The<unk>  (also known as the<unk>  stages or Sexual Maturity Rating (SMR)) is a<unk>  of physical development in children, adolescents and adults. The<unk>  defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitals, testicular volume and development of pubic hair. This<unk>  was first identified in 1969 by James<unk> , a British pediatrician, after a two-decade-long study following the physical changes in girls undergoing puberty. Due to natural variation, individuals pass through the<unk>  stages at different rates, depending in particular on the timing of puberty. Among researchers who study puberty, the<unk>  is commonly considered the "gold standard" for assessing pubertal status when it is conducted by a trained medical examiner. In HIV treatment, the<unk>  is used to determine which regimen to follow for pediatric or adolescent patients on antiretroviral therapy (adult, adolescent, or pediatric guidelines). The<unk>  has also been used in forensics to determine aging, but its usage has decreased due to lack of reliability.
Tanner scale
Horowitz index
Gonadosomatic index
Bishop score
Gravindex
Milch classification
Karyotype
Gnathology