The genital examination of the adolescent boy proceeds like the examination of the adult male. Be particularly aware of the embarrassment of many boys regarding this aspect of the examination.

Important anatomic changes in the male genitalia accompany puberty and help to define its progress. The first reliable sign of puberty, starting between ages 9 and 13.5 years, is an increase in the size of the testes. Next, pubic hair appears, along with progressive enlargement of the penis. The complete change from preadolescent to adult anatomy requires about 3 years, with a range of 1.8 to 5 years.

Delayed puberty is suspected in boys who have no signs of pubertal development by 14 years of age.

An important goal when examining the adolescent male is to assign a sexual maturity rating. The five stages of sexual development, first described by Tanner, are outlined and illustrated on the next page. These involve changes in the penis, testes, and scrotum. In addition, in about 80% of men, pubic hair spreads farther up the abdomen in a triangular pattern pointing toward the umbilicus; this phase is not completed until the 20s.

The most common cause of delayed puberty in males is constitutional delay, a frequently familial condition involving delayed bone and physical maturation but normal hormonal levels.

An important developmental principle is that physical pubertal changes progress along a well-established sequence, as diagrammed below. Although there are wide age ranges for the start and completion, the sequence for each boy is nevertheless the same. This is helpful in counseling an anxious adolescent regarding his current and future maturation, and regarding the normality of pubertal changes along a wide age range. It is also helpful for detecting abnormal physical changes.

While nocturnal or daytime ejaculation tends to begin around Sexual Maturity Rating 3, a finding on either history or physical examination of penile discharge may indicate a sexually transmitted disease.

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