Clitoromegaly refers to the phenomenon that the volume of the clitoris is significantly larger than the normal range. It can occur in newborns, children or adult females. This symptom may be the result of congenital developmental abnormalities, endocrine disorders or acquired factors. Understanding the related disease background of clitoromegaly is of great significance for clinical diagnosis and treatment.
1. Definition and evaluation criteria of clitoral hypertrophy
Clitoral hypertrophy is not judged solely on the basis of clitoral size, but should be judged comprehensively based on factors such as age, physiological status and hormone levels. In newborns, a clitoral length greater than 9 mm is usually considered hypertrophy; in post-pubertal females, if the clitoral length is greater than 35 mm, it is also considered pathological hypertrophy. In addition, individual anatomical differences should also be ruled out.
2. Diseases related to clitoral hypertrophy
1. Congenital adrenal hyperplasia (CAH)
CAH is one of the most common causes of clitoral hypertrophy, especially the 21-hydroxylase deficiency type.
The disease is caused by adrenal cortical enzyme deficiency, which leads to impaired cortisol synthesis, resulting in increased secretion of adrenocorticotropic hormone (ACTH), stimulating the adrenal glands to produce excessive androgens . The excess androgens act on the fetus and cause masculinization of the external genitalia, such as clitoral hypertrophy and vaginal vestibule fusion.
CAH can manifest as a salt-losing type and a simple androgen-excess type. The former is more harmful and requires early identification.
2. Polycystic Ovary Syndrome (PCOS)
PCOS is a common endocrine disease, and some patients will experience mild clitoral hypertrophy.
PCOS patients have elevated androgen levels, which may be related to factors such as insulin resistance and ovarian dysfunction. In clinical practice, clitoral hypertrophy is often accompanied by symptoms such as irregular menstruation, hirsutism, and acne.
Hormone level monitoring and ultrasound examination are needed to confirm and differentiate it from other hyperandrogenism diseases.
3. Adrenal gland or ovarian tumor
Androgen-secreting tumors, such as adrenal cortical adenomas or ovarian sex cord-stromal tumors, can cause acute or subacute clitoral hypertrophy.
This type of tumor is usually accompanied by a significant increase in serum testosterone or DHEA-S . The clinical manifestations progress rapidly, and masculinization of the external genitalia may occur within a few months. The patient may also develop masculinized characteristics such as a deepening of the voice, breast atrophy, and increased muscle mass.
Early diagnosis and surgical intervention are important for restoring endocrine balance.
4. Exposure to exogenous androgens
Long-term or high-dose use of androgen drugs (such as steroids for bodybuilding) can lead to clitoral hypertrophy.
This type of drug includes testosterone, nandrolone, etc., which is commonly found in athletes, transgender people or improper medical users. Due to the continuous and strong effects of exogenous hormones, genital masculinization may be irreversible.
History taking is essential in identifying such causes.
5. Other rare genetic metabolic diseases
Some rare metabolic diseases may also present as clitoral hypertrophy, such as:
Aromatase deficiency : leads to decreased estrogen synthesis and relatively increased androgen production;
11-β-hydroxylase deficiency : Similar to 21-hydroxylase deficiency, it also belongs to CAH;
5α-reductase deficiency : affects the production of dihydrotestosterone and causes abnormal sexual differentiation.
These diseases are often accompanied by more complex changes in hormone levels and abnormal gonadal development, and require diagnosis through genetic testing.
3. Clinical Assessment and Diagnostic Pathway
Clinical diagnosis of clitoral hypertrophy should be combined with the following aspects:
Medical history collection : whether there is a similar family history, whether androgen drugs have been used;
Physical examination : clitoral length, changes in vulva structure, presence of vagina;
Hormone testing : serum testosterone, DHEA-S, 17-OHP, LH/FSH, etc.;
Imaging examination : adrenal CT, ovarian ultrasound, and MRI if necessary;
Genetic testing : used to identify the causes of difficult diseases, such as CAH gene mutation screening.
The key point is to determine whether it is an endocrine disease, its progression rate and reversibility.
IV. Treatment Principles and Intervention Strategies
Treatment strategies vary according to the cause:
CAH patients need long-term oral glucocorticoids (such as hydrocortisone) to suppress ACTH secretion;
PCOS patients mainly control androgens, and can use oral contraceptives and anti-androgen drugs such as spironolactone;
Tumor lesions require surgical removal of the lesion and regular follow-up after surgery;
If drug-induced virilization occurs, the drug should be discontinued immediately and hormone reversal therapy should be considered as appropriate;
Patients with severe clitoral hypertrophy and psychological distress may consider clitoridectomy to improve their appearance and psychological state.
All treatments should be carried out under the guidance of a specialist to avoid over-medicalization or delayed diagnosis.
Beauty Encyclopedia Tips:
Although clitoral hypertrophy is uncommon, it is often a manifestation of more complex diseases. If women find that the clitoral structure is abnormal, they should seek medical evaluation in time and never diagnose themselves or delay treatment. During the treatment process, doctors should take into account physiological functions, psychological needs and social adaptability, and provide individualized and comprehensive intervention measures. Especially in adolescents and women of childbearing age, reasonable guidance and psychological support are equally important. Correctly identifying the potential causes of clitoral hypertrophy is an important step in ensuring women's reproductive health.