of menarche bet\mm motlu*r dAUghtor palm lhu\ wlłm socioeconomic and t»nviromuiiif.il factors kad tu optima! nutrition, generał health and infant utrę. the Ageof onaeł of puberty in normaI ehikłren is matnly dttermined by genetic factors (12).
The physical changes in individuate are defined by objective
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• i rnm . bul n does increasi ift< i -i u ii pr . jretive methodofdifferentSat Ing . I • r. 1 i • u appruximately 9 min fabłe li.l) I cen though the gr »wth of pubie and axillar hair is mainly under the influence of andrugens secreted b the adrenal gland, the stage of breast deveiopment is usuall equal to the stage of pubie hair devdopment in normal gir (Fig. 11.2). However, sińce ditterent endoenne organa contr
g. 11.2. Stages of female pubie hair development, modified from Marshall and Tanner [13], Reynolds and Wines [16) and Dupertuis eta/. [151. Stage 1: •adolescent; the vellus over the area is not further developed than that over the anterior abdominal wali, i.e. no pubie hair. Stage 2: sparse growth of lon' itly pigmented, downy hair, straight or only slightly curled, appearing chiefly along the labia. This stage is difficult to see on photographs. Stage 3: hair iderably darker, coarser and curlier. The hair spreads sparsely over the junction of the labia. Stage 4: hair is now adult in type, but the area covered by wsiderably smaller than in most adults. There is no spread to the medial surface of the thighs. Stage 5: hair is adult in quantity and type, distributed i triangle of the classic feminine pattern. The spread is to the medial surface of the thighs but not up the linea alba or elsewhere above the base of triangle.