No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Clitoral size in normal women
Abstract
We sought to determine clitoral size in normal women and the possible effect of age, height, weight, parity, and oral contraceptive (OC) use.
Prospective measurement was made of clitoral dimensions in 200 consecutive normal women at routine gynecologic examination in an office setting.
The mean (+/- standard deviation) transverse diameter of the glans clitoris was 3.4 +/- 1.0 mm. The longitudinal diameter of the glans was 5.1 +/- 1.4 mm. Total clitoral length including glans and body was 16.0 +/- 4.3 mm. The mean clitoral index was 18.5 mm2. Measurements of all diameters were normally distributed. Age, height, weight, or current use of OCs did not influence clitoral size, but parous women had significantly larger measurements.
It is possible to obtain useful clitoral measurements in the office setting. Parity influences clitoral size, but age, height, weight, and OC use do not.
... In modern times, confusion regarding the CGC continues. A 1992 in vivo anatomical study detailed the length of the glans clitoris in a sample of 200 females by measuring from the "tip to the back of the corona" [9]. The study makes no mention of any absence of a corona from which to measure, thus implying that the CGC is a typical anatomical structure [9]. ...
... A 1992 in vivo anatomical study detailed the length of the glans clitoris in a sample of 200 females by measuring from the "tip to the back of the corona" [9]. The study makes no mention of any absence of a corona from which to measure, thus implying that the CGC is a typical anatomical structure [9]. Yet, in 2014, Di Marino and Lepidi [18] explicitly note that the corona of the glans clitoris exists as part of some, but not all, clitorises. ...
... Despite the confusion regarding the presence of the CGC, and despite the lack of formally recognized terminology specific to the anatomy of the glans clitoris, the terms corona and coronal sulcus continue to be used in the modern-day clinical literature as they relate to the clitoris, especially in the context of disorders of sex development (DSD) (also known as differences in sex development, variations in sex characteristics, and diverse sex development) [1][2][3][4][5][6][7][8][9][10][25][26][27][28]. ...
The corona of the glans clitoris is a clinically important yet poorly understood anatomical structure. There has been longstanding confusion regarding the prevalence of the corona of the glans clitoris and, moreover, its very existence. Therefore, this anatomical study assesses the prevalence of the corona of the glans clitoris and the gross anatomy of the proximal glans clitoris. Anatomy was assessed in 104 female donor bodies ranging in age from 50 to 102 years with an average age-at-death of 78.1±10.9 years (mean±SD). All clitorises (100%; 104:104 dorsums and 100%; 208:208 sides) were found to have a well-defined clitoral corona. Three of 104 (2.9%) coronas possessed grossly visible, outward-projecting, bluntly rounded papillae. Some donors possessed a coronopreputial frenulum. Clitoropreputial adhesions were common and associated with clitoral pearls. Clitoral pearls were identified in 37.8% (14:37) of unembalmed donors and observed to create clitoral craters, structural deformations in the surface of the corona and glans. The results of this study suggest that the corona of the glans clitoris is a ubiquitous anatomical structure. The clitoral coronal papillae and coronopreputial frenulum are novel, previously undescribed, anatomical structures. This study identifies that the corona of the glans clitoris is prone to pathological processes such as clitoral pearl formation and clitoral deformation. In addition to novel anatomical findings, the results of this study call attention to the need for life-long clitoral examinations. Furthermore, the corona of the glans clitoris should be regularly included in anatomical texts and accurately depicted in anatomical illustrations.
... It has proven essentially resistant to medical therapies, and surgical procedures are not without risks and complication. First sug- gested as a possible treatment in 2008 (1) and following the completion of two large phase 3 trials (2,3) , and subsequent FDA approval, Xiaflex, a collagenase compound, has been approved in some parts of the world for intra-lesional treatment of Pey- ronie's disease. Although not yet TGA approved in Australia, the medication has been available via the Special Access Scheme since late 2014. ...
... A single surgeon performed intra-detrusor injection of 100 units of Botox in 20 9 1 mL aliquots using a trigone sparing approach. The BVE was examined in quartiles to see if there was an association with adverse events, especially as previous studies had observed a VE of >75-80% to represent normal voiding 3,4 . Results: All of the sixty-four patients in the study had pre-operative and post- operative VFR and RV measurements. ...
... Conclusions: Down-regulation of ICAD ensues in RCC. ICAD typically prevents DNA fragmentation, and apoptosis, thus its downregulation was unusual in a can- cer known for resistance to apoptosis (2)(3)(4) ...
... This is consistent with the 8 mm average glans length reported by Jackson et al 7 but significantly larger than the 5.1 to 5.5 mm mean glans lengths reported in previous studies. 2,17 Our measurements for the diameters of the clitoris in the 4 specimens where the dorsal nerves terminated at the base of the glans furthermore indicate that the clitoral glans may be significantly larger than reported in previous studies. For these 4 specimens, the average diameter at the base of the glans was 8.3 mm, which differs drastically from the 3.4 to 3.5 mm diameters reported previously. ...
... For these 4 specimens, the average diameter at the base of the glans was 8.3 mm, which differs drastically from the 3.4 to 3.5 mm diameters reported previously. 2,[17][18][19] Although Jackson et al 7 reported an average glans diameter of 4 mm, measured at the base, there was likely some error, as the glans is discernibly not twice as long as it is wide. 7 There are several explanations for why our results appear to conflict with previous findings. ...
Background
The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery.
Objective
To describe the distal course of the dorsal nerves of the clitoris and associated structures.
Methods
Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined.
Results
The dorsal nerves of the clitoris were larger than expected, ranging from 2.0-3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o’clock, and were separated by the deep suspensory ligament of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the deep suspensory ligament was 37.7 mm.
Conclusions
The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.
... The glans clitoris, located at the upper of the vulvar vestibule, is the most erectile part of the clitoris, approximately 1-2 cm in length and 0.5-1 cm in width with a cylindrical shape ( Figure 2). 4,5,[9][10][11] Shih et al. 12 describe the cutaneous corpuscular receptors, which are similar morphologically to Labia minora reduction is the most commonly requested procedure by women who are concerned about the appearance of the vulvar region. In most cases, simultaneous clitoral hoodoplasty should be performed to achieve better aesthetic outcomes. ...
... Other factors that may affect clitoral dimensions include body mass index (BMI) (Vaccaro et al., 2014) and parity (Verkauf et al., 1992). n/a n/a n/a n/a n/a n/a n/a n/a n/a Bowen et al. ...
An understanding of ranges in clitoral anatomy is important for clinicians caring for patients including those who have had female genital mutilation, women seeking genital cosmetic surgery, or trans women seeking reconstructive surgery. The aim of this meta‐analysis is to investigate the ranges in clitoral measurements within the literature. A meta‐analysis was performed on Ovid Medline and Embase databases following the PRISMA protocol. Measurements of clitoral structures from magnetic imaging resonance, ultrasound, cadaveric, and living women were extracted and analyzed. Twenty‐one studies met the inclusion criteria. The range in addition to the average length and width of the glans (6.40 mm; 5.14 mm), body (25.46 mm; 9.00 mm), crura (52.41 mm; 8.71 mm), bulb (52.00 mm; 10.33 mm), and prepuce (23.19 mm) was calculated. Furthermore, the range and average distance from the clitoris to the external urethral meatus (22.27 mm), vagina (43.14 mm), and anus (76.30 mm) was documented. All erectile and non‐erectile structures of the clitoris present with substantial range. It is imperative to expand the literature on clitoral measurements and disseminate the new results to healthcare professionals and the public to reduce the sense of inadequacy and the chances of iatrogenic damage during surgery.
... There was also less variability in most of the computed clitoral morphometrics, as shown by their narrower ranges. Differences in the magnitude and variability of the in vivo vs. cadaveric clitoral dimension measures could be attributed to the following: (1) resolution, slice thickness, and choice of plane of the MRI scans, which can affect the ability to delineate clitoral structures, particularly between (a) the glans and body, (b) body and crura, and (c) crura and ischiocavernosus muscles that insert into each crus [14,16,20]; (2) postmortem edema (swelling) of the clitoral tissues in the unembalmed specimens; (3) morphologic differences in intact vs. dissected clitoral anatomy related to its attachment to its connective tissue and muscular supports; (4) the inherent wider anatomic variation of the cadaver study cohort due to the older, broader age range and (inferred) menopausal and parity status of the sample population [7,17,18,21]. ...
Introduction and hypothesis:
We present a 3D computational approach for automated clitoral measurements. We hypothesized that computationally derived measurements would be comparable and less variable than reported manual measures.
Methods:
In this retrospective study, MRIs of 22 nulliparous women age 20-49 years with normal vaginal and clitoral anatomy were collected. Manual segmentations were performed to reconstruct 3D models of the whole clitoris (glans, body, crura, and bulbs) and vagina. The length, width, and volume of the clitoral structures and the distance between the vagina and clitoral structures were calculated. Computed clitoral morphometrics (length, width) were compared to median [range] values from a previously published cadaver study (N = 22) using the median test and Moses extreme reaction test. Calculated distances were compared to mean (± SD) reported by a 2D MRI study (N = 20) using independent t-test and Levene's test.
Results:
Overall, computed clitoral morphometrics were similar to manual cadaver measurements, where the majority of length and width measures had ~1-2 mm difference and had less variability (smaller range). All calculated distances were significantly smaller and had smaller SDs than manual 2D MRI values, with two-fold differences in the means and SDs. Large variation was observed in clitoral volumetric measures in our cohort.
Conclusions:
The proposed 3D computational method improves the standardization and consistency of clitoral measurements compared to traditional manual approaches. The use of this approach in radiographic studies will give better insight into how clitoral anatomy relates to sexual function and how both are impacted by gynecologic surgery, where outcomes can assist treatment planning.
... In relazione alla variabilità interindividuale, la presenza di clitoridomegalia è talvolta difficile da identificare, in particolare se non associata a ipertrofia muscolare e abbassamento del tono della voce. Una virilizzazione di recente insorgenza può essere indicativa di tumore androgeno-secernente e può essere determinata sulla base della lunghezza della ghiandola (>8 mm) o dell'indice clitorideo (>35 mm 2 ) [22,23]. I rilievi nel valutare la cute debbono soffermarsi sulla presenza di acne e seborrea, acanthosis nigricans (indicativa di iperinsulinemia), strie rubre addominali e assottigliamento della cute (tipici della Sindrome di Cushing). ...
Sommario
L’irsutismo rappresenta un errore nella velocità proliferativa dei cheratinociti della matrice delle unità pilosebacee presenti in aree androgeno-sensibili della cute della donna. Esso è presente nel 5–15% delle donne prevalentemente adolescenti e in età riproduttiva, usualmente indicativo di un disordine endocrino latente. L’irsutismo è provocato da elevato segnale androgenico e dalla possibile modificata azione di fattori paracrini locali presenti a livello della unità pilo-sebacea. Esso si associa frequentemente ad acne, alopecia e virilizzazione, definendo il quadro di sindrome da eccesso di androgeni. Le novità nella sua identificazione sono rappresentate dalla possibilità di affiancare allo storico indice di Ferriman-Gallwey, primo approccio nell’esame obiettivo, nuovi strumenti utilizzati in tricologia, quali dermatoscopi interfacciati con specifici software di analisi di immagine, utilizzanti modelli di intelligenza artificiale in grado di quantificare digitalmente i peli terminali calcolando automaticamente numero, densità, spessore singolo e complessivo, oltre a creare un database utilizzabile per la verifica dell’efficienza delle terapie adottate per ridurlo.
... The mean transverse diameter of the glans, as recorded in 200 premenopausal women, was found to be 3.4 +/-1.0 mm, while the longitudinal diameter was 5.1 +/-1.4 mm, and the total length described as 16 +/-4.3 mm [39]. However, other more recent studies demonstrated a greater dimension, with a length of the descending clitoral body, from the angle to the base of the glans, of 37 mm [40]. ...
In the field of female sexuality, the existence of the so-called “G-spot” represents a topic still anchored to anecdotes and opinions and explained using non-scientific points, as well as being overused for commercial and mediatic purposes.
Purpose of Review
The scope of this review is to give an update on the current state of information regarding the G-spot and suggesting potential future directions in the research field of this interesting, albeit controversial, aspect of human sexual physiology.
Recent Findings
From evolutionary, anatomical, and functional points of view, new evidence has rebutted the original conceptualization of the G-spot, abandoning the idea of a specific anatomical point able to produce exceptional orgasmic experiences through the stimulation of the anterior vaginal wall, the site where the G-spot is assumed to be. From a psychological perspective, only few findings to date are able to describe the psychological, behavioral, and social correlates of the pleasure experience by G-spot-induced or, better, vaginally induced orgasm (VAO).
Summary
Recent literature suggests the existence of a G-spot but specifies that, since it is not a spot, neither anatomically nor functionally, it cannot be called G, nor spot, anymore. It is indeed a functional, dynamic, and hormone-dependent area (called clitorourethrovaginal, CUV, complex), extremely individual in its development and action due to the combined influence of biological and psychological aspects, which may trigger VAO and in some particular cases also female ejaculation (FE).
... Parity influences clitoral size but age, height, weight, and oral contraceptive use do not (Verkauf et al., 1992). Studies by found that clitoral size ''is not necessarily a criterion of responsiveness. ...
For sexologists, physicians, psychologists, gynecologists etc., it is a duty to update their knowledge. Female and male orgasm-sexuality, free pdf with 36 Pubmed-full text Dr Vincenzo Puppo-New Sexology Project: Eur J Obstet Gynecol, Eur Urol, Clin Anat, BJOG, J Urol, Int Urogynecol J, J Sex Med, BJU Int, J Pediatr Adolesc Gynecol, ISRN Obstet Gynecol, Gynecol Obstet Fertil, Maturitas, Int J Urol, etc.
Sexual pleasure/orgasm, (clitoris, labia minora and vestibular bulbs, exist in all women) is a source of physical and psychological wellbeing that contributes to human happiness. Female sexual anatomy is not has been a neglected area of study and the existing terminology is accurate from centuries... The key to female orgasm are the female erectile organs of the vulva (external organs)... Female orgasm is possible in all women, always, with effective stimulation of the female erectile organs... female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm... Female sexual satisfaction is based on orgasm: sexologists must define having sex/love making when orgasm occurs for both partners, always, with or without vaginal intercourse (definition for all human beings)... the duration of penile-vaginal intercourse is not important for a woman’s orgasm: premature ejaculation is not a male sexual dysfunction...
Website http://www.vincenzopuppo.altervista.org/articoli.html
Free video: clitoris/labia minora erection in woman https://www.researchgate.net/publication/273966598_Flaccid_Erect_Clitoris_Labia_minora_in_woman_Clin_Anat_2013
Free video: orgasms in all women https://www.researchgate.net/publication/343851657_Video_Female_orgasms_in_all_women_always_with_stimulation_clitoris-labia_minora_with_fingers
https://www.youtube.com/watch?v=Pm_Qg2b4kKI
... These attachments provide support for the clitoris when it becomes engorged during sexual stimulation. The size of the glans varies between 1 and 2 cm in length with a diameter between 0.5 and 1 cm [6] [12]. The clitoral hood fuses with the labia minora via the frenulum and is homologous to the foreskin in males [13]. ...
Purpose of Review
There is a growing body of evidence-based research in the area of female sexual arousal that has led to improved understanding of the female sexual arousal response and the development of FDA-approved treatments for female sexual dysfunction. The purpose of this paper is to review the existing literature on female sexual arousal and response with a focus on local genital arousal and the mechanisms underlying vaginal lubrication.
Recent Findings
From May 2000 to May 2020, PubMed and Cochrane databases were reviewed and manuscripts selected, based on keywords, content, references, and relevance to the topic. Vaginal lubrication occurs due to vasodilation of the major branches of iliohypogastric and pudendal arterial beds. The increase in intravascular and vaginal wall pressure forces fluid to pass through the vaginal intraepithelial gap junctions, forming a transudate of plasma. The fluid coalesces to form water-like droplets that lubricate the entire vaginal canal, allowing for ease of penetration during sexual intercourse. Vaginal lubrication is a fundamental component of female sexual arousal and directly correlates with subjective levels of satisfaction and enjoyment.
Summary
The female sexual arousal response is a complex reflex involving multiple organs and bodily functions. There are numerous age-related, metabolic, environmental, hormonal, and other factors that can negatively impact female sexual arousal and vaginal lubrication. As women age, vaginal lubrication declines due to declining genital blood flow and serum hormone levels. Concomitant reduction in physical activity and other medical comorbidities can also negatively impact vaginal blood flow and lubrication. The new and evolving treatment modalities for female sexual arousal disorder are directed toward optimizing vaginal health, function, and lubrication.
... cm for the labia minora), and rugosity (ranging from smooth to marked). Other studies in both pre-and postmenopausal women have demonstrated a similarly broad range of normal vulvar dimensions ( Verkauf et al., 1992 ;Weber et al., 1995 ). ...
Vulvar dermatology represents a challenge for many providers. Given that the vulva is both a gynecologic and dermatologic organ, patients with cutaneous lesions involving the vulva may present to primary care, gynecology or dermatology. Particularly within dermatology, the vulva remains understudied, which can lead to anxiety amongst providers as to appropriate next steps in the diagnosis and management of vulvar lesions. Thus, the purpose of this review is to highlight commonly encountered anatomical variants and benign neoplasms of the vulva, distinguish them from key pathological mimickers, and thereby provide guidance to practicing dermatologists as to what may constitute “normal” vulvar variations.
... 40 Despite this the clitorophallus does not grow significantly in the pubertal time frame in someone with low androgen exposure. Although there is substantially less data than for the high-androgen population, the average length of the clitorophallus in a low-androgen population has been reported as ranging from .3-1.2cm [41][42][43] . ...
Background
The clitorophallus, or glans, is a critical structure in sexual development and plays an important role in how gender is conceptualized across the lifespan. This can be seen in both the evaluation and treatment of intersex individuals and the use of gender‐affirming masculinizing therapies to help those born with a clitoris (small clitorophallus with separate urethra) enlarge or alter the function of that structure .
Objectives
To review the role of testosterone in clitorophallus development from embryo to adulthood, including how exogenous testosterone is used to stimulate clitorophallus enlargement in masculinizing gender‐affirming therapy.
Materials and Methods
Relevant English language literature was identified and evaluated for data regarding clitorophallus development in endosex and intersex individuals as well as the utilization of hormonal and surgical masculinizing therapies on the clitorophallus. Studies included evaluated the spectrum of terms regarding the clitorophallus (genital tubercle, clitoris, micropenis, penis).
Results
Endogenous testosterone, and its more active metabolite dihydrotestosterone, play an important role in the development of the genital tubercle into the clitorophallus, primarily during the prenatal and early postnatal periods and then again during puberty. Androgens contribute to not only growth but also the inclusion of a urethra on the ventral aspect. Exogenous testosterone can be used to enlarge the small clitorophallus (clitoris or micropenis) as part of both intersex and gender‐affirming care (in transmasculine patients, up to 2cm of additional growth). Where testosterone is insufficient to provide the degree of masculinization desired, surgical options including phalloplasty and metoidioplasty are available.
Discussion and Conclusion
Endogenous testosterone plays an important role in clitorophallus development, and there are circumstances where exogenous testosterone may be useful for masculinization. Surgical options may also help some patients reach their personal goals. As masculinizing gender‐affirming care advances, the options available for clitorophallus modifications will likely continue to expand and improve.
... It is currently defined as a clitoris longer than 1 cm in newborns [15]. Parity can also affect clitoral size but age, body mass index and oral contraceptive use do not [16]. The most important step while reducing clitoral size is to preserve the neurovascular bundle of the clitoris. ...
Background/Aim: Non-classic congenital adrenal hyperplasia (CAH) is a milder form of CAH. The CYP21A2 gene is involved in the etiopathogenesis of both severe (classic) and mild (non-classic) form CAH, however, genetic mutations in non-classic CAH result in less impairment of 21-hydroxylase activity. Therefore, as in classic CAH, patients with non-classical CAH have no signs and symptoms of cortisol deficiency. Instead, there may be signs of hyperandrogenism that can appear later in childhood or in early adulthood. Due to excess androgenic effect on clitoris, labia minora, majora and the vagina, feminizing genitoplasty should be performed to make gender identities consistent and reshape the proper genital anatomy for sexual intercourse. However, there are few studies and controversy on feminizing genitoplasty procedures in adulthood. In this study, we aimed to design a new procedure to spare the nerves of the clitoris as well as the clitoral body, along with the cavernous tissue.
Methods: This is a case series of nine patients with a mean age of 24.8 years diagnosed with non-classic CAH who underwent feminizing genitoplasty, in which nerve-sparing clitoroplasty was performed with corporal septum excision by ventral approach. Initially, diagnostic cystoscopy was performed to detect the level of vaginal confluence into the urogenital sinus. The enlarged clitoris was degloved from 10 mm proximal to the glans up to the symphysis pubis. Corporal septum was excised from the ventral part of the clitoris up to the bifurcation of crura. Neurovascular bundle was preserved completely dorsally, and the clitoris was folded over itself and fixed at the level of crural bifurcation at 3 and 9 o'clock positions. Degloved clitoral preputium was used as Byars’ flaps for labiaplasty. A perineal inverted U incision was made and the vaginal introitus was enlarged with this flap. Female Genital Image Scale (FGIS) was used in the assessment of patients’ postoperative genital self-image.
Results: Feminizing genitoplasty (nerve-sparing clitoroplasty with corporal septum excision, labiaplasty and perineal flap vaginoplasty) was performed in nine patients diagnosed with non-classic CAH. The mean operation time was 112 minutes with a range of 90-140 minutes. Urogenital sinus mobilization was not performed as the vaginal confluence into urogenital sinus was low in cystoscopy. Patients were re-assessed at 1 month, 3 months and 6 months postoperatively. FGIS scores showed that four patients were “very satisfied,” one patient was “satisfied,” 2 patients were “moderately satisfied”, and one patient was “dissatisfied.” The maximum follow up was 2 years with no recorded short or long-term complications.
Conclusion: Nerve sparing clitoroplasty with corporal septum excision is a good option with satisfactory long term results for non-classic CAH patients. However, we need many more comparative studies to decide the gold standard method for optimal physiologic and cosmetic outcomes in CAH patients.
... In our study, 39.4% of the patients were identified as having FSD, as defined in the literature. Clitoral measurements were taken via magnetic resonance, and the clitoral measurements of anorgasmic subjects were found to be significantly smaller in a study by Oakley et al. (24) Clitoral glans length measurements were between 1 and 2 cm and glans width was between 0.5 and 1 cm and no differences between clitoral dimensions according to age or weight were detected, whereas parity was found to increase the size of the clitoris in another study by Verkauf et al. (25). In our study, clitoral measurements were consistent with the literature; however, although parity did not change the glans size, it was associated with an increase in the size of the prepuce. ...
Objective:
To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception.
Materials and methods:
This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Genital Self-image scale (FGSIS) questionnaires were administered. Participants were divided into two groups according to their female sexual dysfunction (FSD) status. External genital measurements and anterior and posterior vaginal length were measured.
Results:
The external female genital measurements were (cm, mean ± standard deviation): clitoral prepuce length 2.05±0.48; clitoral glans length 0.87±0.21; clitoral glans width 0.60±0.15; clitoris to urethra 2.24±0.55; anterior fornix depth 7.75±0.92; posterior fornix depth 9.25±0.75; labia minora width, right 2.12±0.86, left 2.20±0.96. A weak negative correlation was found between total FGSIS scores and clitoral prepuce length (p=0.01, r=-0.17), whereas a weak positive correlation was seen between total FGSIS scores and anterior-posterior vaginal lengths (p=0.04, r=0.13; p=0.02, r=0.15, respectively). No statistically significant difference was found between the genital measurements of participants with FSD (n=82, 39.4%) and those without FSD (n=126, 60.6%), and the total FSFI scores and orgasm subdomain scores.
Conclusion:
The female genital measurements were found to be distributed over a wide range. Although the relationship between genital measurements and genital perception varied, no significant relationship was found between genital measurements and sexual functions or orgasm. These findings suggest that a more cautious approach should be taken towards genital surgeries for cosmetic purposes.
... Then, the labia majora were separated, and the prepuce of the clitoris was gently retracted. Clitoral size measurement was performed as described by Verkauf et al. (17). CW was measured in the greatest transverse diameter of the clitoris by a digital caliper (Aesculap, Center Valley, PA, USA) with a resolution of 0.01 mm twice for every infant, and the mean was recorded. ...
Background and Objectives: Clitoromegaly is an important parameter in the evaluation of ambiguous genitalia in neonates, but the normative data for clitoral size in newborns have racial/ethnic differences. The present study aimed to determine clitoral length (CL) and clitoral width (CW) values and establish cutoff measurement to define clitoromegaly in both term and preterm Iranian neonates for the first time. Methods: A total number of 580 female newborn infants delivered at 28–42 weeks of gestation were enrolled in the study, and their CL and CW were measured on the first 72 h of birth. Data about birth weight (BW), body length (BL), and head circumference (HC) of newborns; mothers' age; and gestational age (GA) were recorded, too. Results were presented as mean ± standard deviation (SD) for quantitative variables and were summarized by frequency (percentage) for categorical variables. Backward stepwise regression analysis was used for prediction of CL and CW. Results: Among 580 Iranian female newborns studied, 187 were term neonates and the other 393 newborns were preterm. Mean ± SD values of CL were 6.11 ± 0.39 mm in term infants and 5.45 ± 0.64 mm in preterm infants (P < 0.001). Mean ± SD values of CW were 4.22 ± 0.43 in term infants and 3.68 ± 0.53 in preterm infants (P < 0.001). Regression analysis showed that CL was correlated with GA considered by last menstrual period, BL, BW, and HC; and CW was associated with GA, BL, and BW. Conclusion: This study suggests normative values (mean + 1, 2, and 3 SD) of CL and CW according to GA, which can be used as a reference for Middle East's newborns, especially Iranian newborn babies.
... The clitoral length was measured as the distance from crura insertion at the symphysis pubis to the tip of the glans, as described by Verkauff [12]. The clitoral width was recorded as the transverse diameter at the widest point. ...
Aim: The clitoris is the dominant sexual organ in the female, varies in size and plays an active role in genital sensation and orgasm. Since the importance of clitoral glans visibility is known, surgeries of clitoris are increasing day by day. However, there is insufficient literature on the subject. The aim of this study is to determine the effect of measurable dimensions of clitoris and the clitoral glans visibility on female sexual function.Methods: Seventy-seven patients included in this cross-sectional study were examined in the lithotomy position and the measurable dimensions of the clitoris, the visibility of the clitoral glans and the length of the prepuce were noted. The Female Sexual Function Index (FSFI) was applied to all participants, which were divided into two groups, as those with normal orgasmic function and orgasmic dysfunction. One researcher made all measurements.Results: There were no statistically significant differences in clitoral glans width, length, or prepuce length (P=0.11, P=0.63, P=0.35, respectively). Clitoral glans was visible in 41 of 51 patients in the normal orgasmic function group, which was significantly higher than the group with orgasmic dysfunction (P<0.001).Conclusion: Since there is a significant relationship between clitoral glans visibility and orgasm, genital surgeries performed to increase clitoral glans visibility can facilitate sexual satisfaction and/or increase orgasm intensity. The fact that the relationship between measurable dimensions of clitoris, length of prepuce and orgasm cannot be shown suggests that clitoral glans visibility is more important than clitoral size for sexual stimulation.
... At the time of the referral to our clinic, the patient was 42 and she was taking oestrogen/progestin replacement hormone therapy. Physical examination revealed Ferriman Gallwey score 3 [19], normoconformated labia and clitoris length of 5.4 cm with a diameter of 1.6 cm [21]. SRD5A2 deficiency was considered during the diagnostic process and SRD5A2 was sequenced revealing the presence of heterozygous pathogenic variants in SRD5A2 gene (p.Gly183Ser and p.Leu111Hisfs*24), already reported in the literature [22,23]. ...
PurposeGender assignment represents one of the most controversial aspects of the clinical management of individuals with Differences of Sex Development, including 5α-Reductase-2 deficiency (SRD5A2). Given the predominant female appearance of external genitalia in individuals with SRD5A2 deficiency, most of them were assigned to the female sex at birth. However, in the last years the high rate of gender role shift from female to male led to recommend a male gender assignment.Methods
We here describe two cases of subjects with SRD5A2 deficiency assigned as females at birth, reporting their clinical histories and psychometric evaluations (Body Uneasiness Test, Utrecht Gender Dysphoria Scale, Bem Sex-Role Inventory, Female Sexual Distress Scale Revised, visual analogue scale for gender identity and sexual orientation) performed at the time of referral at the Florence Gender Clinic.ResultsBoth patients underwent early surgical interventions without being included in the decision-making process. They had to conform to a binary feminine gender role because of social/familiar pressure, with a significant impact on their psychological well-being. Psychometric evaluations identified clinically significant body uneasiness and gender incongruence in both subjects. No sexually related distress and undifferentiated gender role resulted in the first subject and sexually related distress and androgynous gender role resulted in the second subject.Conclusions
The reported cases suggest the possibility to consider a new approach for gender assignment in these individuals, involving them directly in the decision-making process and allowing them to explore their gender identity, also with the help of GnRH analogues to delay pubertal modifications.
... Prior to 2002, many assumed that the mechanisms underlying clitoral erections were similar to penial erections, due to their structural homologies during embryonic development [40]. There had also been indirect evidence of structural similarity when sildenafil was found to be an effective PDE-5 inhibitor in human clitoral corpus cavernosum tissue [41]. ...
Purpose of the Review
This review investigates known research on ion channels expressed in the clitoris. Specifically, discussing the role these channels play in clitoral arousal, their contributions to sexual dysfunction, and their potential use as a pharmacological targeted treatment. In addition, we propose channels that should be considered as candidate proteins involved in female sexual dysfunction.
Recent Findings
Review of studies published from 1811–2017, found that only BKCa, SK, and TRPA1 channels have been explored in the clitoris. These studies have identified these channels in clitoral tissue and have suggested their involvement in the nitric oxide-cGMP mediated pathway of erection. However, these studies have not resulted in additional or improved treatment options for female patients with sexual dysfunction. Finally, we suggested the consideration of voltage-gated sodium channels as candidate proteins to explore in sexual dysfunction, due to the comorbid relationship with epilepsy.
Summary
Based on these findings, further research is needed into these channels and their role in female sexual arousal. Investments into this area of research have the potential for improving our understanding of sexual dysfunction of arousal, improving pharmacological treatments, and ultimately improving quality of life for patients.
... Se etter clitorishypertrofi. Økt hvis glans er > 5x5 mm 8 . Stor clitoris som 1x1 cm tyder på langvarig, høy androgen påvirkning. ...
... The labia majora were separated and the prepuce of the clitoris gently retracted. Clitoral size was measured as described by Verkauf et al. [15], with clitoral length measured as the distance from the crura insertion at the pubis symphysis to the tip of the glans and clitoral width measured in the greatest transverse diameter (Fig. 1). Both the clitoral length and width were measured twice using digital Vernier calipers (Resolution 0.01 mm, Accuracy +/−0.02 ...
Background
Data on normative clitoral sizes in newborns is relatively sparse and racial/ethnic differences have also been reported. This study was performed to establish norms for clitoral size in term Ghanaian female newborns.
Methods
This was a cross-sectional study of all apparently well full-term newborns of postnatal age < 48 h and birth weight between 2.5 and 4.0 kg delivered at Komfo Anokye Teaching Hospital between May and September, 2014. Anthropometric and genital parameters were documented for study subjects as well as parental socio-demographic indices.
Results
In 612 newborn females studied, the mean (±SD) clitoral length (MCL) and the mean (±SD) clitoral width (MCW) were 4.13 ± 1.6 mm and 4.21 ± 1.1 mm, respectively. MCL was inversely related to birth weight (r = −0.62; p < 0.001) while MCW was inversely related to both gestational age (r = −0.1; p = 0.02) and birth weight (r = −0.54; p < 0.001). Babies with a clitoris that was completely covered by the labia majora had relatively lower clitoral sizes (p < 0.001) than those who had a partially covered or prominent clitoris. Neither MCL nor MCW differed significantly by birth length or maternal tribe.
Conclusions
Clitoral size varies with birth weight and gestational age. Babies with a completely covered clitoris are unlikely to warrant detailed clitoral measurements for clitoromegaly.
... depilation or waxing. Total stretched clitoral length was measured as the distance from the tip of the glans to the point at the symphysis pubis at which the crura are thought to insert, thus including the clitoral body and glans (24). Blood samples were drawn in the morning for the determination of glutamic-oxaloacetic transaminase and glutamic-pyruvate transaminase and were measured in a subsample of patients included in the cross-sectional study using routine clinical chemistry methods. ...
CONTEXT:
To date, there are few studies investigating the impact of body changes induced by cross-sex hormonal treatment (CHT) on psychobiological well-being in gender-dysphoric persons (GDs).
OBJECTIVE:
The objective of the study was to assess whether CHT-related body changes affect psychobiological well-being in GDs.
METHODS:
A consecutive series of 359 GDs was considered for a cross-sectional section of the study. In addition, 54 GDs were studied in a 2-year follow-up. A physical examination was performed, including body mass index, waist circumference, and hair distribution. We also evaluated breast development and testis volume in male to female subjects and clitoris length in female to male. Subjects were asked to complete several psychometric measures for the assessment of body uneasiness, GD, and psychopathology levels. The evaluation was repeated 2 years prospectively.
RESULTS:
The following results were found: 1) GDs undergoing CHT reported significantly lower subjective levels of GD, body uneasiness, and depressive symptoms as compared with those without; 2) CHT-induced body modifications were significantly associated with a better psychological adjustment; 3) during CHT, GDs reported a significant reduction of general psychopathology, depressive symptoms, and subjective GD, whereas social and legal indicators of GD showed a significant increase across time; and 4) among body changes induced by CHT, only breast development and increased body mass index had a significant impact on psychopathology reduction across time in male to female subjects and female to male subjects, respectively.
CONCLUSIONS:
The aforementioned results support the efficacy of CHT intervention in improving subjective perception of one's own body, which was partially associated with objective changes.
... In adults, the average width of the clitoris is usually 3 to 4 mm, and the length is 4 to 5 mm [1]. The most common cause of clitoral hypertrophy in the newborn is congenital adrenal hyperplasia [2]. ...
A 6-year-old female presented to our hospital with clitoromegaly. On physical examination, she demonstrated evidence of precocious pubic hair and clitoromegaly. The relaxed clitoris measured 3.7 cm in length. Her uterus was undetectable on diagnostic transvaginal ultrasonography and abdomen-pelvis computed tomography (CT) with otherwise normal-appearing internal female genitalia. We planned reduction clitoroplasty with preservation of the dorsal neurovascular pedicle to maintain sensitivity of the glans clitoris. After surgery, the patient demonstrated good recovery. The parents of the patient were satisfied with the surgical results. The patient was discharged without complications on hospital day 6.
... Because of the superficial nature of the clitoral glans, it has previously been the subject of considerable study, eg variations in its size and shape have been well documented. 12 The clitoral and perineal neurovascular bundles are paired terminations of the pudendal neurovascular bundles. They arise at the pelvic side wall. ...
Importance
Transvaginal surgery is commonly performed to treat pelvic organ prolapse. Little research focuses on how sexual function relates to clitoral anatomy after vaginal surgery despite the clitoris’ role in the sexual response.
Objective
To determine how postoperative sexual function after vaginal surgery is associated with clitoral features (size, position, shape).
Design, Setting, and Participants
This was a cross-sectional ancillary study of magnetic resonance imaging (MRI) data from the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study. The setting comprised 8 clinical sites in the US Pelvic Floor Disorders Network and included the MRI data of 88 women with uterovaginal prolapse previously randomized to either vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension between 2013 and 2015. Data were analyzed between September 2021 and June 2023.
Exposures
Participants underwent postoperative pelvic MRI at 30 to 42 months (or earlier if reoperation was desired) between June 2014 and May 2018. Sexual activity and function at baseline (preoperatively) and 24- to 48-month follow-up (postoperatively) were assessed using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, International Urogynecological Association Revised (PISQ-IR). Clitoral features were derived from postoperative MRI-based 3-dimensional models.
Main Outcomes and Measures
Correlations between (1) PISQ-IR mean, subscale, and item scores and (2) clitoral size, position, and shape (principal component scores).
Results
A total of 82 women (median [range] age, 65 [47-79] years) were analyzed (41 received hysteropexy and 41 received hysterectomy). Postoperatively, 37 were sexually active (SA), and 45 were not SA (NSA). Among SA women, better overall postoperative sexual function (higher PISQ-IR summary score) correlated with a larger clitoral glans width (Spearman ρ = 0.37; 95% CI, 0.05-0.62; P = .03) and thickness (Spearman ρ = 0.38; 95% CI, 0.06-0.63; P = .02). Among NSA women, sexual inactivity related to postoperative dyspareunia correlated with a more lateral clitoral position (Spearman ρ = 0.45; 95% CI, 0.18-0.66; P = .002), and sexual inactivity related to incontinence/prolapse correlated with a more posterior clitoral position (Spearman ρ = −0.36; 95% CI, −0.60 to −0.07; P = .02) (farther from the pubic symphysis). Shape analysis demonstrated that poorer postoperative sexual function outcomes in SA women and sexual inactivity in NSA women correlated with a more posteriorly positioned glans, anteriorly oriented clitoral body, medially positioned crura, and lateral vestibular bulbs.
Conclusions and Relevance
Results of this cross-sectional study suggest that postoperative sexual function after vaginal surgery was associated with clitoral glans size, position, and shape. Results warrant prospective studies on surgery-induced changes in clitoral anatomy and sexual function.
The glans clitoris has a corona; however, unlike the corona of the glans penis, the corona of the glans clitoris is practically “nonexistent” as evidenced by the noteworthy absence of its mention and depiction in anatomical and clinical sciences. Accordingly, the corona of the glans clitoris has been neglected in anatomical education and clinical practice. This report details the history regarding the anatomical terminology of the glans and identifies that descriptions of the glans penis, corona of the glans penis, and other penile structures have preceded descriptions of the homologous anatomy of the clitoris by at least a century. Today, recognition of the corona of the glans clitoris, as well as the coronal sulcus and neck of the clitoris should be commonplace. Henceforth, the corona of the glans clitoris and its related anatomy including the sulcus of the glans clitoris and neck of the clitoris should be incorporated into anatomical and clinical language, illustrations, textbooks, education, and practice. Likewise, efforts should be made to propagate knowledge regarding the corona of the glans clitoris, coronal sulcus, and neck of the clitoris to the general public. Giving names to the anatomical structures of the clitoris will undoubtedly increase the awareness of their existence which, in turn, will encourage their clinical assessment and result in decreased morbidity and mortality. Likewise, improved self-awareness of clitoral anatomy will promote self-care which is important in the prevention of disease and the promotion of optimal sexual health.
Abnormalities of the external genitalia during childhood are a common reason for presentation in a pediatric gynecological consultation. As girls are not simply “little women” and go through various phases in their development, the symptoms and complaints must be assessed in this context. Through a targeted medical history and appropriate examination, a diagnosis can often be made and the girl and her parents can be advised accordingly. Only in rare cases is a further referral to a specialized center required. Appropriate education and (hygiene) advice is particularly important for prepubertal vulvovaginitis. In the case of puberty-related changes of the inner labia, an empathetic explanation of the physical change and its diversity can take away the fear of not being “normal” and possibly protect the girl from hasty surgical interventions. It still takes far too long to make a diagnosis and initiate treatment, which means a long period of suffering for those affected. Therefore, this article would like to provide an overview of frequent vulvar findings in girls including their diagnostics and the necessary treatment.
Silverberg's Principles and Practice of Surgical Pathology and Cytopathology is one of the most durable reference texts in pathology. Thoroughly revised and updated, this state-of-the-art new edition encompasses the entire fields of surgical pathology and cytopathology in a single source. Its practice-oriented format uniquely integrates these disciplines to present all the relevant features of a particular lesion, side by side. Over 4000 color images depict clinical features, morphological attributes, histochemical and immunohistochemical findings, and molecular characteristics of all lesions included. This edition features new highly experienced and academically accomplished editors, while chapters are written by the leading experts in the field (several new to this edition, bringing a fresh approach). Dr Steven Silverberg's practical approach to problem solving has been carefully preserved. The print book is packaged with access to a secure, electronic copy of the book, providing quick and easy access to its wealth of text and images.
This chapter focuses on the female pelvic anatomy and the clinical correlations associated with each organ. We begin by dividing the pelvis into the external and internal genitalia and incorporate embryology, pathology, and clinical correlates for each organ. We then discuss the vascular and lymphatic system of the pelvis to better understand important surgical complications. This chapter also incorporates adjacent organ systems that are critical to understanding the female reproductive tract. The emphasis of the chapter is to provide clinicians with anatomical guidelines to better understand the complexities of the female reproductive tract.
Introduction
Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the female external genitalia or any other injury of the female genitalia that is performed for nonmedical reasons. FGM is classified into 4 types. Surgical clitoral reconstruction was first described by Thabet and Thabet in Egypt and subsequently by Foldès in France. The technique was then modified by different authors.
Aim
This article aims to provide a detailed description of clitoral surgical reconstruction and the modifications which have been made over time to improve the procedure while recalling current knowledge in the anatomy of the clitoris.
Methods
We performed a broad systematic search in PubMed/Medline and EMBASE bibliographic databases for studies that report the surgical technique of clitoral reconstruction. From the anatomical point of view, we examined available evidence (from 1950 until 2020) related to clitoral anatomy, the clitoral role in sexual functioning, female genital mutilation/cutting, and surgical implications for the clitoris.
Main Outcomes
A review of the surgical techniques for clitoral reconstruction after female genital mutilation/cutting
Results
We described the current anatomical knowledge about the clitoris, and the procedures based on the surgical technique by Pierre Foldès, We included the technical modifications and contributions described in articles published subsequently.
Conclusion
Surgical repair of the clitoris for FGM offers anatomical and functional results although they still have to be evaluated. However, it should not be the only therapeutic solution offered to women with FGM.
Botter C, Sawan D, SidAhmed-Mezi M, et al. Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique. J Sex Med 2021;XX:XXX–XXX.
Background:
Labiaplasty has grown in popularity, but it remains controversial. Few studies have quantified the change in specific symptomatology from before to after labiaplasty to establish its effectiveness in improving quality of life.
Methods:
In a prospective study, 62 patients undergoing labiaplasty completed written surveys privately in an examination room preoperatively and postoperatively about the presence of 11 physical and appearance-related symptoms.
Results:
Mean patient age was 33.5 years (range, 17 to 61 years). Two patients were of minority age. All patients presented with at least one symptom, averaging 6.5 (range, one to 11). Most (82.2 percent) had a trim labiaplasty, and the rest (17.7 percent) had a wedge. After labiaplasty, 93.5 percent of patients were symptom-free, with the average dropping to 0.23 of 11 symptoms. Symptom-prevalence changes from preoperatively to postoperatively included self-consciousness, dropping from 93 percent to 6.5 percent; tugging (from 66.1 percent to 0 percent); feeling less attractive (from 66.1 percent to 0 percent); negative impact on self-esteem (from 64.5 percent to 1.6 percent); negative impact on intimacy (from 62.5 percent to 0 percent); twisting (from 58.1 percent to 3.2 percent); being uncomfortable (from 56.5 percent to 4.8 percent); clothing restriction (from 54.8 percent to 3.2 percent); visible outline (from 46.8 percent to 1.6 percent); pain (from 43.5 percent to 1.6 percent); and exposure in swimsuits (from 38.7 percent to 1.6 percent). No major complications occurred. Two patients felt their labia were still too long and revision was offered. Average follow-up was 13.3 months (range, 6 to 24 months).
Conclusions:
Patients with elongated labia have a high incidence of functional and appearance-related symptoms. Labiaplasty is a safe procedure that yields significant improvement in quality of life.
Clinical questions/level of evidence:
Therapeutic, IV.
An accurate understanding of anatomy allows designers and scientists to create medical devices that work well for their market. However, reliable descriptions of vulva vaginal dimensions are not currently available for reference. This literature review attempts to survey the existing data collected on vulva vaginal dimensions and report the findings. We located scholarly journal articles and cross-sectional studies via academic databases and online search engines. To pinpoint the data that would be helpful in dimensional analysis of vulva vaginal measurements, key search terms included: “vulva dimensions”, “vulva measurements”, “vaginal dimensions”, “vaginal measurements”, “labia dimensions”, “labia measurements”, “clitoral dimensions”, “clitoral measurements”, and “vulva cross-sectional study”.
In diesem Kapitel werden die Referenzwerte für das äußere Genitale dargestellt.
Die Vulva umfasst die Gesamtheit der primären äußeren weiblichen Geschlechtsorgane. Die Entwicklungsgeschichte ist komplex, da bei der Ausbildung des äußeren Genitales Derivate aller drei Keimblätter (Ekto-, Meso- und Endoderm) interagieren. Hinsichtlich Form und Größe der einzelnen Strukturen besteht eine große interindividuelle Variabilität. Die Vagina ist ein muskuläres Hohlorgan, welches sich vom Hymenalsaum bis zur Cervix uteri erstreckt. Entwicklungsgeschichtlich existieren verschiedene konkurrierende Theorien, welche hier kurz vorgestellt werden. Die Form der Vagina im proximodistalen Verlauf wird hauptsächlich durch ihre Beziehung zu umliegenden Strukturen bestimmt. Eine genaue Kenntnis der topografischen Anatomie der Vulva und Vagina sind sowohl für die klinische Diagnostik als auch für die operative Therapie von größter Bedeutung.
Objective:
Accurate and detailed description of a "normal vulva" is rare, even though few studies dealt with the topic of normal measurements of parts of the external female genitalia. This leads to a situation with a wide range of existing diagnoses concerning "normal" vulvar morphology.
Design:
Cross-sectional prospective single center study.
Setting:
From August 2015 to April 2017 we included 657 women in our gynecological and uro-gynecological outpatient clinic of the Cantonal Hospital Lucerne.
Population or sample:
We recruited Caucasian women aged 15-84 years.
Methods:
Standardized defined measurements were taken of the clitoral gland, distance from the base of the gland to the urethral orifice, length of introitus, length of perineum, length of labia majora, length and width of labia minora. Furthermore we recorded baseline characteristics.
Main outcome measures:
The length of labia minora (r = -.364, p < .001, n = 657) as well as the length of the perineum (r = -.095, p =.014, n = 657) are inversely correlated with the age. A positive correlation between BMI and the length of the labia majora (r = .150, p < .001, n = 657) and the length of the introitus (r = .097, p =.014, n = 657) was found.
Results:
We provide detailed-data on age-related dimensions and description of the external female genitalia in a homogenous group of caucasian women.
Conclusion:
With our data we present a baseline for the appearance of a normal caucasian vulva, which could set up standards for indication in gynecological cosmetic surgery. This article is protected by copyright. All rights reserved.
Office Care of Women covers a wide range of topics which are pertinent to the provision of excellent healthcare. Common gynecologic topics are discussed in depth, as well as non-gynecologic medical conditions which are frequently faced by female patients. This book is designed as a single source reference which covers the majority of topics seen by clinicians as they care for women patients in the office setting. The fifty chapters include topics unique to female patients but also include other health conditions which are affected by the patient's gender. The authors of this book span six specialties and three continents thereby giving the reader a comprehensive source of information to improve the healthcare of women.
Office Care of Women covers a wide range of topics which are pertinent to the provision of excellent healthcare. Common gynecologic topics are discussed in depth, as well as non-gynecologic medical conditions which are frequently faced by female patients. This book is designed as a single source reference which covers the majority of topics seen by clinicians as they care for women patients in the office setting. The fifty chapters include topics unique to female patients but also include other health conditions which are affected by the patient's gender. The authors of this book span six specialties and three continents thereby giving the reader a comprehensive source of information to improve the healthcare of women.
The clitoris is a highly complex organ whose structure has only been clarified in recent years through the use of modern imaging techniques. Clitoromegaly is an abnormal enlargement of this organ. It may be congenital or acquired and is usually due to an excess of androgens in fetal life, infancy, or adolescence. Obvious clitoromegaly in individuals with ambiguous genitalia is easily identifiable, whereas borderline conditions can pass unnoticed. Case reports of clitoromegaly with or without clinical or biochemical hyperandrogenism are quite numerous. In these subjects, a comprehensive physical examination and an accurate personal and family history are needed to investigate the enlargement. We reviewed the literature on the conditions that may be involved in the development of clitoromegaly in childhood and adolescence.
Background:
Mild degree of clitoromegaly can be associated with patient with polycystic ovarian syndrome (PCOS). We describe an unusually significant clitoromegaly in a patient with PCOS.
Clinical case:
An 18-year old non-obese female referred for clitoromegaly. Her genitalia exam showed significant clitoral enlargement with a well-formed glans, clitoris measured at 35 mm for length and 10 mm for width. Pelvic ultrasound showed left ovarian cyst. Testosterone level ranged from 28.8 to 64.1 ng/dl (normal: 8.4-48.1 ng/dl) with normal sex hormone binding globulin. Other ovarian hormones were in acceptable ranges.
Conclusion:
This case demonstrates the coexistence of significant clitoromegaly, PCOS, and non-functioning ovarian cyst.
We have identified a non-steroidal selective androgen receptor modulator (SARM), termed LY305, that is bioavailable through a transdermal route of administration while highly cleared via hepatic metabolism to limit parent compound exposure in the liver. Selection of this compound and its transdermal formulation was based on the optimization of skin absorption properties using both in vitro and in vivo skin models that supported PBPK modeling for human PK predictions. This molecule is an agonist in perineal muscle while being a weak partial agonist in the androgenic tissues such as prostate. When LY305 was tested in animal models of skeletal atrophy it restored the skeletal muscle mass through accelerated repair. In a bone fracture model, LY305 remained osteoprotective in the regenerating tissue and void of deleterious effects. Finally, in a small cohort of healthy volunteers, we assessed the safety and tolerability of LY305 when administered transdermally. LY305 showed a dose-dependent increase in serum exposure and was well tolerated with minimal adverse effects. Notably, there were no statistically significant changes to hematocrit or HDL after 4-week treatment period. Collectively, LY305 represents a first of its kind de novo development of a non-steroidal transdermal SARM with unique properties which could find clinical utility in hypogonadal men.
Objective: Acquired clitoromegaly is a relatively rare condition, with hyperandrogenism among the possible etiologies. We report the case of a postmenopausal woman who presented with acquired clitoromegaly that was caused by a Leydig cell tumor, a rare type of ovarian tumor.
Method: Clinical, laboratory, imaging, and pathology data are presented.
Results: A 66-year-old postmenopausal female was referred to the endocrine office for evaluation of hyperandrogenism after she was found to have an enlarged clitoris on her annual gynecologic exam. Laboratory work-up was remarkable for elevated levels of total and free testosterone, 17-hydroxyprogesterone, and androstenedione concurrent with normal levels of dehydroepiandrosterone sulfate, sex hormone–binding globulin, follicle-stimulating hormone, luteinizing hormone, estradiol, prolactin, random cortisol, and thyroid-stimulating hormone. Pelvic ultrasound and abdominal/pelvic computed tomography were unrevealing. Given the concern for an ovarian malignancy, the patient underwent a laparoscopic bilateral salpingo-oophorectomy. Pathology showed a left ovarian hilar Leydig cell tumor with a benign mucinous cyst. Postoperatively, her total and free testosterone normalized.
Conclusion: Acquired clitoromegaly and ovarian Leydig cell tumors are both rare entities. New clitoromegaly in postmenopausal women necessitates careful evaluation for biochemical evidence of hyperandrogenism.
Abbreviations: DHEA-S dehydroepiandrosterone sulfate PCOS polycystic ovary syndrome SLCT Sertoli-Leydig cell tumor
Background:
Clitoromegaly is often a sign of an underlying disorder of sexual development. Isolated clitoromegaly may occur as a result of benign or malignant neoplasm.
Case:
A 10-year-old female presented with clitoral swelling and discomfort and was noted to have a 5X2X2 centimeter, tender, cystic mass in the left periclitoral area. Ultrasound confirmed the primarily cystic nature of the lesion. At surgery the mass was carefully excised not damaging the clitoral neurovascular bundle. Pathology demonstrated a hemangioma.
Summary and conclusions:
Differentiating between potential etiologies of clitoromegaly requires a careful history, physical examination, select hormone levels, imaging, and pathology which allows for appropriate management. In this case the pain, tenderness, disfigurement, and imaging demonstrating a cystic mass resulted in surgical removal of the mass.
The female genitalia can be subdivided into the internal genitalia (vagina, cervix, uterus, fallopian tubes, and ovaries) and external genitalia (vulva), including the mons pubis, clitoris, labia majora and minora, which are the structures surrounding the urogenital cleft. In anatomy textbooks there is a separation between the embryological development of the internal and external genital organs in males and females. It is important to know this because it is related to the function of these organs, that is, the internal genitals have a reproductive function, while the external ones have the function of giving pleasure (Puppo 2011). This chapter describes the structure directly involved in the physiological sexual response.
Chronic neurological disease can have a tremendous impact on a woman’s health, self-image, and consequently on self-esteem [1]. One of the most important areas that could be impaired after the onset of a neurological disease is sexual function.
This article focuses on anti-FGM laws aiming at eliminating gender-based violence. It uses intersectionality to question the underlying conceptualization of gender-based violence, and examines how the problem is represented , and which solutions have been proposed by French, British and Italian laws, showing their inconsistencies and biases. It also considers silenced dissenting voices by focusing on the proposal of " circumcision without cutting ". The main goal is to uncover how anti-FGM laws generate new forms of vulnerability for African descent women in Europe, calling for a more complex articulation of gender at the intersection with migration status, ethnicity and neo-colonial relations.
Purpose: Angiotensin (ANG) II has been known to be a potent modulator for the maintenance of smooth muscle tone of the penile cavernosum. However, its role in clitoral cavernosum is unknown. The clitoris is the homologue of the penis arising from the embryological genital tubercle. We investigated the presence of ANG II receptors, the function of ANG II, and its interaction with nitric oxide (NO) in rabbit clitoral cavernosum. Materials and Methods: The isometric tension was measured in the strips of clitoral cavernosum. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to evaluate expression of AT1a and AT1b ANG II receptor subtype mRNAs. In vitro autoradiography was used to localize ANG II receptors in the clitoral cavernosum. Results: The clitoral cavernosum was contracted dose-dependently by the addition of ANG II. Dup 753 (ANG II type 1 receptor antagonist) inhibited significantly ANG II induced contraction. PD 123,319 (ANG II type 2 receptor antagonist) did not affect the ANG II response. Pretreatment with N-G-nitro-L-arginine methyl ester (NO synthase inhibitor) accentuated contractions induced by ANG II. Specific binding sites for I-125-ANG II were found in the clitoral cavernosum, The dissociation constant (K-d) was 0.58 +/- 0.05 nM. Specific binding of I-125-ANG II was displaced by Dup 753 (10(-5) M) but not by PD 123,319 (10-5 M). The inhibitory constant (Ki) for Dup 753 was 23.4 +/- 9.73 nM and mRNAs for AT1a and AT1b receptor subtypes were detected by RT-PCR. Conclusion: The present study shows that ANG II is involved in the regulation of clitoral cavernosum smooth muscle tone via ANG II receptor subtype AT1, and that ANG II has cross-talk with NO.
It is probably well within bounds to affirm that our present beliefs concerning normal sex life and average experience and practice have the status of surmises standing on foundations no more secure than general impressions and scattering personal histories. It is time we began building on collected case records running through lifetimes in series counted in tens of thousands. In view of the pervicacious gonad urge in human beings, it is not a little curious that science develops its sole timidity around about the pivotal point of the physiology of sex. Perhaps this avoidance—not of the bizarre and the extreme, the abnormal and the diseased, but of the normal usages and medial standards of mankind—perhaps this shyness is begotten by the certainty that such study cannot be freed from the warp of personal experience, the bias of individual prejudice, and, above all, from the implication of prurience. And yet a
Plasma androgen, 17 beta-estradiol, and sex hormone-binding globulin (SHBG) levels were measured in 11 normal subjects (group 1), 18 hirsute patients with no clitoromegaly (group 2), 13 hirsute patients with clitoromegaly (group 3), and 8 patients with clitoromegaly but no hirsutism (group 4). Significantly elevated levels of testosterone (T) and dihydrotestosterone (DHT) were found in groups 2 and 3 but not in group 4 when compared with group 1. In contrast, levels of dehydroepiandrosterone (DHEA) in groups 1 and 2 were comparable but significantly lower than those in group 3 and 4; the levels in the latter two groups were not significantly different from each other. In groups 2, 3, and 4, levels of androstenedione (delta 4A) and the factor T/SHBG were significantly elevated whereas SHBG levels were significantly suppressed when compared with those of group 1. The clitoral index correlated (P less than 0.01) with DHEA levels in group 3. It is concluded that clitoromegaly without hirsutism is associated with increased plasma levels of DHEA and delta 4A. In contrast, hirsutism without clitoromegaly is associated with elevated levels of T, DHT, and delta 4A but normal DHEA levels.
