Clitoral Length Research Articles

7745 Hirsutism in young girls, Beyond PCOS

Abstract Disclosure: I. Mishra: None. A. Baliarsinha: None. Hirsutism is excessive terminal hair that appears in a male pattern in women.Though obesity,insulin resistance and PCOS are common cause of hirsutism in young girls,suspicion of other etiologies must be made on a background of overlapping features.We describe 3 cases of young females presenting with hirsutism with varied etiologies. Case 1.16 year 11months old female presented with oligomenorrhea -3years,excessive hair growth over face -2 years.On examination,BMI was 25.2 kg/m2,Grade 2 acanthosis,A3P5B5,modified FG- 16/36,clitoral length-1.3cm and clitoral index - 70 mm2.Biochemical evaluation revealed normal thyroid function tests,s.prolactin- 23.65 ng/ml,ONDST- 1.2 mcg/dl,LH - 1.49 IU/ml,FSH- 7.44IU/ml,serum testosterone- 70ng/dl,17OHP- 7.03 ng/ml,DHEAS- 553mcg/dl and post synacthen 17OHP- 36.89 ng/ml respectively. USG abdomen & pelvis was normal.HOMA-IR was 4.1. Diagnosis was LOCAH Case 2.19 year old female presented with hair growth in androgen dependent areas-5years, regular predictable menstrual cycles and was treated as a case of PCOS for 5 years with no changes in hair growth pattern.She was off therapy since 1 year prior presenting to us.On examination,BMI was 24 kg/m2,acanthosis absent,A3P5B5,modified FG- 18/36, clitoral length- 6 mm,clitoral index - 25mm2.Biochemical evaluation revealed normal thyroid function tests,s.prolactin- 22.9 ng/ml,ONDST- 0.508 mcg/dl,LH - 5.98 IU/ml,FSH- 5.29 IU/ml, serum testosterone- 23.4 ng/dl,17OHP- 1.01 ng/ml and DHEAS- 298 mcg/dl respectivelyUSG Abdomen & pelvis;RO - 5.7cc,LO - 5.6 cc with B/L PCOM.Review TVS was normal.In view of discordant results DHT and luteal phase serum progesterone were done which were 80.5 pg/ml and 2.1ng/ml respectively.HOMA IR was 1.9.Diagnosis was IDIOPATHIC HIRSUTISM. Case 3.12 year old female child presented with excessive hair growth over face,chest,back and abdomen- 1yr,hoarseness of voice - 1 yr,onset of breast enlargement apprx 8 to 9yrs with non-attainment of menarche.On examination BMI was 30 kg/m2,Grade 3 acanthosis, A3P5B3,modified FG- 15/36,clitoral length- 2.8 cm & clitoral index - 120 mm2. Biochemical evaluation revealed normal thyroid function tests,LH - 15.3 IU/ml,FSH- 6 IU/ml,s.prolactin- 11.2 ng/ml,ONDST- 0.38 mcg/dl,DHEAS- 161 mcg/dl,serum testosterone- 140 ng/dl,17OHP- 3.9 ng/ml and post synacthen 17OHP- 4.10 ng/ml respectively.USG abdomen-s/o PCOS with normal adrenals. In view of discordant results short DAST was done which was Testosterone(ng/dl)baseline-125;4hr-91.1, DHEAS (mcg/dl) baseline-180;4hr-188 cortisol (mcg/dl) baseline-7.04;4hr-0.95.HOMA-IR was 5.4. Diagnosis was PCOS(OVARIAN THECOSIS).Varied presentations of hyperandrogenic disorders occurs in young females.A need to revise the diagnosis must be made if no response is obtained with initial drug regimes. Presentation: 6/3/2024

The Batalha Clitoropexy: Shortening an Elongated Clitoris - A Minimally Invasive Technique.

Female cosmetic genital surgery is becoming increasingly sought after by women who are concerned with the appearance of their vulva. Labiaplasty for the labia minora is undoubtedly the most commonly performed female cosmetic genital surgery. However, an increasing number of patients seen in our clinics in both Brazil and the United States are presenting with clitoral hypertrophy, specifically clitoral elongation. The elongated clitoris will usually protrude beyond the labia minora and majora and from the patient's perspective will give a less feminine appearance as they will often describe the protruding clitoris as feeling like they have a small penis. The surgical technique described here, Batalha Clitoropexy, is a minimally invasive surgical technique for clitoral length-reduction that does not require amputation or debulking. This technique is presented in the form of the detailed sequential steps needed to achieve satisfactory results. Photos taken before and after the procedure in a representative case show that the clitoral length has been shortened from 5.0 cm to 1.5 cm without the need of an invasive amputation or debulking clitoroplasty. Many patients with clitoromegaly or an elongated protruding clitoris do not need to undergo an invasive clitoroplasty. Specifically, patients with clitoral elongation or clitoral ptosis can be surgically treated with a less-invasive clitoropexy surgical procedure which can restore normal anatomic position to treat a protruding clitoris.

Ovarian reserve and fertility parameters in post-pubertal females with congenital adrenal hyperplasia: a case-control study.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder characterized by impaired activity of the enzyme required for cortisol and aldosterone production, resulting in increased adrenal androgen synthesis. Factors affecting fertility in CAH patients include ambiguous genitalia and their complications, excessive androgen secretion, adrenal progesterone hypersecretion, and various psychosocial factors. Serum anti-Müllerian hormone (AMH) level is used to assess ovarian reserve in women. A few data on serum AMH levels in CAH patients are available in the literature. The aim of the study was to evaluate ovarian reserve in a group of post-menarche females diagnosed with CAH by measuring serum AMH level and assessing the number of antral follicles sonographically. A case-control study was conducted on 17 post-pubertal CAH females and 17 age-matched healthy female controls; the mean age of the patient group was 15.09±3.55 years ranging from 11 to 24 years, while the mean age of the control group was 16.04±3.72 years ranging from 12 to 25 years, the mean post-menarchal age of the patients group was 3.29±1.37 years ranging from 1 to 6 years while the mean post-menarchal age of the control group was 4.13±1.62 years ranging from 1 to 9 years. The degree of hirsutism was compared between the two groups according to the modified Ferriman-Gallwey score, clitoral length was assessed using a digital caliber. Serum levels of adrenal androgens in addition to basal levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and serum AMH were measured in both groups. Patients had smaller uterine volumes, and smaller ovarian volumes but a comparable number of antral follicles and comparable serum AMH levels relative to controls. Good compliance with treatment in patients with CAH results in good hormonal control, low risk of PCOS, good fertility parameters, and a good ovarian reserve.

Generation of South Indian Data for Normal Clitoral Dimensions and Anogenital Ratio in Term Neonates.

Assessment of genitalia is an important part of the neonatal examination. Regional, racial, and ethnic variations in phallic length have been documented. Clitoral dimensions may also show similar variations. Normal values for neonatal clitoral measurements may help the pediatrician/neonatologist to accurately diagnose clitoromegaly and underlying etiology to guide appropriate investigations. Data on clitoral measurements is limited with only one study from India (Kolkata). Hence we aimed in this study to generate south Indian data on neonatal clitoral dimensions, anogenital distance, and anogenital ratio. Two hundred and fifty two hemodynamically stable term female neonates without ambiguous genitalia/vulval masses born in a community hospital. Hospital-based cross-sectional study. 1. To measure clitoral dimensions, anogenital distance, and anogenital ratio in female neonates. 2. To correlate clitoral dimensions, anogenital distance, and ratio with anthropometric measurements, gestational age, and maternal comorbidities. Measurements were recorded using a digital vernier caliper, under strict aseptic precautions with labia majora gently separated and the baby held in a frog-leg position. Clitoral length, width, and anogenital distance were measured and anogenital ratio and clitoral index were calculated. In term neonates, the mean ± SD of clitoral length (CL), clitoral width (CW), anogenital ratio (AGR) were 6.34 ± 1.75 mm, 6.39 ± 1.27 mm and 0.39 ± 0.05, respectively. The 3rd and 97th centiles for mean clitoral length were 3.55 and 9.93 mm, for mean clitoral width were 3.37 and 8.35 mm, and for AGR were 0.28 and 0.48, respectively. These clitoral dimensions in south Indian neonates were higher than those from East India (Kolkata), lower than Nigerian babies, and similar to Israeli neonates. Mean CL and CW had no statistical correlation with birth weight, gestational age, head circumference, or length in term neonates. A significant correlation was noted between pregnancy-induced hypertension and mean clitoral width, and between gestational diabetes and AGR. Normative values for clitoral dimensions (length and width) and AGR for south Indian term female neonates have been established. 97th centiles of 9.93 mm (CL) and 8.35 mm (CW) and 0.48 mm (AGR) may be used as practical cut-offs to diagnose clitoromegaly and virilization. Clitoral measurements had no statistical correlation with birth weight, gestational age, or anthropometry. Clitoral measurements exhibit ethnic and racial differences, thus emphasizing the importance of regional cut-offs and need for more studies from different parts of India on CL.

Assessment of neophallus length following metoidioplasty.

An increasing number of gender diverse individuals are presenting for gender affirming care. An option for genital gender affirming surgery (gGAS) in transmasculine individuals is metoidioplasty, creating a small neophallus from enlarged clitoral tissue following prolonged testosterone exposure. The goal of this study is to understand factors which contribute to greater exposed neophallus length following metoidioplasty. We performed a retrospective chart review on patients presenting to a single academic institution who underwent a metoidioplasty. All operations were performed using the Belgrade technique with or without urethral lengthening depending on patient preference. Twenty-seven patients underwent metoidioplasty from 2017-2022. Sixteen had recorded stretched clitoral length (pre-operatively) and exposed neophallus length (post-operatively). The median length of time on testosterone therapy was 4.6 years. The median stretched clitoral length was 5.8 cm, and exposed neophallus length was 6 cm. There was a strong correlation between pre-operative length and post-operative length (ρ=0.9; P<0.0001). There were no correlations between pre-operative length or exposed neophallus length and BMI (ρ=-0.02, P=0.93; ρ=0.05, P=0.83, respectively). Time on testosterone does not correlate with stretched clitoral length nor exposed neophallus length (ρ=-0.28, P=0.15; ρ=-0.35, P=0.18, respectively). Patients considering metoidioplasty often wonder how large their neophallus will be. We found that patients can expect exposed neophallus length to be about 0.6 cm longer than their pre-operative stretched clitoral length. No evidence of association of time on testosterone nor BMI with exposed neophallus length was found. This information is crucial for gender diverse patients to make informed decisions about gGAS.

Estimation of Reference Values for External Genitalia Parameters in North Indian Preterm and Term Female Newborns.

To establish gestation-wise normative data of external genitalia measurements in North Indian term and preterm female newborns. In this cross-sectional descriptive study, institutionally-born female neonates between 28-42 wk gestation were consecutively enrolled between 24-72 h of life. Newborns with major congenital malformations, chromosomal anomalies, multifetal gestation and birth injuries were excluded. Data on various genital measurements were collected [Clitoral length (CL), clitoral width (CW), ano-clitoral distance (AGDAC), ano-fourchette distance (AGDAF) and anogenital ratio (AGR)]. One hundred ninety-eight of 508 neonates (39%) were preterm and 310 (61%) were term. Mean (± SD) CL and CW were 4.6 ± 1.8 mm and 3.9 ± 1.6 mm, respectively. Mean (± SD) values for AGDAF, AGDAC and AGR were 9.3 ± 1.8 mm, 30.2 ± 3.9 mm, and 0.31 ± 0.05, respectively. According to these results, term female newborns with CL more than 7 mm and/or CW more than 6 mm (95th centile) warrant evaluation for clitoromegaly. An anogenital ratio greater than 0.45 should be considered as a sign of virilization in a female neonate. Gestation-wise percentile charts for CL, CW, AGDAF, AGDAC and AGR were generated. The percentile values defined in the study can serve as local normative data for accurate interpretation of genital measurements in North Indian female newborns and enable health care professionals for early identification of genital virilization.

MP20-12 ASSESSMENT OF NEOPHALLUS LENGTH FOLLOWING METOIDIOPLASTY

You have accessJournal of UrologyCME1 May 2022MP20-12 ASSESSMENT OF NEOPHALLUS LENGTH FOLLOWING METOIDIOPLASTY Hannah Glick, Stephanie Diagnault-Newton, and Miriam Hadj-Moussa Hannah GlickHannah Glick More articles by this author , Stephanie Diagnault-NewtonStephanie Diagnault-Newton More articles by this author , and Miriam Hadj-MoussaMiriam Hadj-Moussa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An increasing number of transgender and gender diverse individuals are presenting to care for gender affirming services. Genital gender affirming surgery (gGAS) improves quality of life and sexual satisfaction. An option for gGAS in transmasculine individuals is the metoidioplasty, creating a small neophallus from enlarged clitoral tissue following prolonged testosterone exposure. A commonly asked question for patients considering metoidioplasty is what size neophallus they can expect postoperatively. There are currently no studies to date which have shown how preoperative stretched clitoral length correlates with postoperative exposed neophallus length. The goal of this study is to understand factors which contribute to greater exposed neophallus length following metoidioplasty. METHODS: We performed a retrospective chart review on patients from 2000-2021 presenting to a single academic institution who underwent a metoidioplasty utilizing the Belgrade style technique, with or without urethral lengthening. RESULTS: A total of 23 patients underwent metoidioplasty. Of those patients, 11 had recorded stretched clitoral length (preoperatively) and exposed neophallus length (postoperatively). There were 9 (82%) patients who identified as transgender men, and 2 (18%) who identified as nonbinary. In this cohort, the median length on testosterone was 4.1 years. The median stretched clitoral length was 5cm, the median exposed neophallus length was 6cm. There was a strong correlation between preoperative length and postoperative length (ρ=0.9) (figure 1). Increased length on testosterone was not associated with longer exposed neophallus length (p=0.09) and had a negative correlation (ρ=-0.53). CONCLUSIONS: Patients considering metoidioplasty understandably wonder how large their neophallus will be after surgery. We’ve found that patients can expect postoperative neophallus exposed length to be about 1cm larger than their preoperative stretched clitoral length. A longer time on testosterone is not associated with longer exposed neophallus length. Our study was limited by its small sample size. Future studies should be done to elucidate factors which may preclude to longer exposed neophallus length after metoidioplasty. This information is crucial for our gender diverse patients to make informed decisions about gGAS. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e321 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Glick More articles by this author Stephanie Diagnault-Newton More articles by this author Miriam Hadj-Moussa More articles by this author Expand All Advertisement PDF DownloadLoading ...

Defining Ideal External Female Genital Anatomy via Crowdsourcing Analysis.

Despite existing anthropometric data in the literature regarding the variation of female external genital anatomy, the ideal aesthetic characteristics have yet to be defined. The authors utilized crowdsourcing to better evaluate preferred anatomic characteristics of external female genitalia. Fifty-six total images were digitally created by altering the proportions of the labia minora, labia majora, and clitoral hood. Images with differing ratios were presented in pairs to Amazon Mechanical Turk (Seattle, WA, USA) raters. Three different experiments were performed with each varying 2 of the 3 image characteristics to permit 2-factor modeling. The Bradley-Terry-Luce model was applied to the pairwise comparisons ratings to create a rank order for each image. Preferences for each anatomic variable were compared with chi-squared tests. A total of 5000 raters participated. Experiment 1 compared differing widths of the labia majora and labia minora and determined a significant preference for larger labia majora width and mid-range labia minora width (P = 0.007). Experiment 2 compared labia minora width vs clitoral hood length and showed a statistically significant preference for wider majoras (P < 0.001) but no significant preference in clitoral hood length (P = 0.54). Experiment 3 compared clitoral hood length vs labia minora width and showed a statistically significant preference for mid-range labia minora widths (P < 0.001) but no significant preference in clitoral hood length (P = 0.78). Raters preferred a labia majora to labia minora width ratio of 3:1 with minimal preference in clitoral hood length.

Reference values for penile and clitoral lengths of healthy term Egyptian newborn infants.

Examination of the external genital organs is an integral part of the routine physical examination of the newborn. Early recognition of micropenis or clitoromegaly is important as they may be the only obvious manifestation of pituitary or hypothalamic hormonal deficiencies at birth. Studies suggest that differences in penile or clitoral anthropometry may exist between different populations. Therefore, reference values for genital organs dimensions should be available and well known to medical personnel. We aim to establish reference values for the penile length in Egyptian newborn boys and reference values for the clitoral length in Egyptian newborn girls and to define micropenis and clitoromegaly according to Egyptian reference values. A total of 500 healthy term newborn boys and 500 healthy term newborn girls were enrolled in the study. Stretched penile length and clitoral length were measured during the first 7 days of postnatal life. Birth weight, length and head circumference were measured and recorded. The mean (±SD) stretched penile length was 3.16 ± 0.41 cm. The mean (±SD) clitoral length was 0.51 ± 0.13. There was no significant correlation between penile or clitoral length, and body weight, length or head circumference. Our study provides reference values for normal penile length and clitoral length in Egyptian newborns. Our study suggests that among healthy term Egyptian newborns, penile length of less than 2.13 cm may be considered micropenis and clitoral length of more than 0.83 cm may be considered clitoromegaly.

Comparative study of neonatal clitoral length measurement using calliper and spatula

Background: When standard instruments are unavailable for clitoral length measurement, improvisation with locally available tools could be of diagnostic value. Objective: The objective of this study was to determine how the clitoral length measured with a wooden spatula compared to that measured with a caliper. Methods: This was a comparative cross-sectional study. Three hundred and five term female infants were recruited from multiple health facilities in Sagamu, Ogun State, Nigeria. The clitoral length was measured with a sliding digital caliper and a wooden spatula (tongue depressor). All the measurements were taken within the first 72 hours of life and comparative analysis was carried out. Results: The mean (± SD) clitoral length using the sliding digital caliper and the spatula were 6.7 ± 1.6 mm and 6.5 ± 1.8 mm respectively. There was no statistically significant difference between the mean values of both measurements (t = 1.369, p = 0.171). Pearson’s correlation showed that both variables were significantly correlated (r = 0.693, p &lt; 0.001) and the spatula length was a moderate predictor of the caliper length (Coefficient of determination [R2] = 0.48 and p &lt; 0.001). Conclusion: The findings of this study suggest that the determination of clitoral length using a spatula, commonly found in all community settings, is similar to determination of clitoral length using a digital caliper, most often used for clinical research.

Do external female genital measurements affect genital perception and sexual function and orgasm?

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.

Are anogenital distance and external female genitalia development changed in neural tube defects? Study in human fetuses

Anogenital distance (AGD), the distance from the anus to the genitals, is a marker of normal genital development. AGD and other biometric parameters of external female genitalia are important as ultrasonographic markers that can determine fetal gender in the first trimester. Neural tube defects are one of the commonest congenital malformations of the central nervous system, with anencephaly being the most severe defect. Female genitalia development and their association with anencephaly have not been previously described. The aim of this study was to compare the biometric parameters of external female genitalia in fetuses with anencephaly and compare it to the parameters of normocephalic fetuses at different gestational ages. We studied 34 female fetuses, 22 normocephalic and 12 anencephalic, aged between 12 and 22 weeks post-conception. The fetuses were placed in the classic lithotomy position and before the fetal dissection, the external female genitalia were photographed with a digital camera. Biometric parameters were recorded and measurements were performed using the Image J software, version 1.46r. Clitoral length and width, clitoris to anus distance, vaginal opening length and width, vaginal opening to labia majora distance, and AGD were measured (Figure). For statistical analysis, the Wilcoxon-Mann-Whitney test was used (p<0.05). We observed a significant difference between some measurements of the groups: the vaginal opening width was significantly greater in anencephalic fetuses and the vaginal opening length, clitoris to anus distance and vaginal opening to labia majora distance were significantly greater in normocephalic fetuses. For the clitoris length and width, we did not find statistical differences. We also did not find statistical significance in AGD between groups (normocephalic 2.32mm [2.46-6.42/SD=2.17] vs. anencephalic 3.93mm [1.15-6.65/SD=1.93]; p=0.499). The linear regression analysis indicated that AGD increased more with age in anencephalic than in the normocephalic group, but without significant differences (r2=0.01677; p<0.318). This article is the first to report the female external genitalia parameters in fetuses with anencephaly. In our study we observed some alterations in biometry of the external genitalia in anencephalic fetuses, with a pattern of morphological reduction in this group. The vaginal opening length, clitoris to anus distance and vaginal opening to labia majora distance were significantly lower in anencephalic fetuses but we did not find statistical significance in clitoris measurements and AGD. Anencephalic fetuses had some alterations in external genitalia development, but the anogenital distances did vary significantly between the groups.

Reference values for the external genitalia of full-term and pre-term female neonates

Background and objectivesIdentifying virilisation of the genitalia in female newborns early during the neonatal period is important to diagnose pathologies. However, there is no clear threshold for clitoromegaly or for...

The Nomogram of Clitoral Length and Width in Iranian Term and Preterm Neonates.

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.

Relationship of orgasm with measurable dimensions of clitoris and visibility of clitoral glans

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&lt;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.

SUN-LB16 Clitoromegaly in Premature Infants: Is It Truly Pathologic?

Background: Normative data for clitoral size in premature infants are limited. Consequently, the potential for over-diagnosis is high; leading to unnecessary investigations, increased healthcare costs and parental stress. Several proposed mechanisms, e.g., persistence of fetal adrenal zone activity to term gestation, point to the transient physiologic nature of clitoromegaly in premature infants. Studies of normative data have shown a negative correlation between birth weight and clitoral size. We hypothesized that 1) the majority of clitoromegaly in premature infants is not associated with hormonal dysfunction and 2) lower birth weight and lower gestational age increase the likelihood of a formal consult in premature infants with perceived clitoromegaly. Methods: A retrospective chart review of female infants born at our institution from January 2012 to December 2018 with perceived clitoromegaly was conducted. Birth history, demographic and laboratory data were collected. Patients were divided into two groups: ‘formal consult’ and ‘no formal consult’ for clitoromegaly. True clitoromegaly was defined as clitoral length >9 mm or clitoral width >6 mm. Patients not meeting these criteria or those with clitoral edema, prominent clitoral hood were classified under false clitoromegaly. In the ‘no formal consult’ group, the documented discharge examination was used to assess persistence of clitoromegaly. Uni- and multi-variable logistic regression were used to determine factors that increased the likelihood of a formal consult. Results: 29 patients met inclusion criteria; 15 in the ‘formal consult’ group and 14 in the ‘no formal consult’ group. No significant differences were found between the groups in terms of birth weight, gestational age, race, ethnicity and maternal factors. History of IUGR (intrauterine growth restriction) was more common in the ‘formal consult’ group (60%) vs. ‘no formal consult’ group (21%) (p=0.04). Only 3/15 patients in the ‘formal consult’ group had true clitoromegaly; all 3 had normal 17-hydroxyprogesterone levels, and only 1 patient had transient elevation in androgen levels (androstenedione, deoxycortisol and testosterone). Of the ‘no formal consult’ group, only 3/14 patients had clitoromegaly noted on discharge; outcome was unknown for 1. Multi-variable logistic regression showed that lower gestational age (p=0.04) and history of IUGR (p=0.03), even after adjusting for birth weight, increased the likelihood of a formal consult. Conclusion: In summary, the majority of perceived clitoromegaly in premature infants is not associated with hormonal dysfunction. Lower gestational age and a history of IUGR increase the likelihood of a formal consult for clitoromegaly in these patients. Approximately half of the patients were noted to have false clitoromegaly indicating inconsistencies in examination technique and need for provider education.

Clitoral length in immature and mature captive tufted capuchin (Sapajus spp.) females: A cross-sectional study.

Quantitative data on female external genital morphology are sporadic in the primate literature, and the intraspecific and interfemale variation is especially under investigated (e.g., external clitoris length). Since in most anthropoid primate species female external genitals are relatively small and often hidden, for those species whose external clitoris is described as hypertrophic, external genital resemblance may represent a source of confusion in distinguishing the sexes at a distance. This is the case of both captive and wild tufted capuchin (Sapajus spp.) infants. We provided data on external clitoral length and investigated differences in this trait at different ages in a captive female tufted capuchin population. Since likely allometric growth describes changes in relative dimensions of parts of the body that are correlated with changes in overall size, clitoris length has been analyzed by using body weight as a covariate. We measured clitoral length by adapting a technique developed for spotted hyenas (Crocuta crocuta). Our results suggest that the small body size may be only in part responsible of the perception of long clitoris in female infants, since the clitoris is actually longer in immature females compared to adult ones and its size is inversely related to body weight. While the cross-sectional nature of these data does not allow for conclusive interpretation of the results, we tentatively suggest this phenomenon as a transient male-mimicry by immature females. Our study contributed to the description of normative data in a clitoral trait, thus providing foundation for future studies about causal mechanisms and possible adaptive function(s).

Clitoral sizes and anogenital distances in term newborns in Nigeria

BackgroundPrevious studies suggest significant ethnic and racial differences in clitoral sizes and anogenital distances in the newborn. This study aimed to document normative data on clitoral sizes and anogenital distances of apparently normal term female infants in Sagamu.MethodsThe study was a multi-center, cross-sectional descriptive research carried out among 317 female term infants within the first 72 h of life. Interviewer-based questionnaire was applied to obtain sociodemographic data, pregnancy and birth history. A sliding digital caliper was used for measurement. Data analysis was with SPSS version 20.0.ResultsThe mean clitoral length was 6.7 ± 1.6 mm while the mean clitoral width was 5.6 ± 0.8 mm. The mean fourchette-clitoris distance, anus-clitoris distance and anus-fourchette distance were 21.9 ± 2.1 mm, 35.5 ± 2.5 mm and 17.0 ± 2.6 mm respectively. The anus-clitoris and anus-fourchette distances significantly correlated with the anthropometric parameters while the clitoral measurements did not.ConclusionThe mean values recorded in this study were higher than observed in most previous studies. This simple, affordable and non-invasive evaluation could aid early diagnosis and treatment of female infants with potentially harmful conditions such as congenital adrenal hyperplasia.

Incidence of disorders of sexual development in neonates in Ghana: prospective study

ObjectiveThe incidence of disorders of sexual development (DSD) is unknown in sub-Saharan Africa. We describe the characteristics and incidence of DSD in a cohort of infants born in Ghana.DesignTrained research...

Novel Observations of Female Genital Anatomy in Classic Bladder Exstrophy Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Understanding the distinct female anatomy in classic bladder exstrophy is crucial for optimal reconstructive and functional outcomes. We present novel quantitative anatomical data in females with classic bladder exstrophy before primary closure. 3-Dimensional reconstruction was performed in patients undergoing pelvic magnetic resonance imaging, and pelvic anatomy was characterized, including measurements of the vagina, cervix and erectile bodies. We examined magnetic resonance imaging of 5 females (mean age 5.5 months) with classic bladder exstrophy and 4 age matched controls (mean age 5.8 months). Mean distance between the anal verge and vaginal introitus was greater in patients with classic bladder exstrophy (2.43 cm) than in controls (1.62cm). Mean total vaginal length in patients with classic bladder exstrophy was half that of controls (1.64 cm vs 3.39 cm). All 4 controls had posterior facing cervical ora, while 4 of 5 females with exstrophy had anterior facing cervical ora located in the anterior vaginal wall. Lateral deviation of the cervical ora was also seen in all 5 patients with classic bladder exstrophy but in only 1 control. Clitoral body length was comparable in both groups (26.2 mm and 28.0 mm). However, the anterior cavernosa-to-posterior (pelvic rami associated) cavernosa ratio was much greater in patients with classic bladder exstrophy (6.4) compared to controls (2.5). This study uncovers the uniquely novel finding that contrary to their male counterparts, females with classic bladder exstrophy have the majority of the clitoral body anterior to the pelvic attachment. This discovery has surgical and embryological implications.