title: Self-esteem and social adjustment in young women with Turner syndrome--influence of pubertal management and sexuality: population-based cohort study.
abstract: 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.
authors.affiliation: Pediatric Endocrinology, Hôpital Robert Debré, 48 boulevard Sérurier, 75935 Paris Cedex 19, France. carel@paris5.inserm.fr
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Carel
authors.forename: Caroline
authors.initials: C
authors.lastname: Elie
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ecosse
authors.forename: Maïthé
authors.initials: M
authors.lastname: Tauber
authors.forename: Juliane
authors.initials: J
authors.lastname: Léger
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cabrol
authors.forename: Marc
authors.initials: M
authors.lastname: Nicolino
authors.forename: Raja
authors.initials: R
authors.lastname: Brauner
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Chaussain
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
mesh_terms: 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