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Delayed Sexual Development

(Delayed Puberty; Delayed Sexual Maturation)

En Español (Spanish Version)

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention


Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. When this stage is late, it is called delayed sexual development.


This condition can be caused by:

Complications From Cystic Fibrosis

mucous plug aveoli and pancrease
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Risk Factors

Factors that may increase the chance of delayed puberty include:


One common symptom for both boys and girls is shortness in height. Other symptoms by sex include:

  • Symptoms in boys:
    • Lack of testicular enlargement by age 14
    • Lack of pubertal maturation by age 14
    • Sex organs that don’t completely develop within five years after they started to develop
  • Symptoms in girls:
    • Lack of breast development by age 13
    • No breast tissue or pubic hair by the age of 14
    • Lack of menstruation for five years or more after initial breast development
    • Failure to menstruate by age 15-16


The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Your doctor will review your child's milestones and growth record. An x-ray of the left wrist bone may be taken. This will help to assess if bone development is normal for your child’s age.

Your child's bodily fluids and tissues may be tested. This can be done with blood tests.

Images may be taken of your child's bodily structures. This can be done with:

  • MRI scan
  • Pelvic ultrasound (female)
  • Skull x-ray


There is often no treatment for those who are healthy and just starting later than their peers. They will continue to be monitored.

Other treatment depends on the cause. For those who have a chronic underlying disease, treatment is aimed at the specific condition. After the condition is treated, puberty often begins on its own.

For others treatments may include:

Sex hormones will help begin sexual development. They may be given to those with chromosomal abnormalities. This can include Turner or Klinefelter syndrome. Hormones may also be given to teens who are severely delayed or overly stressed by their lack of development.

Other medications may be added to sex hormone replacement. They may help increase height in boys with constitutional delay of puberty.

Counseling may be suggested for adolescents who are struggling with the delay. This may help the child cope with social pressures.

The doctor will continue to monitor your child’s height, weight, and sexual development. This will help determine if any treatment has been effective.


Most causes of delayed sexual development cannot be prevented. To help reduce the chance, make sure your child is kept as healthy as possible. This includes making sure your child is eating well and getting nutrients. Make sure any underlying illness is treated.


The American Academy of Family Physicians


American Academy of Pediatrics



Delayed puberty. Nemours KidsHealth website. Available at: http://kidshealth.org/teen/sexual_health/changing_body/delayed_puberty.html. Updated August 2011. Accessed July 22, 2013.

Delayed Puberty. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx. Updated May 11, 2013. Accessed July 22, 2013.

Female delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 15, 2013. Accessed July 22, 2013.

Male delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 7, 2012. Accessed July 22, 2013.

Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. Am Fam Physician. Available at: http://www.aafp.org/afp/990700ap/209.html. Accessed July 22, 2013.

Last reviewed July 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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