Clitoromegaly

Clitoromegaly
A woman with clitoromegaly
SpecialtyGynaecology 
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Clitoromegaly (or macroclitoris[1]) 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.[2][3][4][5] Clitoromegaly is not the same as normal enlargement of the clitoris seen during sexual arousal.

Presentation

The different grade of genital ambiguity is commonly measured by the Prader classification,[6] which ranges, in ascending order of masculinisation, from 1: female external genitalia with clitoromegaly through 5: pseudo-phallus looking like normal male external genitalia.[7]

Causes

Clitoromegaly is 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 people who received norethisterone during pregnancy, masculinization of the fetus occurs, resulting in hypertrophy of the clitoris;[8] 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.[9]

In acquired clitoromegaly, the main cause is endocrine hormonal imbalance affecting the adult person, including polycystic ovarian syndrome (PCOS)[10] 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.[11] Another cause is clitoral cysts.[12] Sometimes there may be no obvious clinical or hormonal reason.[2]

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.[13][14] For transgender men taking testosterone as part of transgender hormone therapy (female-to-male) masculinization of the clitoris may be a desired effect. 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".[2]

Anatomy

In Atlas of Human Sex Anatomy (1949) by 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).[15] On the other hand, in obstetrics and gynecology medical literature, a frequent definition of clitoromegaly is when there is a clitoral index (product of lengthwise and crosswise widths) of greater than 35 mm2 (0.05 inches2), which is almost twice the size given above for an average sized clitoral hood.[16]

Human rights concerns

Early surgical reduction of clitoromegaly via full or partial clitoridectomy is controversial, and intersex people exposed to such treatment have spoken of their loss of physical sensation, and loss of autonomy.[17][18] In recent years, human rights institutions have criticized early surgical management of such characteristics.[19][20][21]

In 2013, it was disclosed in a medical journal that four unnamed elite female athletes from developing countries were subjected to gonadectomies and partial clitoridectomies after testosterone testing revealed that they had an intersex condition.[22][23] In April 2016, the United Nations Special Rapporteur on health, Dainius Pūras, condemned this treatment as a form of female genital mutilation "in the absence of symptoms or health issues warranting those procedures."[24]

See also

  • Pseudo-penis, an enlarged clitoris or other penis-like structure that is normally present in some mammal, bird, and insect species

References

  1. ↑ "Dorland Medical Dictionary". Archived from the original on 2006-10-22. Retrieved 2006-10-18.
  2. 1 2 3 Copcu E, Aktas A, Sivrioglu N, Copcu O, Oztan Y (2004). "Idiopathic isolated clitoromegaly: A report of two cases". Reproductive Health. 1 (1): 4. doi:10.1186/1742-4755-1-4. PMC 523860. PMID 15461813.
  3. ↑ Senaylı A (December 2011). "Controversies on clitoroplasty". Therapeutic Advances in Urology. 3 (6): 273–7. doi:10.1177/1756287211428165. PMC 3229251. PMID 22164197.
  4. ↑ Perovic SV, Djordjevic ML (December 2003). "Metoidioplasty: a variant of phalloplasty in female transsexuals". BJU International. 92 (9): 981–5. doi:10.1111/j.1464-410X.2003.04524.x. PMID 14632860. S2CID 11836091.
  5. ↑ Meyer WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA (April 1986). "Physical and hormonal evaluation of transsexual patients: a longitudinal study". Archives of Sexual Behavior. 15 (2): 121–38. doi:10.1007/BF01542220. PMID 3013122. S2CID 42786642.
  6. ↑ PRADER A (July 1954). "Der genitalbefund beim Pseudohermaproditismus femininus des kongenitalen adrenogenitalen Syndroms. Morphologie, Hausfigkeit, Entwicklung und Vererbung der verschiedenen Genitalformen" [Genital findings in the female pseudo-hermaphroditism of the congenital adrenogenital syndrome; morphology, frequency, development and heredity of the different genital forms]. Helvetica Paediatrica Acta (in German). 9 (3): 231–48. PMID 13201003.
  7. ↑ "Congenital Adrenal Hyperplasia(CAH), Prader Scale". Archived from the original on 2008-05-09. Retrieved 2008-09-28.
  8. ↑ Beischer NA, Cookson T, Sheedy M, Wein P (August 1992). "Norethisterone and gestational diabetes". The Australian & New Zealand Journal of Obstetrics & Gynaecology. 32 (3): 233–8. doi:10.1111/j.1479-828X.1992.tb01954.x. PMID 1445134. S2CID 19741452.
  9. ↑ van Haelst MM, Scambler PJ, Hennekam RC (December 2007). "Fraser syndrome: a clinical study of 59 cases and evaluation of diagnostic criteria". American Journal of Medical Genetics Part A. 143A (24): 3194–203. doi:10.1002/ajmg.a.31951. PMID 18000968. S2CID 25053508.
  10. ↑ Mukhtar I Khan, MD. "Polycystic Ovarian Syndrome". Retrieved 2008-09-28.
  11. ↑ Horejsí J (June 1997). "Acquired clitoral enlargement. Diagnosis and treatment". Annals of the New York Academy of Sciences. 816 (1): 369–72. Bibcode:1997NYASA.816..369H. doi:10.1111/j.1749-6632.1997.tb52163.x. PMID 9238289. S2CID 85705035.
  12. ↑ Linck D, Hayes MF (May 2002). "Clitoral cyst as a cause of ambiguous genitalia". Obstetrics and Gynecology. 99 (5 Pt 2): 963–6. doi:10.1016/S0029-7844(02)01967-1. PMID 11975977. S2CID 43432622.
  13. ↑ Freberg, Laura A. (2009). Discovering Biological Psychology. Cengage Learning. p. 300. ISBN 978-0-547-17779-3. Retrieved November 7, 2012.
  14. ↑ "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. Archived from the original on April 9, 2004. Retrieved November 7, 2012.
  15. ↑ Dickinson, Robert Latou (1949). Atlas of Human Sex Anatomy. Williams & Wilkins Co. p. . ISBN 0-88275-014-3.
  16. ↑ "Female Sexual Anatomy: Clitoral and Labia Size".
  17. ↑ Holmes, Morgan. "Is Growing up in Silence Better Than Growing up Different?". Intersex Society of North America. Retrieved 2016-08-26.
  18. ↑ Bastien-Charlebois, Janik (August 9, 2015). "My coming out: The lingering intersex taboo". Montreal Gazette. Retrieved 2016-08-26.
  19. ↑ Méndez, Juan (February 2013). "Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez, A.HRC.22.53" (PDF).
  20. ↑ Council of Europe; Commissioner for Human Rights (April 2015), Human rights and intersex people, Issue Paper
  21. ↑ Asia Pacific Forum of National Human Rights Institutions (June 2016). Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics. Asia Pacific Forum of National Human Rights Institutions. ISBN 978-0-9942513-7-4.
  22. ↑ Fénichel, Patrick; Paris, Françoise; Philibert, Pascal; et al. (June 2013). "Molecular Diagnosis of 5α-Reductase Deficiency in 4 Elite Young Female Athletes Through Hormonal Screening for Hyperandrogenism". The Journal of Clinical Endocrinology & Metabolism. 98 (6): –1055–E1059. doi:10.1210/jc.2012-3893. ISSN 0021-972X. PMID 23633205.
  23. ↑ Jordan-Young, R. M.; Sonksen, P. H.; Karkazis, K. (April 2014). "Sex, health, and athletes". BMJ. 348 (apr28 9): –2926–g2926. doi:10.1136/bmj.g2926. ISSN 1756-1833. PMID 24776640. S2CID 2198650.
  24. ↑ Pūras, Dainius; Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (April 4, 2016), Sport and healthy lifestyles and the right to health. Report A/HRC/32/33, United Nations
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