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Clitoromegaly
Specialty	Gynaecology

Clitoromegaly (or macroclitoris) is an abnormal enlargement of the clitoris that is mostly congenital or acquired, though deliberately induced clitoris enlargement as a form of female genital body modification is achieved through various uses of anabolic steroids, including testosterone, and may also be referred to as clitoromegaly. Clitoromegaly is not the same as normal enlargement of the clitoris seen during sexual arousal.

Anatomy

In Atlas of Human Sex Anatomy (1949) by Dr. Robert Latou Dickinson, the typical clitoris is defined as having a crosswise width of 3 to 4 mm. (0.12 - 0.16 inches) and a lengthwise width of 4 to 5 mm (0.16 - 0.20 inches). On the other hand, in Obstetrics and Gynecology medical literature, a frequent definition of clitoromegaly is when there is a CI of greater than 35 mm (0.05 inches), which is almost twice the size given above for an average sized clitoral hood.

Presentation

In the most pronounced cases, clitoromegaly is a symptom of intersexuality since the large clitoris resembles a penis. The different grade of genital ambiguity is commonly measured by the Prader classification ranging, in ascending order of masculinisation, from 1: Female external genitalia with clitoromegaly through 5: Pseudo-Phallus looking like normal male external genitalia.

Causes

Clitoromegaly is otherwise a rare condition and can be either present by birth or acquired later in life. If present at birth, congenital adrenal hyperplasia can be one of the causes, since in this condition the adrenal gland of the female fetus produces additional androgens and the newborn baby has ambiguous genitalia which are not clearly male or female. In pregnant women who received norethisterone during pregnancy, masculinization of the fetus occurs, resulting in hypertrophy of the clitoris; however, this is rarely seen nowadays due to use of safer progestogens. It can also be caused by the autosomal recessive congenital disorder known as Fraser syndrome.

In acquired clitoromegaly, the main cause is endocrine hormonal imbalance affecting the adult woman, including polycystic ovarian syndrome (PCOS) and hyperthecosis. Acquired clitoromegaly may also be caused by pathologies affecting the ovaries and other endocrine glands. These pathologies may include virulent (such as arrhenoblastoma) and neurofibromatosic tumors. Another cause is clitoral cysts. Sometimes there may be no obvious clinical or hormonal reason.

Female bodybuilders and athletes who use androgens, primarily to enhance muscular growth, strength and appearance (see Use of performance-enhancing drugs in sport), may also experience clearly evident enlargement of the clitoris and increases in libido. Women who use testosterone for therapeutic reasons (treating low libido, averting osteoporosis, as part of an anti-depressant regimen, etc.) experience some enlargement of the clitoris, although the dosages warranted for these conditions are much lower. Pseudoclitoromegaly or pseudohypertrophy of the clitoris "has been reported in small girls due to masturbation: manipulations of the skin of prepuce leads to repeated mechanical trauma, which expands the prepuce and labia minora, thus imitating true clitoral enlargement".

References

1. "Dorland Medical Dictionary".
2. ^ Copcu E, Aktas A, Sivrioglu N, Copcu O, Oztan Y (2004). "Idiopathic isolated clitoromegaly: A report of two cases". Reprod Health. 1 (1): 4. doi:10.1186/1742-4755-1-4. PMC 523860. PMID 15461813.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
3. "Controversies on clitoroplasty". Therapeutic Advances in Urology. 3 (6): 273–277. 2011. doi:10.1177/1756287211428165. PMC 3229251. PMID 22164197. {{cite journal}}: Unknown parameter |authors= ignored (help); Unknown parameter |month= ignored (help)
4. "Metoidioplasty: a variant of phalloplasty in female transsexuals". BJUI. 92 (9): 981–985. 2003, first published online on November 24, 2003. doi:10.1111/j.1464-410X.2003.04524.x. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |authors= ignored (help); Unknown parameter |month= ignored (help)
5. "Physical and hormonal evaluation of transsexual patients: A longitudinal study". Archives of Sexual Behavior. 15 (2): 121–138. 1986. doi:10.1007/BF01542220. {{cite journal}}: Unknown parameter |authors= ignored (help); Unknown parameter |month= ignored (help)
6. Dickinson, Robert Latou (1949). Atlas of Human Sex Anatomy. Williams & Wilkins Co. ISBN 0-88275-014-3.
7. "Female Sexual Anatomy: Clitoral and Labia Size".
8. Prader Von, A. (1954). "Der genitalbefund beim Pseudohermaproditismus femininus des kongenitalen adrenogenitalen Syndroms. Morphologie, Hausfigkeit, Entwicklung und Vererbung der verschiedenen Genitalformen." Helv. Pediatr. Acta. 9: 231-248.
9. "Congenital Adrenal Hyperplasia(CAH), Prader Scale". Archived from the original on 2008-05-09. Retrieved 2008-09-28.
10. NA, Beischer (Aug 1992). "Norethisterone and gestational diabetes". Aust N Z J Obstet Gynaecol. 32 (3): 233–8. PMID 1445134. Retrieved 7 December 2012. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
11. van Haelst MM, Scambler PJ, Hennekam RC (2007). "Fraser syndrome: A clinical study of 59 cases and evaluation of diagnostic criteria". Am J Med Genet. 143a (24): 3194–203. doi:10.1002/ajmg.a.31951. PMID 18000968.{{cite journal}}: CS1 maint: multiple names: authors list (link)
12. Mukhtar I Khan, MD. "Polycystic Ovarian Syndrome". Retrieved 2008-09-28.
13. Horejsí J. (1997). "Acquired clitoral enlargement. Diagnosis and treatment". Ann N Y Acad Sci. 816: 369–372. doi:10.1111/j.1749-6632.1997.tb52163.x. PMID 9238289.
14. Linck D, Hayes MF. (2002). "Clitoral cyst as a cause of ambiguous genitalia". Obstet Gynecol. 99 (5 Pt 2): 963–966. doi:10.1016/S0029-7844(02)01967-1. PMID 11975977.
15. Freberg, Laura A. (2009). Discovering Biological Psychology. Cengage Learning. p. 300. ISBN 978-0-547-17779-3. Retrieved November 7, 2012.
16. "A Dangerous and Illegal Way to Seek Athletic Dominance and Better Appearance. A Guide for Understanding the Dangers of Anabolic Steroids". Drug Enforcement Administration. 2004. Retrieved November 7, 2012.

• Congenital disorders of female genital organs
• Clitoris