Vulvar Developmental Stages During Puberty: A Systematic Review.

Study Objective: Puberty is associated with important changes in secondary sexual characteristics, but the changes occurring in female external genitalia are not thoroughly described. The aim of this systematic review is to summarize and assess the current scientific knowledge regarding vulvar changes and development during puberty.

Methods: PubMed, Embase, Web of Science, and Cochrane were searched, using keywords related to "puberty", "vulva", and "morphology". Inclusion criteria were observational studies describing vulvar development in individuals between the ages of 8 and 16 years. The outcomes of interest were quantitative and/or qualitative descriptions of the vulva, including anatomical, physiological and histological changes.

Results: Of the 1658 articles screened, 10 were included. The mean clitoral glans diameter increases during puberty, as does the length of the clitoral hood. The clitoral hood changes, to become more retractile and rugose. The inner labia width and length increases throughout puberty, and the development of inner labia varies between individuals, with labial asymmetry being a common characteristic. The most frequent hymenal configuration found during puberty is the crescentic form, and features such as hymenal mounds, longitudinal intravaginal ridges, and most notches, are physiological.

Conclusion: Reliable data on pubertal development of the external female genital organs is scarce. Future research is needed in order to provide more precise data to help categorize vulvar development into stages. A detailed description of vulvar maturation into sequential stages throughout puberty (as done by the Tanner scale for the male homologous structures) can increase knowledge of its morphological diversity and help reach clinical consensus on the nature of pathological variants. In addition, better knowledge of vulvar diversity is of importance to both healthcare professionals and individuals, and may empower and promote self-esteem.