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 genital

body modification Body modification (or body alteration) is the deliberate altering of the human anatomy or human physical appearance. In its broadest definition it includes skin tattooing, socially acceptable decoration (''e.g.'', common ear piercing in many so ...

is achieved through various uses of anabolic steroids, including

testosterone Testosterone is the primary sex hormone and anabolic steroid in males. In humans, testosterone plays a key role in the development of male reproductive tissues such as testes and prostate, as well as promoting secondary sexual characteristi ...

. 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, which ranges, 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 a rare condition and can be either present by birth or acquired later in life. If present at birth,

congenital adrenal hyperplasia Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the synthesis of cortisol in the adrenal cort ...

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 Progestogens, also sometimes written progestagens or gestagens, are a class of natural or synthetic steroid hormones that bind to and activate the progesterone receptors (PR). Progesterone is the major and most important progestogen in the bod ...

. It can also be caused by the

autosomal An autosome is any chromosome that is not a sex chromosome. The members of an autosome pair in a diploid cell have the same morphology, unlike those in allosomal (sex chromosome) pairs, which may have different structures. The DNA in autosom ...

recessive In genetics, dominance is the phenomenon of one variant (allele) of a gene on a chromosome masking or overriding the effect of a different variant of the same gene on the other copy of the chromosome. The first variant is termed dominant and t ...

congenital disorder known as

Fraser syndrome Fraser syndrome (also known as Meyer-Schwickerath's syndrome, Fraser-François syndrome, or Ullrich-Feichtiger syndrome) is an autosomal recessive congenital disorder, identified by several developmental anomalies. Fraser syndrome is named for t ...

. In acquired clitoromegaly, the main cause is endocrine hormonal imbalance affecting the adult person, including polycystic ovarian syndrome (PCOS) and hyperthecosis. Acquired clitoromegaly may also be caused by pathologies affecting the ovaries and other

endocrine gland Endocrine glands are ductless glands of the endocrine system that secrete their products, hormones, directly into the blood. The major glands of the endocrine system include the pineal gland, pituitary gland, pancreas, ovaries, testes, ...

s. 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

androgen An androgen (from Greek ''andr-'', the stem of the word meaning "man") is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This in ...

s, primarily to enhance muscular growth, strength and appearance , may also experience clearly evident enlargement of the clitoris and increases in

libido Libido (; colloquial: sex drive) is a person's overall sexual drive or desire for sexual activity. Libido is influenced by biological, psychological, and social factors. Biologically, the sex hormones and associated neurotransmitters that act u ...

. For transgender men taking testosterone as part of

transgender hormone therapy (female-to-male) Masculinizing hormone therapy, also known as transmasculine hormone therapy, or female-to-male (or FTM) hormone therapy, is a form of hormone therapy and gender affirming therapy which is used to change the secondary sexual characteristics of t ...

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.) may 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".

Anatomy

In ''Atlas of Human Sex Anatomy'' (1949) by

Robert Latou Dickinson Robert Latou Dickinson (1861–1950) was an American obstetrician and gynecologist, surgeon, maternal health educator, artist, sculptor and medical illustrator, and research scientist. Early life Robert Latou Dickinson was born on February 21, 1 ...

, 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 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 clitoris.

Human rights concerns

Early surgical reduction of clitoromegaly via full or partial

clitoridectomy Clitoridectomy or clitorectomy is the surgical removal, reduction, or partial removal of the clitoris. It is rarely used as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. It is often performed on i ...

is controversial, and

intersex Intersex people are individuals born with any of several sex characteristics including chromosome patterns, gonads, or genitals that, according to the Office of the United Nations High Commissioner for Human Rights, "do not fit typical bin ...

people exposed to such treatment have spoken of their loss of physical sensation, and loss of autonomy. In recent years, human rights institutions have criticized early surgical management of such characteristics. 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. 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."

References

External links