Body development

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Body development

Puberty

Developmental phenomenon that completes childhood and introduces the person to adolescence.

Characterized by the appearance of primary and secondary sexual characteristics and by the "growth spurt", an acceleration of growth with which the definitive height is reached.

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Fertility is acquired and there is cognitive and psychosocial maturation.

The somatic changes typical of pubertal maturation have been divided into stages by Marshall and Tanner and this description still represents the reference standard today.

Puberty presents itself as a continuum, whose programming begins in prenatal age and ends in adult life, when all hormonal secretions are completely self-regulated.

Puberty timing varies and is due to genetic, nutritional and environmental factors

F 8-13 years (average 10.5) ----- breast bud M 9-14 (average 11) ----- testicles 4ml

Beginning

HYPOTHALAMIC-PITUITARY AXIS

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Even today, the precise molecular mechanism in the regulation of puberty is not entirely clear, but we know that at the genetic level the secretion of the hormone GnRH is activated.

HYPOTHALAMIC-PITUITARY AXIS HORMONES (e.g. OVARY)

GnRH

Stimulates the release of gonadotropins (FSH/LH)

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Stimulates follicular growth Stimulates the secretion of estrogen

FSH

Induces luteinization Stimulates ovarian hormone production

LH

Sexuality from a biological point of view: 1. Anatomical integrity 2. Endocrine system 3. Central and peripheral nervous system

PUBARCA

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Appearance of hair and secondary sexual characteristics. In females it precedes menarche, in males it precedes spermatogenesis.

Premature Appearance of pubic hair (scrotum/labia majora) of a sexual nature, without other pubertal signs. In a male < 9 years or a female < 8 years

TELARCA

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Isolated premature Breast development is transitory, it can persist for several years, very rarely until the onset of puberty, which occurs at a normal age:

• Transient thelarche of the infant
• Estrogen contamination
• Onset of true idiopathic precocious puberty
• Onset of true organic precocious puberty

SOME CAUSES OF PUBERAL DELAY

Chronic asthma Congenital cardiovascular malformations Nephrotic syndrome Chronic renal failure Cystic fibrosis Inflammatory bowel diseas Juvenile rheumatoid arthritis Diabetes mellitus Sickle cell anemia Celiac disease

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Menstrual cycle

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The roots and body of the clitoris, as well as the bulbs of the vestibule, are composed mainly of cavernous tissue in which sexual arousal is translated into vasodilation through the androgen-dependent pathway.

Female ejaculation (prevalence 10-50%)

• Female ejaculate: origin female prostate (Skene's glands) 30-50 ml, PSA
• Squirting: transurethral expulsion and increased amount of fluid

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Orgasm Neuromuscular phenomenon accompanied by a central perception judged pleasant by the cortex and characterized by a great variability of experienced intensity. It involves both centripetal activity (from the genitals to the CNS) and centrifugal activity (from the CNS to the muscular apparatus of the genital organs).

CUV (clitoris-urethra-vagina)

Sexual Desire and Hormones

Serotonin Endorphins Prolactin

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Estrogens Androgens Progesterone

Tanner's Puberty Development

From about 6-8 years of age until the completion of puberty, the following is observed:

• a progressive increase in LH and FSH concentrations - in the early part of puberty, the average LH levels increase more than those of FSH
• a nocturnal hypersecretion of LH is typical during the intermediate phase of puberty.

From 12 years old, testosterone Increase is observed: - modification of androgen-dependent organs and acquisition of secondary sexual characteristics- maturation of the endocrine glands of the male genital system - ejaculation - acquisition of fertility

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Why do the first andrological interview (post-pubertal period 16-20 years): 1. Verify that pubertal development has occurred or identify a picture of delayed puberty. 2. Exclude the presence of congenital or acquired anomalies of the genital system, in particular those potentially harmful to future reproductive capacity. 3. Establish a trusting doctor-patient relationship that gives space to elements of prevention and discussion of any insecurities regarding one's "sexual adequacy" and first experiences.

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SEXUAL MATURATION - Early- Late- Incomplete- Absent

Early diagnosis and timely intervention to prevent emotional-affective problems.

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EARLY Onset of pubertal development before the age of 9. It is due to hypersecretion of androgens which determine a development of secondary sexual characteristics that is disharmonious with the psycho-affective one.

Present in: Adopted People Covid

Affect: environment, stress, change of habits

1. TRUE (the entire endocrine axis is activated)- Idiopathic (familial): 40-50% [F =95%] - Neurogenic (CNS tumors, hydrocephalus)

2. PRECOCIOUS PSEUDOPUBERTY (incomplete virilization with 1 or 2 small testicles) - Secretory tumors - Adrenal hyperfunction - Testicular tumors - Androgen intake

DELAYED M 1. HYPOGONADOTROPIC HYPOGONADISM - Multiple pituitary hormone deficiency - Isolated GT deficiency - Constitutional delayed puberty (+) 2.HYPERGONADOTROPIC HYPOGONADISM - Klinefelter syndrome (47 XXY) - Congenital Anorchia (When there has been no increase in testicular volume by the age of 14-16)

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F > 13 .0 years old M > 14.0 years old Absence of menarche at 15 years old in women

F preterm False clitoromegaly a preterm infant may show a falsely hypertrophic clitoris in relation to the labia majora

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HYMEN Thin membrane of stratified squamous epithelium that surrounds the vaginal opening. The presence of mucus at the vaginal ostium is an indirect indicator of hymenal patency, which should always be verified.

Imperforate

Primary amenorrhea associated with recurrent pelvic pain. Rarely pain radiating to the lumbosacral region and constipation. Treatment is surgical.

GENITAL MALFORMATIONS F

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Synechiae minora labia Clitoral hypertrophy (clitoromegaly) Short vagina (vaginal hypoplasia)

Abnormal midline fusion of the labia minora making it impossible to visualize the external urethral meatus, vaginal entrance and hymen

Prematurity, androgenizing drug intake during pregnancy, syndromic conditions, idiopathic, frequent masturbation

Vaginal canal smaller than normal

GENITAL MALFORMATIONS M

At birth < 1.9 cm Between 6-12 years < 4 cm Adult < 9 cm

Micropenis

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Inability to retract the foreskin over the glans, and may be physiological in the first years of life. Also pay attention to the short Frenulum.

Phimosis

Cryptorchidism

Incomplete descent of one or both testicles into the scrotal sac

Micro-Orchid

Scrotal sac with smaller than normal dimensions

Hypospadias

Abnormal location of the external urethral meatus

Webbed penis

Absence of the angle between the penis and the scrotum