Self-esteem and social adjustment in young women with Turner syndrome--influence of pubertal management and sexuality: population-based cohort study.
BACKGROUND
Pediatric management of patients with Turner syndrome focuses on height, frequently resulting in a delay of pubertal induction. The influence of pubertal management on psychosocial adjustment and sex life has not been evaluated in Turner syndrome patients.


OBJECTIVE
The objective of the study was to identify the determinants of self-esteem, social adjustment, and initiation of sex life in patients with Turner syndrome, particularly those related to pubertal management.


METHODS
This was a prospective evaluation, the StaTur study.


METHODS
The study was conducted with a population-based registry of GH-treated patients.


METHODS
Participants included 566 young adult women with Turner syndrome, aged 22.6 +/- 2.6 yr (range, 18.3-31.2).


METHODS
Measures used in the study were Coopersmith's Self-Esteem Inventory, Social Adjustment Scale Self-Report, questions on sexual experience, and extensive data on pediatric management.


RESULTS
Low self-esteem was associated with otological involvement and limited sexual experience. Low social adjustment was associated with lower paternal socioeconomic class and an absence of sexual experience. Late age at first kiss or date was associated with cardiac involvement and a lack of spontaneous pubertal development. Age at first sexual intercourse was related to age at puberty and paternal socioeconomic class. Delayed induction of puberty had a long-lasting effect on sex life. Height and height gain due to GH treatment had no effect on outcomes.


CONCLUSIONS
Puberty should be induced at a physiologically appropriate age in patients with Turner syndrome to optimize self-esteem, social adjustment, and initiation of the patient's sex life. Therapeutic interventions altering normal pubertal development in other groups of patients should be reconsidered in light of these findings.
Carel
Jean-Claude
JC
Pediatric Endocrinology, Hôpital Robert Debré, 48 boulevard Sérurier, 75935 Paris Cedex 19, France. carel@paris5.inserm.fr
Elie
Caroline
C
Ecosse
Emmanuel
E
Tauber
Maïthé
M
Léger
Juliane
J
Cabrol
Sylvie
S
Nicolino
Marc
M
Brauner
Raja
R
Chaussain
Jean-Louis
JL
Coste
Joël
J
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001827:Body Height; D015992:Body Mass Index; D003075:Coitus; D005260:Female; D006801:Humans; D008572:Menarche; D011627:Puberty / Q000502:physiology* / Q000523:psychology; D012649:Self Concept; D012725:Sexual Behavior; D019529:Sexuality / Q000502:physiology / Q000523:psychology; D012917:Social Adjustment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014424:Turner Syndrome / Q000523:psychology* / Q000628:therapy