From the Guidelines
SMR I refers to Sexual Maturity Rating stage 1 in the Tanner scale, which represents the prepubertal stage of development in adolescents, characterized by the absence of secondary sexual characteristics and pubic hair, with small testes, scrotum, and penis in males, and a flat chest with no breast development in females. In this stage, the genitalia and secondary sexual characteristics appear as they would in a young child. For males, SMR I is characterized by small testes, scrotum, and penis with no pubic hair. For females, SMR I shows a flat chest with no breast development and no pubic hair. This is the baseline stage before any pubertal changes begin, typically seen in children younger than 10 years old. During a genitourinary examination, identifying the SMR stage helps clinicians assess whether pubertal development is occurring at an appropriate age or if there might be precocious or delayed puberty requiring further evaluation, as noted in the American Academy of Pediatrics clinical report 1. Understanding normal developmental milestones is essential for distinguishing between physiologic variations and pathologic conditions affecting growth and sexual development in adolescents. The external genitalia examination, including the assessment of Tanner stage, is a crucial part of the pelvic examination, as described in the clinical report 1.
Key Points to Consider
- SMR I is the prepubertal stage of development in adolescents
- Characterized by the absence of secondary sexual characteristics and pubic hair
- Small testes, scrotum, and penis in males, and a flat chest with no breast development in females
- Typically seen in children younger than 10 years old
- Identifying the SMR stage helps clinicians assess pubertal development and potential pathologic conditions, as emphasized in the clinical report 1
Clinical Implications
- The external genitalia examination, including the assessment of Tanner stage, is a crucial part of the pelvic examination, as described in the clinical report 1
- Clinicians should be sensitive to the possibility of past or current sexual abuse, which can affect the patient’s comfort with the examination, as noted in the clinical report 1
- The examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women’s health care, as emphasized in the clinical report 1
From the Research
Sexual Maturity Rating (SMR) I in Adolescent Genitourinary (GU) Examination
- There is no direct information available in the provided studies to define Sexual Maturity Rating (SMR) I in an adolescent Genitourinary (GU) examination.
- However, the study 2 discusses the development of secondary sexual characteristics, which is related to sexual maturity.
- According to 2, the main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys.
- The other studies 3, 4, 5, 6 focus on the importance and techniques of genitourinary examinations in adolescents, but do not provide information on Sexual Maturity Rating (SMR) I.
- Therefore, there are no research papers to assist in answering this question directly.