Clitoromegaly is a clinical manifestation involving the female external genitalia, often caused by congenital or acquired factors. Although it is relatively rare in clinical practice, it may be related to a variety of endocrine disorders, chromosomal abnormalities or drugs. Early identification and accurate diagnosis are of great significance. This article systematically sorts out the diagnostic process and identification points of clitoromegaly to provide a reference for clinical practice.
1. Definition and Normal Standards
Clitoral hypertrophy refers to the volume of the clitoris being significantly larger than the normal range. Its diagnosis is usually based on the Clitoral Index, which is the length of the clitoris multiplied by the width. It is generally believed that hypertrophy exists when the clitoris length is greater than 10 mm or the Clitoral Index is greater than 35 mm².
The normal length of the clitoris of a newborn is about 2-6 mm , and the width is 2-4 mm. The normal length of the clitoris of a post-pubertal female is usually no more than 10 mm, and the width is no more than 6 mm. Therefore, those who exceed this range should be vigilant.
2. Classification of etiology
Clitoral hypertrophy can be divided into two categories: congenital and acquired :
1. Congenital causes
Congenital adrenal hyperplasia (CAH) : The most common cause, especially the 21-hydroxylase deficiency type, can cause clitoral hypertrophy in female fetuses in utero due to excessive secretion of androgens.
Increased maternal androgen levels : such as use of androgen drugs during pregnancy, adrenal or ovarian tumors.
Sex chromosome abnormalities : such as true hermaphroditism (46,XX DSD) and mixed gonadal dysgenesis.
2. Acquired causes
Adrenal or ovarian tumors : such as adrenal cortical adenoma and ovarian Leydig cell tumor, which can secrete androgens.
Exogenous androgen use : such as the use of steroids by athletes or transgender people.
Idiopathic : No obvious endocrine abnormalities, may be individual variation.
3. Clinical manifestations
Patients usually complain of abnormal enlargement of the vulva and masculinization of the external genitalia , which are often discovered by parents during infancy. Some adolescent or adult females show symptoms of hyperandrogenism such as abnormal menstruation, deepening of the voice, hirsutism, and acne .
The physical examination should focus on:
①. Clitoris size (record length and width)
②Whether there is labia fusion or vaginal developmental abnormality
③. Breast development and body hair distribution
4. Auxiliary examination
Laboratory tests are the key to clarifying the cause:
Hormone level testing :
②, serum testosterone, DHEAS, estradiol, 17-OHP
③. LH/FSH ratio, evaluation of pituitary function
Chromosome karyotype analysis : to determine chromosome sex (such as 46,XX or 46,XY)
Genetic testing : CAH-related genes such as CYP21A2 mutation analysis
Imaging examination :
Ultrasound or MRI : To evaluate whether the adrenal glands, ovaries, uterus and other structures are abnormal
Pelvic MRI : This can help clarify the development of the reproductive tract, especially in patients with abnormalities in sexual differentiation.
5. Recommendations for diagnostic process
The following is a recommended standardized diagnostic process :
Initial physical examination , measurement of clitoral index
Basic hormone testing to preliminarily determine the source of androgen
Chromosome karyotype analysis to determine chromosome sex
4. Based on the hormone results, further ACTH stimulation test or ovarian tumor marker test
5. Clarify structural development through imaging
Before a clear diagnosis is made, blind hormone therapy or surgical intervention should be avoided, especially in pediatric patients.
6. Differential Diagnosis
Need to be distinguished from the following situations:
Pseudohermaphroditism : 46,XX individuals with masculinized external genitalia
Hypospadias with small penis : Some cases are misdiagnosed as female clitoromegaly
Clitoral hood hypertrophy : non-substantial hypertrophy, a structural variation
VII. Treatment and Follow-up
Treatment depends on the cause:
CAH patients : Glucocorticoid replacement therapy should be given as early as possible to inhibit ACTH secretion and androgen synthesis.
Tumor-related : Surgery or chemoradiotherapy is selected according to the nature of the tumor.
Exogenous drug factors : Stop the drug immediately and evaluate whether it is reversible.
Cosmetic surgery : For those with obvious physiological and psychological effects, clitoroplasty may be considered , but it should be performed on the basis of psychological evaluation and fully informed consent.
Regular follow-up is required after surgery to evaluate clitoral morphology, sexual function, psychological state, and endocrine indicators to avoid further enlargement or other complications.
Beauty Encyclopedia Tips:
Clitoral hypertrophy is not only an anatomical or aesthetic problem, but may also reflect internal hormonal disorders or developmental abnormalities. Early identification, systematic evaluation, and multidisciplinary collaboration are particularly critical. Female patients and their families should avoid delaying diagnosis due to shame in seeking medical treatment. If necessary, they can seek collaborative evaluation from endocrinology, gynecology, pediatrics, and psychology departments. When faced with diseases involving gender, psychology, and appearance, doctors should provide empathy and respect, and build a patient-centered diagnosis and treatment system.