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The Quigley scale is a descriptive, visual system of
phenotypic
In genetics, the phenotype () is the set of observable characteristics or traits of an organism. The term covers the organism's morphology or physical form and structure, its developmental processes, its biochemical and physiological proper ...
grading that defines seven classes between "fully masculinized" and "fully feminized" genitalia. It was proposed by pediatric endocrinologist
Endocrinology (from ''endocrine'' + '' -ology'') is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events ...
Charmian A. Quigley et al. in 1995. It is similar in function to the Prader scale and is used to describe genitalia in cases of androgen insensitivity syndrome
Androgen insensitivity syndrome (AIS) is a difference in sex development involving hormonal resistance due to androgen receptor dysfunction.
It affects 1 in 20,000 to 64,000 XY ( karyotypically male) births. The condition results in the partial ...
, including complete androgen insensitivity syndrome
Complete androgen insensitivity syndrome (CAIS) is an AIS condition that results in the complete inability of the cell to respond to androgens. As such, the insensitivity to androgens is only clinically significant when it occurs in individuals ...
, partial androgen insensitivity syndrome
Partial androgen insensitivity syndrome (PAIS) is a condition that results in the partial inability of the cell to respond to androgens. It is an X linked recessive condition. The partial unresponsiveness of the cell to the presence of androgenic ...
and mild androgen insensitivity syndrome
Mild androgen insensitivity syndrome (MAIS) is a condition that results in a mild impairment of the cell's ability to respond to androgens. The degree of impairment is sufficient to impair spermatogenesis and / or the development of secondary sexu ...
.
Schematic representation
Staging
The first six grades of the scale, grades 1 through 6, are differentiated by the degree of genital masculinization. Quigley describes the scale as one depicting "severity" or "defective masculinization". Grade 1 is indicated when the external genitalia is fully masculinized, and corresponds tomild androgen insensitivity syndrome
Mild androgen insensitivity syndrome (MAIS) is a condition that results in a mild impairment of the cell's ability to respond to androgens. The degree of impairment is sufficient to impair spermatogenesis and / or the development of secondary sexu ...
. Grades 6 and 7 are indicated when the external genitalia is fully feminized, corresponding to complete androgen insensitivity syndrome
Complete androgen insensitivity syndrome (CAIS) is an AIS condition that results in the complete inability of the cell to respond to androgens. As such, the insensitivity to androgens is only clinically significant when it occurs in individuals ...
.
Grades 2 through 5 quantify four degrees of decreasingly masculinized genitalia that lie in the interim. Grades 2 through 5 of the Quigley scale quantify four degrees of increasingly feminized genitalia that correspond to partial androgen insensitivity syndrome.
Grade 7 is indistinguishable from grade 6 until puberty, and is thereafter differentiated by the presence of secondary terminal hair
In humans, terminal hair is a variant of hair that is thick and long such as what grows on the scalp, as compared with vellus hair, colloquially known as peach fuzz, growing elsewhere.Marks, James G; Miller, Jeffery (2006)''Lookingbill and M ...
. Grade 6 is indicated when secondary terminal hair is present, whereas grade 7 is indicated when it is absent.
Controversy
While the scale has been defined as a grading system for feminized or undermasculinized genitalia, the concept that atypical genitals are necessarily abnormal is contested. An opinion paper by the Swiss National Advisory Centre for Biomedical Ethics advises that "not infrequently" variations from sex norms may not be pathological or require medical treatment. Similarly, an Australian Senate Committee report on involuntary sterilization determined that research "regarding 'adequate' or 'normal' genitals, particularly for women, raises some disturbing questions", including preferences influenced by doctors' specialism and gender. In a 2015 issue paper on ''Human rights and intersex people'', the Commissioner for Human Rights of the Council of Europe recommended a review of medical classification that pathologise variations in sex characteristics.Related concepts
Numerous clinical scales and measurement systems exist to define genitals as normal male or female, or "abnormal", including theorchidometer
An orchidometer (or orchiometer) is a medical instrument used to measure the volume of the testicles.
The orchidometer was introduced in 1966 by Swiss pediatric endocrinologist Andrea Prader of the University of Zurich. It consists of a string of ...
, Prader scale and the satirical Phall-O-Meter.
See also
* Ambiguous genitalia *Development of the reproductive system
The development of the reproductive system is the part of embryonic growth that results in the sex organs and contributes to sexual differentiation. Due to its large overlap with development of the urinary system, the two systems are typically ...
* Sex assignment
References
{{Male congenital anomalies of genital organs , state=collapsed Male genital procedures Female genital procedures Intersex and medicine