Clitoral hypertrophy is a relatively rare abnormal manifestation of the female vulva. It may be caused by congenital factors or acquired pathological factors such as endocrine disorders and tumors. Understanding its etiology, clinical manifestations and related examination methods is of great significance for timely diagnosis and standardized treatment.
1. Definition and clinical manifestations of clitoral hypertrophy
Clitoromegaly refers to a significant increase in the volume of the female clitoris, which exceeds the normal anatomical range and may be accompanied by changes such as hardening and pigmentation. The length of a normal female clitoris usually does not exceed 10 mm and the diameter does not exceed 6 mm. If it exceeds this range, especially exceeds 35 mm, it can be considered abnormal.
Common clinical manifestations include:
① Abnormal appearance of the vulva, with a prominent clitoris;
② The sensitivity of the clitoris to friction stimulation increases or decreases;
③ Some patients may experience sexual dysfunction;
④ Infants and young children may have difficulty identifying their gender;
⑤. If the cause is related to endocrine disorders, it may be accompanied by androgenic characteristics such as hirsutism and deep voice.
2. Common causes of clitoral hypertrophy
The causes of clitoral hypertrophy are complex and can be divided into two categories: congenital and acquired:
(1) Congenital adrenal hyperplasia (CAH)
This is the most common congenital cause, often caused by 21-hydroxylase deficiency, leading to excessive synthesis of androgens, which in turn causes masculinization of the vulva during the fetal period.
(2) Other congenital endocrine abnormalities
Diseases such as aromatase deficiency and 17β-hydroxysteroid dehydrogenase deficiency can cause increased androgen levels in the body.
(3) Tumor factors
Androgen-secreting tumors of ovarian or adrenal origin (such as adrenal adenoma, ovarian granulosa-theca cell tumor, etc.) may cause a significant increase in the size of the clitoris.
(4) Exogenous hormone intake
Improper use of androgen-containing drugs, such as the use of steroids by bodybuilders and the use of androgen by pregnant mothers, may have effects on the fetus or the woman herself.
(5) Idiopathic clitoral hypertrophy
In some patients, no clear cause can be found, and these patients are classified as idiopathic.
3. Examinations required for clitoral hypertrophy
To clarify the cause and extent of clitoral hypertrophy, a series of examinations are required. The general recommendations are as follows:
1. Physical examination
The doctor will examine the vulvar anatomy in detail, including the length, diameter, symmetry, skin color, and presence of nodules of the clitoris, and will assess secondary sexual characteristics in combination with the breasts and hair distribution.
2. Endocrine hormone testing
Testing the level of sex hormones in the body is extremely important for determining whether there is an increase in androgen:
1. Testosterone (T)
2. Dehydroepiandrosterone (DHEA-S)
③. Estradiol (E2)
4. Luteinizing hormone (LH)
⑤. Follicle-stimulating hormone (FSH)
⑥17-hydroxyprogesterone (17-OHP) is used to screen for congenital adrenal hyperplasia
⑦. Cortisol and ACTH levels to assess adrenal function
3. Imaging examination
(1) Pelvic ultrasound or MRI:
Assess the structure of the ovaries and uterus to check for tumors or cysts.
(2) Adrenal CT or MRI:
Used to rule out adrenal tumors, hyperplasia and other lesions.
4. Chromosome Karyotype Analysis
For infants or patients with suspected abnormal sex development, it is very important to perform chromosome karyotype analysis (such as 45,X; 46,XX; 46,XY) to determine genetic sex.
5. Genetic testing
When congenital adrenal hyperplasia or other hereditary endocrine diseases are suspected, screening of CYP21A2 gene, HSD17B3 gene, etc. is recommended to identify the pathogenic mutation.
6. Histopathological examination (if necessary)
If a suspicious mass is found in the clitoris or related areas, a tissue biopsy is required to clarify the pathological nature.
4. Treatment principles for clitoral hypertrophy
Treatment should be based on the cause and may include the following:
(1) Medical treatment:
For those caused by endocrine abnormalities (such as CAH), long-term use of glucocorticoids is required to regulate hormone levels in the body. If caused by tumors, endocrine suppressive drugs are needed to control hormone secretion.
(2) Surgical treatment:
For those whose clitoral volume is significantly enlarged and affects their quality of life or appearance, clitoral plastic surgery (clitoroplasty) may be considered.
During surgery, care should be taken to preserve the clitoral nerve endings to avoid decreased sexual sensitivity after surgery.
(3) Psychological and gender cognition intervention:
Especially in children or adolescent patients, it is necessary to cooperate with psychologists to conduct gender identity assessment and intervention to reduce their social adaptation disorders.
5. Prognosis and management of clitoral hypertrophy
With early detection and targeted treatment, most patients with clitoral hypertrophy can achieve a good prognosis. If it is caused by congenital diseases, lifelong management and regular review of hormone levels are required, as well as assessment of bone age and growth and development status.
Patients undergoing surgery should pay attention to the prevention and treatment of postoperative complications, such as scar hyperplasia, dissatisfactory appearance, sensory impairment, etc., and should choose an experienced plastic surgeon to perform the operation.
For patients who want to have children, it is also necessary to evaluate the recovery of ovarian function and hormone levels, and provide assisted reproductive support if necessary.
Beauty Encyclopedia Tips:
Although clitoral hypertrophy is relatively rare, it should be given sufficient attention in clinical practice, especially when infants and young children have abnormal vulva structures. Parents should take them to the doctor as soon as possible to check the cause to avoid missing the best time for treatment. At the same time, the public should get rid of prejudice against the morphology of female vulva and respect everyone's physical differences. Through standardized examinations and treatments, most patients can restore their health and confidence in life.