Puberty is the period of life during which his body is a biological sexual maturity. This period is called puberty and is characterized by the appearance of secondary sexual characteristics (see Sexual characteristics), final formation of the sexual organs and sexual glands. The time of onset of puberty depends on many factors - nationality, climatic conditions, nutrition, living conditions, gender, and so on, boys, on average comes from 15-16, girls with 13-14 years and ends respectively by 20 and 18 years. It should be emphasized that the dates of the onset of puberty, there are significant individual deviations. In physiological respect of this period is characterized by the maturity and the operation of the sex glands. In the adrenal cortex start hard to produce androgens (see Sex hormones), increases the secretion of pituitary gonadotropins (see Gonadotropic hormones)that accelerates the development of the sex glands. Girls with strengthening the function of the ovaries to produce estrogen, begins the growth of the mammary glands, external and internal genital organs of uterus, vagina, labia. At the age of 14-15 years, sometimes earlier, the development of the menstrual cycle (see). Objective criterion of maturity of the sex glands are menstruating girls and emission (see) in boys. The most common sequence of appearance of the sexual characteristics presented in the table.

The sequence of signs of puberty
Age in years Signs of puberty
girls boys
8 The pelvis becomes wider, rounded hips  
9 The increased secretion of the sebaceous glands  
10-11 The beginning of the development of the mammary glands The beginning of the growth of the penis and testicles
12 The appearance of hair on the genitals, increase sexual organs The growth of the larynx
13 Alkaline reaction in the vaginal secretion becomes sour Enlargement of the testicles and penis. Small hair to appear on the genitals. The beginning of the formation of the skeleton of a male
14 The appearance of menstruation and the appearance of hair in axillary hollows Change the voice (broken), a slight increase (swelling) of the breast
15 Significant changes in size of the pelvis and proportions of female type Pigmentation of the scrotum, the emergence of a mustache and hair to appear in axillary hollows. Significant enlargement of the testicles
16-17 Menstruation occurs regularly, with ovulation (see the Menstrual cycle). Increased hair growth on the face, body; male type of vegetation on the pubis. The occurrence of wet dreams
18-19 Stops the growth of the skeleton The slowdown in the growth of the skeleton

Often normal puberty occurs in a slightly different sequence. In these cases, it is sometimes very difficult to find a clear line between norm and pathology. One of the reasons for such deviations are violations hormonal systems, in other cases, a particular importance constitutional features of a teenager in puberty, and psychogenic factors that can lead to significant endocrine disorders. It is extremely important to consider these cases, as the irrational use of hormonal therapy for the treatment may cause significant damage to many systems. During puberty, there are sometimes small temporary deviations, i.e. variation of the normal development process. They are regarded as a physiological phenomenon. Girls may be significant growth of mammary glands (macromastia), and premature puberty is reached. To the physiological variations puberty include menstrual irregularities, juvenile uterine bleeding, amenorea (see). Often there are painful menstruation, accompanied by headaches, vomiting, weakness. These disorders commonly seen in women with unstable nervous system. Boys may be small breast growth (pubertal gynecomastia), which fully takes place.
Late (pubertas tarda) is considered puberty observed in girls at the age of 18-20, the boys in 20 - 22 years. With this pathology, therapeutic measures should be directed on improvement of conditions of life, food and the introduction of male, female sex hormones and products containing gonadotropic hormones of the pituitary gland. The delay of sexual development and stunted growth observed in the infantilism (see). Underdevelopment of the sexual apparatus and the absence of sexual characteristics given sex - gipogenitalizm (see) is caused by a dysfunction of endocrine glands and first of all of the pituitary gland.
Early (pubertas raesk) is considered puberty, coming in girls younger than 8 years in boys younger than 10 years and is characterized by the premature appearance of secondary sexual characteristics, the rapid development of the genital organs, and accelerated growth. Boys this is reflected in the growth acceleration, and then early termination growth (which further leads to stunting), the fast growth of sex organs and the appearance of secondary sexual characteristics (hair growth, low voice, expressed skeletal muscles). Possible erections and wet dreams. Girls marked acceleration of growth, and then early cessation of growth, pelvis becomes wide, increase the size of the uterus and ovaries. There are cases of menstrual periods in pre-school age.
Early puberty in combination with the rapid growth, but sharp disproportion of the skeleton, short stature and mental retardation is defined as macrogenitosomia praesox.
The problem of puberty is closely related to the issue of sex education. It is a system of medical, educational influence on adolescents with the aim of instilling in them the certain norms of behavior in sexual life. The objective of sex education is to create a physically healthy generation, sextila life which should be subordinated to moral standards of our society. Joint training and education of boys and girls, early involvement in public life, combining education with productive labour, wide development of physical culture and sports among the youth create the basis for a reasonable generic upbringing.

Puberty (lat. pubertas) - the process of growth and differentiation of sexual glands, sexual organs and secondary sexual characteristics. Puberty occurs with the complex changes in the nervous, endocrine, cardiovascular and other systems of the organism, physical development and ends with the onset of puberty.
A major role in sexual maturation plays the hypothalamus area, located in close functional relationship with the pituitary gland. In the period of P.F. has raised the activity of gonadotropic hormones of the pituitary gland, increases the content of androgen and estrogen in the blood and urine. The estrogen produced by the ovaries cause the increase of the uterus, vagina, labia minora, mammary glands and keratinization of the vaginal epithelium. Androgens are responsible sexual adult, the growth of the penis and scrotum in boys and in girls - the clitoris and the labia majora. Sex hormones, especially the androgens, stimulates growth and differentiation of bone tissue, promote the closure of the areas of growth, enhance muscle development. In these processes is evident protein anabolic effects of sex hormones. The relationship between different systems, regulatory P.F. shown in Fig. 1.

Fig. 1. The scheme of interrelations between the different systems that regulate growth and sexual development (from Willensward, Wilkins).

Puberty begins earlier in girls than in boys. During this period, girls are significantly increases the excretion of urine estrogen and gonadotropinov, and boys - androgens. In recent years in all countries of the commencement of P.F. moved to an earlier period. So, according to the observations C. S. Gruzdev related to 1894, menses have begun in 15 years 8 months. currently (1965) they start the bowl in the 13-14 years. In boys, the date of onset of sexual maturity is set on the first ejaculations. Beginning and duration of puberty depend on family (constitutional) features, body composition and environmental conditions (food, climate, housing and other). P.F. begins girls from 8-11 and usually 17 years of age, the young men, with 10-13 and up to 19 years.
In the period of pubescence may be hypertensive response and hypotonic condition, lability heart rate, acrocyanosis, spots trusso, orthostatic albuminuria, spontaneous hypoglycemia, and sometimes mental disorders. The degree of P.F. judged by secondary sexual characteristics - owolosenie pubic hair (11-13 years) and in the armpit (12-15 years), girls, moreover, in terms of the beginning of menstruation and breast development (10-15 years), and also with the help of x-ray of the hand and distal ends of the bones of the forearm. The beginning of P.F. corresponds ossification sesamoides bones, then you receive siestas in the first metacarpal bones and terminal phalanges; at the end of P.F. is full serotoninovye epiphyses radiation and ulna. To assess the degree of P.F. boys by dimensions of the external genitalia should carefully because their growth is often lagging behind.
Premature puberty (pubertas praecox) is true and the false. If true there is a linkage between the hypothalamic-pituitary region, sex glands and the adrenal glands. There are constitutional (essential) and cerebral form of the true P.F.
Constitutional form is observed almost always in girls, and caused, apparently, by family type. Secondary sexual characteristics appear early, even from birth, but more often in 7-8, and menstruation - in 8-10 years. The ovulatory menstrual period. Boys ' secondary sexual characteristics can occur already in 9-11 years, rarely before. There macrogematuria (premature increase in external genital organs). 12 - 13 years of P.F. ends.
Originally children with premature puberty ahead in the physical development of their peers. However, in the future due to the closure of the areas of growth, some of them have short stature and disproportionality lower extremity relatively short compared to the trunk (Fig. 2). Mental development of such children often corresponds to the age, as if behind, approximately 2 years. Girls excretion of follicle-stimulating hormone or estrogen with urine reaches puberty. Contents 17-ketosteroidov daily urine exceeds the level of age norm. For tumors of the adrenal and sexual glands level excretion of hormones is much higher. Vaginal smear confirms the normal menstrual cycle.
The prognosis for constitutional form of premature P.F. favorable. The treatment is not provided.
When cerebral form of the true puberty are the defeat of the hypothalamic region (tumors, hemorrhage, birth defects of the brain, encephalitis) or swelling of the pineal gland. Currently, most researchers believed that even if the pineal gland tumors premature sexual development again due to changes arising in the hypothalamus in connection with the internal hydrocephaly. In children celebrated early and rapid development of the sexual organs and secondary sexual characteristics. In the ovaries arise Mature grafovi follicles, a yellow body. In the testicles are formed interstitial cells and occurs spermatogenesis. The content of the gonadotropins, estrogens, 17-ketosteroid Dov in urine corresponds pubertal period.
Premature P.F. observed, when multiple fibrous dysplasia, in which there are changes in bone, skin pigmentation and increased activity of the thyroid gland.
False sexual maturation (pseudopubertas praecox) occurs when pathological changes in the adrenal glands, ovaries or testes. Ovulation and spermatogenesis missing. After removal of the tumor may reverse the development of secondary sexual characteristics.
Delayed puberty (pubertas tarda) characterized the later development of the genital organs and glands, and the appearance of secondary sexual characteristics. In boys, it is diagnosed in the age of 20-22, girls at the age of 18-20. Most often occurs under the influence of constitutional (family) factor, less often due to poor hygienic conditions, and nutritional reasons. The delay of P.F. observed sometimes to 15-16 years. This is behind the physical and often mental development. Differentiation of bone system also lags behind, often in 2-4 years. Most children in years to reach sexual development of their peers.
Assessment of puberty should be based on the number of signs and especially x-ray data on the differentiation of bone. Compliance of ossification of the actual age, usually eliminates the lag in P.F.
Variation of puberty. Premature breast development (premature thelarche) girls may be the only sign of deviations. Absence of secondary sexual characteristics, estrogen changes vaginal smear and increase internal and external genital organs to differentiate the process from the true P.F. Suggest that in the basis of premature telarche lies increased reaction breast tissue to estrogens. In the future, this reaction may disappear. Treatment is not required.
Boys often observed pubertal gynecomastia (see), expressed more often on the left and disappearing without treatment. Treatment of male sex hormones is contraindicated.
Premature secondary adult premature pubarche) develops pubic armpits without other signs of virilization and is more often observed in girls. Only 10-12 years it is combined with increasing mammary glands, external and internal genital organs. Later, the children develop normally. Urinary excretion of 17-ketosteroids corresponds to age norm or exceeds it. Children with premature P.F. require the observation of the doctor and should be periodically tested.
During puberty, sometimes there is an increase in thyroid II and III degree without dysfunction. Treatment it has not done. Often, especially boys, are developing akromegaliei phenomena (physiological). Perhaps the predominance of male or female. The prognosis of this favourable. In the same period, sometimes there is the so-called pseudoreligious type of obesity, somewhat similar in outward appearance to the obesity in adipose-genital dystrophy (see). The distribution of fat even with a certain predominance in the chest, abdomen and thighs. Hands and feet often shortened. Body length and differentiation of bone correspond to the actual age. Gipogenitalizm missing or expressed slightly. The selection of 17-ketosteroids and 17-oxycorticosteroids with urine in the norm. The main currency is reduced or normal. P.F. comes in normal times or more lags. Drug treatment is not required.
In the period of puberty in girls with symptoms of basophilia (basophilic cells of the pituitary gland strenuously function) there is a female type of obesity, appear strip on the thighs, buttocks, Breasts. Blood pressure is often raised. However, sexual development does not broken or even accelerated. Menstruation occur in time, and the cycle saved. Forecast, as in the above variants of obesity, favorable.
Pubertal depletion is observed mainly among girls. The first symptoms: loss of appetite, abdominal pain, belching and vomiting, often repeated. The skin is dry, wrinkled. Marked bradycardia, dull colours of the heart, arterial hypotension, amenorrhea. Unlike pituitary cachexia, there is atrophy of the mammary glands and hair loss. The main currency reduced. Thyroid function is not broken. The content of 17-ketosteroids, urine is reduced, after the introduction of ACTH reach the standards. Follicle-stimulating hormone in the urine more often absent or reduced. The prognosis is generally favorable. Treatment needs special care, chlorpromazine, the protein anabolic steroids. Methandrostenolone (or nerobolum) 5 mg per day, probaly intramuscularly in a dose of 25-50 mg 1 time per week (4-6 injection).
To diagnosis, prescription medicines, especially hormones, and prediction of diseases and conditions within the period of P.F. should be approached with caution.

Fig. 2. Girl 2.5 years: early sexual and physical development (the growth of 110 cm).