Learning Objective
Explain the components of human sexuality—including gender identity, gender role, sexual orientation, and normal sexual behaviors—and apply Tanner staging to assess normal puberty development in adolescents.
Core Concepts in Sexuality
Gender identity
- Internal sense of being male or female; established by age 3.
Sexual identity
- Determined by secondary sexual characteristics (e.g., breasts, genitalia, pubic hair).
Gender dysphoria
- Disconnect between gender identity and sexual identity; boys > girls.
Gender role
- Behaviors expressing masculinity/femininity; usually congruent with gender identity.
Sexual orientation
- Homosexual (same gender identity; may be ego-syntonic or ego-dystonic—latter is pathological)
- Heterosexual (opposite gender identity)
- Bisexual (both)
- Asexual (neither).
- Masturbation
Normal at all ages; pathological only when impairing functioning.
Exploration of sexuality
Normal in adolescence; may include exploration with same-sex peers.
Tanner Stages of Development
| Stage | Female Breast | Female Pubic Hair | Male Genitalia | Male/Female Pubic Hair (Both) |
|---|---|---|---|---|
| I | Preadolescent | None | Childhood size | None |
| II | Breast bud | Sparse, long, straight | Enlargement of scrotum & testes | Sparse, long, straight |
| III | Areolar diameter enlarges; breast elevates | Darker, curling, increased amount | Penis length increases; testes enlarge | Darker, curling hair |
| IV | Secondary mound; areola/mound separation | Coarse, curly, adult-type | Penis increases in length & breadth; scrotum darkens | Adult-type hair (not yet on thighs) |
| V | Mature female breast | Adult, extending to the thighs | Adult size & shape | Adult distribution (extends to thighs) |
