Clitoromegaly Explained

Clitoromegaly

Clitoromegaly (or macroclitoris[1]) is an abnormal enlargement of the clitoris that is mostly congenital; it is otherwise acquired through deliberately induced clitoral enlargement e.g. body modification by use of anabolic steroids, including testosterone.[2] [3] [4] It can happen as part of a gender transition. It is not the same as normal enlargement of the clitoris seen during sexual arousal.

Presentation

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

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 women who received norethisterone during pregnancy, masculinization of the fetus occurs, resulting in hypertrophy of the clitoris;[7] 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.[8]

In acquired clitoromegaly, the main cause is endocrine hormonal imbalance affecting the adult person, including polycystic ovarian syndrome (PCOS)[9] 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.[10] Another cause is clitoral cysts.[11] Sometimes there may be no obvious clinical or hormonal reason.[12]

Female bodybuilders and athletes who use androgens, primarily to enhance muscular growth, strength and appearance, may also experience clearly evident enlargement of the clitoris and increases in libido.[13] [14] Women who use testosterone for therapeutic reasons (treating low libido, averting osteoporosis, as part of an anti-depressant regimen, etc.) may experience some enlargement of the clitoris, although the dosages warranted for these conditions are much lower.

Anatomy

In Atlas of Human Sex Anatomy (1949) by Robert Latou Dickinson, the typical clitoris is defined as having a crosswise measurement of 3 to 4 mm (0.12 - 0.16 inches) and a lengthwise measurement 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 measurements) of greater than 35 mm2 (0.05 inches2), which is almost twice the size given above for an average sized clitoris.[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]

In 2013, it was disclosed in a medical journal that four unnamed elite female athletes from developing countries were required to receive gonadectomies and partial clitoridectomies if they wanted to continue competing after testosterone testing revealed that they had an intersex condition.[21] [22] 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."

See also

Notes and References

  1. Web site: Dorland Medical Dictionary . 2006-10-18 . https://web.archive.org/web/20061022181659/http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_m_01zPzhtm#12508261 . 2006-10-22 . dead .
  2. Senaylı A . Controversies on clitoroplasty . Therapeutic Advances in Urology . 3 . 6 . 273–7 . December 2011 . 22164197 . 3229251 . 10.1177/1756287211428165.
  3. Perovic SV, Djordjevic ML . Metoidioplasty: a variant of phalloplasty in female transsexuals . BJU International . 92 . 9 . 981–5 . December 2003 . 14632860 . 10.1111/j.1464-410X.2003.04524.x. 11836091 .
  4. Meyer WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA . Physical and hormonal evaluation of transsexual patients: a longitudinal study . Archives of Sexual Behavior . 15 . 2 . 121–38 . April 1986 . 3013122 . 10.1007/BF01542220. 42786642 .
  5. PRADER A . 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 . de . Helvetica Paediatrica Acta . 9 . 3 . 231–48 . July 1954 . 13201003.
  6. Web site: Congenital Adrenal Hyperplasia(CAH), Prader Scale . 2008-09-28 . https://web.archive.org/web/20080509182258/http://www.sickkids.ca/childphysiology/cpwp/genital/GenitalCAH.htm . 2008-05-09 . dead .
  7. Beischer NA, Cookson T, Sheedy M, Wein P . Norethisterone and gestational diabetes . The Australian & New Zealand Journal of Obstetrics & Gynaecology . 32 . 3 . 233–8 . August 1992 . 1445134. 10.1111/j.1479-828X.1992.tb01954.x . 19741452 .
  8. van Haelst MM, Scambler PJ, Hennekam RC . Fraser syndrome: a clinical study of 59 cases and evaluation of diagnostic criteria . American Journal of Medical Genetics Part A . 143A . 24 . 3194–203 . December 2007 . 18000968 . 10.1002/ajmg.a.31951. 25053508 .
  9. Web site: Polycystic Ovarian Syndrome . Mukhtar I Khan, MD . 2008-09-28 .
  10. Horejsí J . Acquired clitoral enlargement. Diagnosis and treatment . Annals of the New York Academy of Sciences . 816 . 1. 369–72 . June 1997 . 9238289 . 10.1111/j.1749-6632.1997.tb52163.x. 1997NYASA.816..369H . 85705035 .
  11. Linck D, Hayes MF . Clitoral cyst as a cause of ambiguous genitalia . Obstetrics and Gynecology . 99 . 5 Pt 2 . 963–6 . May 2002 . 11975977 . 10.1016/S0029-7844(02)01967-1. 43432622 .
  12. Copcu E, Aktas A, Sivrioglu N, Copcu O, Oztan Y . Idiopathic isolated clitoromegaly: A report of two cases . Reproductive Health . 1 . 1 . 4 . 2004 . 15461813 . 523860 . 10.1186/1742-4755-1-4 . free .
  13. Book: Freberg, Laura A. . Discovering Biological Psychology . . 2009 . 300 . November 7, 2012 . 978-0-547-17779-3 .
  14. Web site: A Dangerous and Illegal Way to Seek Athletic Dominance and Better Appearance. A Guide for Understanding the Dangers of Anabolic Steroids . . 2004 . November 7, 2012 . April 9, 2004 . https://web.archive.org/web/20040409111211/http://www.deadiversion.usdoj.gov/pubs/brochures/steroids/public/index.html . dead .
  15. Book: Dickinson, Robert Latou. Atlas of Human Sex Anatomy . 0-88275-014-3 . Williams & Wilkins Co. . 1949 . .
  16. Web site: Female Sexual Anatomy: Clitoral and Labia Size .
  17. Web site: Holmes. Morgan. Morgan Holmes . Is Growing up in Silence Better Than Growing up Different?. Intersex Society of North America. 2016-08-26.
  18. News: Bastien-Charlebois. Janik. Janik Bastien-Charlebois . My coming out: The lingering intersex taboo. Montreal Gazette. August 9, 2015. 2016-08-26.
  19. Web site: Méndez. Juan. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez, A.HRC.22.53. February 2013.
  20. Book: Asia Pacific Forum of National Human Rights Institutions. Asia Pacific Forum of National Human Rights Institutions. 978-0-9942513-7-4. Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics. June 2016 .
  21. 10.1210/jc.2012-3893. 23633205 . 0021-972X . 98. 6. –1055–E1059. Fénichel. Patrick. Paris. Françoise. Philibert. Pascal. Hiéronimus. Sylvie. Gaspari. Laura. Kurzenne. Jean-Yves. Chevallier. Patrick. Bermon. Stéphane. Chevalier. Nicolas. Sultan. Charles. Molecular Diagnosis of 5α-Reductase Deficiency in 4 Elite Young Female Athletes Through Hormonal Screening for Hyperandrogenism. The Journal of Clinical Endocrinology & Metabolism. June 2013. 3. free.
  22. 10.1136/bmj.g2926. 1756-1833. 348. apr28 9. –2926–g2926. Jordan-Young. R. M.. Sonksen. P. H.. Karkazis. K.. 2198650. Rebecca Jordan-Young . Katrina Karkazis . Sex, health, and athletes. BMJ. April 2014 . 24776640.

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