The presence of a vaginal discharge in a young adolescent should be treated as in the adult. Causes include physiologic leukorrhea, sexually transmitted diseases from consensual sexual activity or sexual abuse, bacterial vaginosis, foreign body, and external irritants.
You should assign a sexual maturity rating to every female, irrespective of chronologic age. The assessment of sexual maturity in girls is based on both growth of pubic hair and the development of breasts. The assessment (Tanner staging) of pubic hair growth is shown in the figure illustrating the five Tanner stages of sexual maturity, below. See p. 700 for breast development assessment.
Although there is a wide variation in the age of onset and completion of puberty, remember that the stages occur in a predictable sequence, as shown here.
It is helpful to counsel girls about this sequence and their current matura-tional stage. A girl's initial signs of puberty are hymenal changes secondary to estrogen, widening of the hips, and beginning of a height spurt, although these changes are difficult to detect. The first easily detectable sign of pu-
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