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Self-Esteem and Social Adjustment in Young Women with Turner Syndrome—Influence of Pubertal Management and Sexuality: Population-Based Cohort Study

Department of Pediatric Endocrinology and Institut National de la Santé et de la Recherche Médicale U561 (J.-C.C., J.-L.C.) and Department of Biostatistics (C.E., E.E., J.C.), Groupe Hospitalier Cochin-Saint Vincent de Paul and Université Paris V, 75014 Paris, France; Department of Pediatric Endocrinology (M.T.), Hôpital des Enfants, 31059 Toulouse, France; Department of Pediatric Endocrinology (J.L.), Hôpital Robert Debré, 75935 Paris, France; Department of Pediatric Endocrinology (S.C.), Hôpital Armand Trousseau, 75571 Paris, France; Department of Pediatric Endocrinology (M.N.), Hôpital Debrousse, 69322 Lyon, France; and Department of Pediatric Endocrinology (R.B.), Hôpital de Bicêtre, 94275 Le Kremlin Bicêtre, France

Address all correspondence and requests for reprints to: Professor Jean-Claude Carel, Pediatric Endocrinology, Hôpital Robert Debré, 48, boulevard Sérurier, 75935 Paris Cedex 19, France. E-mail: carel{at}paris5.inserm.fr.

Context: 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.

Design: This was a prospective evaluation, the StaTur study.

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

Participants: Participants included 566 young adult women with Turner syndrome, aged 22.6 ± 2.6 yr (range, 18.3–31.2).

Main Outcome Measures: 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.

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