Puberty assessment in general practice: between recommendations and reality-results from two qualitative studies on perceptions and use of Tanner staging.

Abstract

Background: The Tanner staging system is recommended to assess pubertal development and to screen for pubertal development disorders. General practitioners (GPs) play a central role in monitoring pubertal development, yet the practical application of the Tanner stages in general practice remains underexplored.

Objectives: To explore the perceptions of GPs regarding Tanner stages and their experiences in performing these assessments in children and adolescents.

Methods: Two studies were conducted using an inductive qualitative approach. Study 1 examined the views and practices of GPs during puberty assessments. We then asked the doctors to assess the Tanner stages before exploring their personal feelings and the challenges they faced in Study 2. Semi-structured interviews were conducted from November 2022 to November 2023.

Results: GPs report that they rarely perform systematic puberty assessments using Tanner stages. Key barriers included insufficient training, lack of confidence in grading, and the sensitive nature of the examination. Participants questioned the clinical utility of Tanner staging, preferring general observation of pubertal onset over precise quantification. GPs remained sceptical about the routine use of Tanner stages in general practice and emphasized the need for additional support, training, and practical tools to enhance implementation.

Conclusion: While GPs focus on how to screen for pubertal disorders, the underlying purpose and potential benefits remain less clear to them. Raising GPs' awareness of the importance of identifying pubertal disorders and providing practical strategies is essential for adolescent care. We recommend that GPs systematically check that puberty begins at the expected age in their young patients.