Premature Sexual Maturation (PSM) and Precocious Puberty

Premature Sexual Maturation (PSM) is a rare condition affecting the gonads, adrenal or other glands and causing premature sexual maturation. The child grows at a faster rate than normal and develops secondary sexual characteristics (such as pubic hair, penile enlargement or breast development) at an inappropriately early age.

When puberty occurs at a younger age than expected it can be a stressful and emotional experience for the parents as well as the child.

Premature sexual maturation is a general term (which includes precocious puberty and other disorders) and implies the onset of sexual characteristics (eg breast development or pubic hair) below the age of 8 years in girls and 9 years in boys.

Central precocious puberty is rare. However, some forms of premature sexual maturation e.g. Isolated premature thelarche and premature adrenarche, are common. In rare cases, Premature Sexual Maturation can be a symptom of a serious condition for both boys and girls, so it is important to be assessed by an Endocrinologist (growth specialist).


In girls, the physical changes of puberty generally occur between the ages of 8 years to 14. The first principal signs of puberty are either pubic hair or budding of the breasts.  The growth spurt occurs early in puberty at the same time as the breast development.  Sometimes girls can experience a vaginal discharge, spotting and urinary infections.

In boys, the start of physical changes is between the ages of 9 years to 14 years. The first signs of puberty are the increase in size of the testes and then pubic hair. Underarm and facial hair along with the deepening of the voice is a late event in puberty as is the growth spurt.

Other Signs of Puberty Often Noticed

  • Body odour
  • Spots and acne
  • Change in body shape

It is probable that your specialist will arrange some tests to be able to make an accurate diagnosis and to determine what, if any, treatment will be required. The tests will be blood tests and for girls, a pelvic ultrasound which is an external examination performed by a radiologist.   Depending on the results of these tests an MRI or CT scan of the brain may need to be performed.


If treatment is required, your child may receive a medication (analogue or form of GnRH).  Treatment aims to supress the puberty and decrease the rate of bone maturation.  Depending on the age of the child, it can be very difficult and psychological support could be of benefit.

GnRH analogues are given by injection or as an implant. Generally the injection will be administered by a community nurse or in the medical day unit of your child’s hospital. Medication will continue until the appropriate time for puberty to commence. Puberty will usually resume as normal.


Further Reading

 CGF Guide to Premature Sexual Maturation (pdf)


Puberty and the Tanner Stages (pdf)

CGF Measuring Guidelines (pdf)

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