SEXUALITY IN EARLY ADOLESCENCE: PRECOCIOUS PUBERTY
The line drawn between “early normal” and pathologically early or precocious puberty is somewhat arbitrary. In the leading American handbook of pediatric endocrinology, van der Werft ten Bosch refrains from giving a definition of sexual precocity other than “the appearance of symptoms and signs of puberty earlier than is to be expected in a child with a particular genetic and environmental background.” He finds it desirable that a child of either sex who begins pubertal changes before age nine years have detailed medical investigation. By contrast, some endocrinologists agree with Bierich’s definition by which the term sexual precocity is used for girls, and if they show signs of sexual maturity before their sixth birthday (menarche before their eighth birthday), and for boys, if signs of sexual maturity appear before their eighth birthday. Precocious puberty can be secondary to a variety of more general medical abnormalities, including a lesion in the brain or the peripheral endocrine glands. It also can be idiopathic or spontaneous without any other physical disorder. Children with idiopathic precocious puberty show a hormonal pattern similar to that of normal children during puberty, including the pubertal pattern of sleep-associated LH release (Boyar and others), and in girls, an enhanced (in some cases even exaggerated) gonadotropin response to JLH-RH administration (Reiter and others). It is not yet quite clear, however, if idiopathic precocious puberty can simply be equated with an early timed but otherwise completely normal puberty: for instance, Bidlingmaier and others found considerably lower basal gonadotropin and estrogen levels in girls with precocious puberty than in normally maturing girls of the same developmental stage, although those patients who were examined repeatedly at short intervals, showed an almost cyclic pattern of their estradiol levels similar to the pattern of normal pubertal girls before menarche. The authors speculate that enhanced receptor sensitivity or changes in the concentration of sex-hormone binding globulin may play a role in idiopathic precocious puberty, in addition to the premature neural activation of the hypothalamic-pituitary-gonadal system. Clarification of this issue is obviously important to the interpretation of future behavioral studies on such children. A girl with precocious puberty typically has to cope with an early growth spurt putting her on the growth level of other children who are two or three years older than her chronological age, so that a six-year-old girl may be as tall as one who is eight or nine years old. At the same time, she will begin to show pubic and axillary hair, breast enlargement, and menstruation. The psychosexual development of girls with precocious puberty is not well researched. In an early medical review, Reuben and Manning cited eighty-three cases of pregnancy below age fifteen years—thirty of those below age twelve years—and claimed that the majority of the young women had a history of precocious puberty; they screened their own eight female cases of precocious puberty without pregnancy and noticed “sexual desire” only in one, mentally defective girl. Kinsey and others, in examining cases of precocious puberty, “have rarely found sexual activities which exceeded those ordinarily found among normal children of the same age.” In a follow-up study of fifteen girls with idiopathic precocious puberty (ages ten to twenty-five years) by Money and Walker, apart from case reports the only more recent study that deals with this particular issue, masturbation and sex play did not appear to be increased. Normal sexual curiosity occurred more or less consistent with age and independent from the precocious puberty. Premarital intercourse did not occur earlier than normally expected (age seventeen years and up), with the exception of one girl who became pregnant at age eleven and was the only mother in the sample. Contrary to the typical fears of parents and teachers, precocious sexual behavior did not seem to be a frequent concomitant of precocious puberty in these girls. We do not know, however, how representative the sample was for such patients in general.
Precocious puberty occurs less frequently in boys than in girls. The overall somatic effects in boys with precocious puberty are analogous to the ones in girls. Parental fear is even higher than with girls that their sexual behavior will become a problem at an early age; however, this fear seems to be largely unwarranted. Money and Alexander studied eighteen boys with precocious puberty; four of them had the idiopathic condition and fourteen were virilized as a result of congenital adrenal hyperplasia. In the latter condition, the adrenal is defective and produces high amounts of androgens leading to the typical signs of male pubertal maturation except for testicular development, since the hypothalamic-pituitary-gonadal axis is not involved. Onset of the corrective glucocorticoid treatment may occasionally induce true precocious puberty. The authors found that sociosexual behavior typically was only moderately ahead of chronological age. Erotic fantasies and masturbation occurred considerably earlier than usual, but the fantasy content was often very immature and reflected the age-typical lack of adequate sex information. Homosexuality and paraphilias did not develop. Unfortunately, the two diagnostic groups were not compared to each other.
In summary, the clinical studies of precocious puberty provide some evidence for hormonal effects on sexual behavior, more so in boys than in girls. In most cases, the effects are usually not very dramatic and do not involve uncontrollable overt sexual behavior.
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