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Most girls go through puberty with awareness of their sexuality and recognition of the physical changes but with little concern for the details such as onset or rate of progress. Some girls and most mothers are not eager for sexual maturity and recognition of delay is late, unless there are complicating features. Diagnosis of delay and its cause may require careful observation over several months and judicious selection of appropriate tests. It is important not to jump to conclusions which may be wrong. Identification of the occasional serious cause is important since harm may result from delay. Recognition of constitutional delay from long-term causes of hypogonadotrophic hypogonadism may be difficult and replacement treatment may be advisable to gain oestrogen benefits with deferment of final diagnosis. Where there is a fundamental defect of the ovaries or genital tract which will prevent fertility, the condition must be communicated with sensitivity but without ambiguity. Conditions which are reversible so far as pubertal development is concerned require accurate diagnosis and, usually, long-term management. |
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