Study objective: Puberty is associated with important changes in secondary sexual characteristics, but the changes occurring in female external genitalia are not thoroughly described. The aim of this systematic review is to summarize and assess the current scientific knowledge regarding vulvar changes and development during puberty.

Methods: PubMed, Embase, Web of Science, and Cochrane were searched using keywords related to "puberty," "vulva," and "morphology." The inclusion criteria were observational studies describing vulvar development in individuals between the ages of 8 and 16 years. The outcomes of interest were quantitative and/or qualitative descriptions of the vulva, including anatomic, physiological, and histological changes.

Results: Of the 1658 articles screened, 10 were included. The mean clitoral glans diameter increases during puberty, as does the length of the clitoral hood. The clitoral hood changes to become more retractile and rugose. The inner labia width and length increase throughout puberty, and the development of the inner labia varies between individuals, with labial asymmetry being a common characteristic. The most frequent hymenal configuration found during puberty is the crescentic form, and features such as hymenal mounds, longitudinal intravaginal ridges, and most notches are physiological.

Conclusion: Reliable data on pubertal development of the external female genital organs are scarce. Future research is needed to provide more precise data to help categorize vulvar development into stages. A detailed description of vulvar maturation into sequential stages throughout puberty (as done by the Tanner scale for the male homologous structures) can increase knowledge of its morphologic diversity and help reach clinical consensus on the nature of pathologic variants. In addition, better knowledge of vulvar diversity is important to both health care professionals and individuals and may empower and promote self-esteem.