Delayed Puberty (Pubertas Tarda): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; furthermore:
  • Inspection (viewing) of the skin, mucous membranes, abdominal wall, and inguinal region (groin area).
  • Inspection and palpation (palpation) of the thyroid gland [goiter (thyroid enlargement)?]
• Gynecological examination (girl)
  • Inspection
    • Vulva (external, primary female sexual organs).
    • Vagina (vagina)
    • Cervix uteri (cervix), or portio (cervix; transition from the cervix (cervix uteri) to the vagina (vagina)), if necessary, taking a Pap smear (for early detection of cervical cancer).
  • Palpation (bimanual; palpation with both hands) of the internal genital organs.
    • Cervix uteri (cervix).
    • Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal-sized]
    • Adnexa (appendages of the uterus, i.e., the ovary (ovary) and uterine tubule (fallopian tube)) [Normal: free]
    • Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
    • Pelvic walls [Normal: free]
    • Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) at the back and the uterus (uterus) at the front) [Normal: clear].
  • Inspection of the mammae (breasts), right and left; nipple (breast), right and left; and skin [Normal: unremarkable; furthermore, note the following:
    • Galactorrhea/diseased breast milk discharge? (due tohyperprolactinemia/elevation of blood prolactin levels);
    • In case of primary amenorrhea: assessment of the mammaries (breasts) according to “Tanner’s pubertal development”.
  • Palpation of the mammae, the two supraclavicular pits (upper clavicular pits) and axillae (axillae) [Normal: unremarkable].
• Urological examination (boy)
  • Inspection and palpation (palpation) of the mammae (mammary glands).
  • Inspection and palpation of the abdomen (belly), inguinal region (groin region), etc.
  • Inspection and palpation of the genitals (penis and scrotum; assessment of pubes (pubic hair), penis (penis length; presence of: Indurations (tissue hardening), abnormalities, phimosis/foreskin stenosis? ); assessment according to: pubertal development according to Tanner) and palpation of:
    • Inguinal canal
    • Scrotum (scrotum) [empty testicular compartment; if testis present → differential diagnosis (distinguish if):
      • Gleithoden or
      • Pendulum testis; in pendulum testis, the testis remains in the scrotum until the cremasteric reflex is triggered, and only then does the testis disappear upward]
  • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation (assessment of prostate size, shape and consistency).

Pubertal development according to Tanner