Clitoromegaly

Clitoromegaly
Classification and external resources
ICD-10	Q52.6
ICD-9	752.49
DiseasesDB	30822

Clitoromegaly (or macroclitoris ^[1]) is an abnormal enlargement of the clitoris (not to be confused with the normal enlargement of the clitoris seen during sexual arousal).

Although clitoromegaly denotes just a clitoris larger than expected (thus involving some uncertainty about what can be defined as normal), it is commonly seen as a congenital anomaly of the genitalia.

In Atlas of Human Sex Anatomy (1949)^[2] 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 mm² (0.05 inches²), which is almost twice the size given above for an average sized clitoral hood.^[3]

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^[4] ranging, in ascending order of masculinisation, from 1: Female external genitalia with clitoromegaly through 5: Pseudo-Phallus looking like normal male external genitalia.^[5]

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. It can also be caused by the autosomal recessive congenital disorder known as Fraser syndrome.^[6]

In acquired clitoromegaly the main cause is due to endocrine hormonal imbalance affecting the adult women, including polycystic ovarian syndrome (PCOS)^[7] 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.^[8] This can also be caused by clitoral cysts.^[9] In addition, sometimes there may be no obvious or hormonal reason.^[10]

Clitoromegaly may be acquired through use of anabolic steroids, including testosterone. This occurs in female to male transsexuals (FtM) after a period of hormone replacement therapy. Trans men generally consider the genital enlargement to be a desirable and expected part of medical transition. This enlargement may be complemented by surgery including metoidioplasty or clitoral release.

Like FtM transsexuals, female bodybuilders who use androgens 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.) may also experience some enlargement of the clitoris although the dosages warranted for these conditions are much lower.

Deliberately induced clitoris enlargement, as form of female genital body modification, is reported to be achieved through various uses of testosterone and more temporarily with devices such as the clitoral pump.^{[citation needed]} This may require altered masturbation techniques.^{[citation needed]}

Notes

1. ^ "Dorland Medical Dictionary". http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_m_01zPzhtm#12508261. 
2. ^ Dickinson, Robert Latou (1949). Atlas of Human Sex Anatomy. Williams & Wilkins Co. ISBN 0-88275-014-3. 
3. ^ "Female Sexual Anatomy: Clitoral and Labia Size". http://www.the-clitoris.com/f_html/c_size.htm. 
4. ^ 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.
5. ^ "Congenital Adrenal Hyperplasia(CAH), Prader Scale". Archived from the original on 2008-05-09. http://web.archive.org/web/20080509182258/http://www.sickkids.ca/childphysiology/cpwp/genital/GenitalCAH.htm. Retrieved 2008-09-28. 
6. ^ 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 a 143a (24): 3194. doi:10.1002/ajmg.a.31951. PMID 18000968. 
7. ^ Mukhtar I Khan, MD. "Polycystic Ovarian Syndrome". http://www.emedicine.com/med/topic2173.htm. Retrieved 2008-09-28. 
8. ^ 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. 
9. ^ 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. 
10. ^ 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. http://www.reproductive-health-journal.com/content/1/1/4.