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Document Type

Article

Abstract

Pubertal anomalies fall into two major groups: errors of timing (delayed puberty and precocious puberty) and errors of congruence (for example, adolescent gynecomastia in boys, and hirsutism in girls). In cases of timing errors, the disparity between physique age and chronologic age creates a problem in social age which cannot correspond precisely with either. Social age includes academic age, recreational age and psychosexual age. Physique age dictates, in an almost automatic fashion, the expectancies of other people, who, therefore, overestimate the social age in precocious puberty, and underestimate it in delayed puberty. In consequence, the patient receives negative reinforcement when behaving concordantly with chronologic age. The patient with precocious puberty, for example, is expected by others to behave in a more adult manner than his chronologic age permits. From the patient’s point of view, it is a challenge to close the gap between social age and physique age, without the benefit of the usual period in which to learn more mature behavior. When I.Q. and school perfonnance permit, school acceleration has been successfully used to foster precocious social maturation. This, in turn, assists to ameliorate the feeling of being a misfit. Psychosexual maturation is concordant with social age rather than physique age, for the most part. Masturbation may or may not be increased in frequency, relative to chronologic age. Masturbation imagery is dependent upon erotic knowledge. Dating and romance follow the usual chronologic age patterns and do not parallel the precocious maturation of physique. Early and straightforward sex education is imperative and successful in guiding sexual behavior. To date, treatment with antagonistic hormone therapy has been unsuccessful. Consequently, psychologic help is primary to the successful management of cases of precocious puberty. For the teenager with delayed puberty, the discrepancy between physique age and chronological age induces others to infantilize or juvenilize the delayed boy or girl. In consequence, the patient may react accordingly. Also he may become a social isolate or loner. Psychosexual maturation is typically delayed and may be associated with long-term sexual inertia. Amelioration of problems of age-physique discrepancy in delayed puberty usually requires psychologic counseling and appropriate exogenous sex hormone therapy. The major problem for people with incongruous pubertal development is to reconcile the self-concept or body image with actual physique. Typically their major concern is the matching of physique and gender identity, by means of appropriate hormonal and/or surgical therapy. Teenagers with incongruous pubertal development tend to withdraw from social relationships—particularly those that may risk their revealing their medical problem to others. Dating and romantic relationships may be disrupted. While psychologic counseling is often helpful it is not always readily available.

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