu/decreasing-age-puberty/ | title=The decreasing age of puberty |website= Texas A&M Health Science Center|date=10 January 2018 }}</ref>

==Criticism==
The scale has been criticized by the [[pornography]] industry for its potential to lead to false [[child pornography]] convictions, such as in the case of [[pornographic actress]] [[Lupe Fuentes]] where in 2009 United States federal authorities used it to assert that she was not an adult despite her age. Fuentes personally appeared at the trial and provided documentation that showed that the DVDs in question were legally produced.<ref>{{cite news|url=http://business.avn.com/articles/Lupe-Fuentes-Saves-Man-From-Bogus-Child-Porn-Charge-394003.html|title=Lupe Fuentes Saves Man From Bogus 'Child Porn' Charge|date=April 16, 2010|work=AVN|access-date=November 9, 2013|archive-date=January 29, 2012|archive-url=https://web.archive.org/web/20120129004325/http://business.avn.com/articles/Lupe-Fuentes-Saves-Man-From-Bogus-Child-Porn-Charge-394003.html|url-status=dead}}</ref><ref>{{cite web|title=Adult Film Star Verifies Her Age, Saves Fan From 20 Years In Prison|url=http://www.radaronline.com/exclusives/2010/04/adult-film-star-verifies-her-age-saves-fan-20-years-prison |work=Radar Online|date=April 21, 2010}}</ref>

Tanner, the author of the classification system, has argued that age classification using the stages of the scale misrepresents the intended use. Tanner stages do not match with chronological age, but rather maturity stages and thus are not diagnostic for age estimation.<ref name="pmid9882230">{{cite journal|last=Rosenbloom|first=AL|author2=Tanner, JM |title=Misuse of Tanner puberty stages to estimate chronologic age.|journal=Pediatrics|date=December 1998|volume=102|issue=6|page=1494|doi=10.1542/peds.102.6.1494|pmid=9882230}}</ref>

==See also==
* [[Delayed puberty]]
* [[Gonadarche]]
* [[Precocious puberty]]
* [[Pubarche]]
* [[Vellus hair]]

==References==
{{reflist|30em}}

==External links==
{{Commons category|Tanner scale}}
{{Spoken Wikipedia|En-tanner-scale.ogg|date=2019-04-16}}
* [https://fpnotebook.com/Endo/Exam/MlTnrStg.htm The Male Tanner stages]
* [https://fpnotebook.com/Endo/Exam/FmlTnrStg.htm The Female Tanner stages]
* {{cite web |url=https://www.afraidtoask.com/vulva/ |title=Line drawing of female Tanner stages (genitals)}}
* {{cite web |url=https://www.afraidtoask.com/penis/ |title=Line drawing of male Tanner stages}}

{{Reproductive physiology}}
{{Authority control}}

[[Category:Medical scales]]
[[Category:Endocrinology]]
[[Category:Paraphilias]]
[[Category:Pediatrics]]
[[Category:Sexology]]
[[Category:Sexuality and age]]
[[Category:Puberty]]
[[Category:1969 introductions]]