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Sexual Development

Important Milestones For Development

Most babies develop at their own pace. Developmental milestones provide a general idea of the changes you can expect, but don’t be alarmed if your own baby’s development takes a slightly different course.

Birth to 4 Months
4 Months to 8 Months
8 Months to 12 Months
12 Months to 24 Months
24 Months to 36 Months

It may be helpful to record milestones and speak with your medical provider if you have any concerns. Your provider may refer your child for an Early Intervention Evaluation.

What will an Early Intervention Evaluation tell me about my child?
During an evaluation, the early intervention team will gather information about your child to answer specific questions about your child’s development. An early intervention evaluation will give you and the early intervention team information about your child’s development and help decide if there is a need for ongoing early intervention services.
The early intervention evaluation will look at gross motor skills, fine motor skills, communication, speech, language, sensory, social & emotional development, cognitive adaptive and self-help skills.

Who is eligible for early intervention services?
In many states infants and toddlers are eligible for early intervention services if they are under 3 years of age and meet the following criteria:

  • Developmental delay of 25% or more areas of development


  • Developmental delay of 33% or more in one area of development


  • Medically diagnosed physical or mental condition that typically results in developmental delay (for example, Turner Syndrome, Autism, Cerebral Palsy etc.)

Sexual Development

Delayed Puberty Requires a Timely Intervention
The ovarian cells in females with Turner Syndrome undergo premature cell death.  By 20 weeks gestation, 70% of ovarian germ cells were apoptotic in those with Turner Syndrome, compared to 3% in age-matched normal XX ovaries.  The ovarian failure manifests itself as both estrogen deficiency as well as a lack of fertilizable ovum.

Girls with Turner Syndrome tend to have normal pubic and axillary hair development, as these are due to adrenal androgens, rather than ovarian estrogens.  However, most girls with TS will not have full breast development nor menstrual cycles.  Occasionally, there is enough residual ovarian function for breast development and/or menstrual periods.   Because of the ovarian failure, natural fertilization is quite rare in women with TS.

The estrogen deficiency is treated with replacement estrogen, either as pills or estrogen patches.  Studies show that estrogen patches have the advantage of not causing liver enzyme elevations and promote increased growth factor (IGF-1) levels.  There are various estrogen replacement regimens that are used, but the common point among of all of them is to start with low dose estrogen, and slowly increase the dose over a couple of years.  This allows for normal uterine and breast development.

Implications of a Delayed Puberty
It is psychologically beneficial for girls to experience puberty along with peer group. Girls who had not transitioned with peer group often experienced being teased and feeling left out. Shyness, social anxiety, and reduced self-esteem generally relate to the premature ovarian failure and fertility issues.

Pubertal Development
Since only a small percentage of girls will go into puberty without intervention, it is essential for the patient to discuss treatment options with their provider to coincide treatment in addition to growth hormone.

Puberty is a series of well defined stages controlled by connections between the hypothalamus, pituitary, and ovaries 

• Spontaneous puberty can occur in Turner Syndrome 

• More commonly, hormonal induction of puberty is required 

• Treatment should be individualized for every girl 

• Consideration of height and psychosocial benefits are critical in the decision-making process 

• The likelihood of early ovarian failure should be discussed even with women who undergo spontaneous puberty and menarche for timely evaluation and intervention 

Puberty in Turner Syndrome, Zoltan Antal, MD, Weill Cornell Medical College Slide Presentation
Menstruation 3 D Animation (Sherring Plough) Video

Becoming a Family
There is much research looking into various forms of assisted reproductive technologies to help women with TS carry a pregnancy. 
Read more

Maintaining Good Health
Women with Turner Syndrome are urged to adhere to the recommended clinical guidelines for ongoing screenings and hormone replacement therapy to achieve the essential benefits from screenings and therapies.  

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