Clitoral hypertrophy is understood in medicine as an abnormal enlargement of the clitoris. In this case, women suffer from a clitoris that sometimes resembles the male penis due to its unusual size. In many cases it is a congenital malformation. However, it can also develop in the course of life for a wide variety of reasons.
What is clitoral hypertrophy?
Clitoral hypertrophy is also referred to as megaloclitoris or clitoromegaly. The malformation is divided into four classes:
- A hormonally induced clitoral hypertrophy.
- A non-hormonal clitoral hypertrophy.
- A pseudo-clitoromegaly
- Idiopathic clitoromegaly
There are many reasons for the development of clitoral hypertrophy. The most common cause of the development of this malformation of the female genitals is a hormonal disorder. This occurs very often in younger girls. In most cases there is a defect of the enzyme CYP21. This enzyme influences the hormonal processes in the body. The result is a reduced breakdown of the steroid hormone progesterone. As a result, both androstenedione and testosterone are produced excessively. This increased production of androgens causes masculinization of females.
Causes
Among the most common causes is so-called pseudohermaphroditism, which develops as a result of adrenogenital syndrome or adrenocortical hyperplasia. The development often occurs in early pregnancy. If the female fetus suffers from an enzyme defect, a disproportionate excess of male hormones develops. If this disorder occurs before the 14th week of pregnancy, pronounced hermaphroditism may result. Basically, the expression of later clitoral hypertrophy depends on the timing, intensity as well as duration of the influence of androgens. Enlargement of the clitoris can further be triggered by tumors with androgenic effect. The malignant neoplasms are not only found in the area of the ovaries such as the hilar cell tumor and the Leydig cell tumor. Cancers of the adrenal gland, gonadal tumors that produce steroids, and carcinosarcomas in the urinary bladder can also have masculinizing effects. In addition, Cushing syndrome, Fraser syndrome, gonadal dysgenesis, Turner syndrome, and neurofibromatosis are among the diseases that can cause clitoromegaly. Besides, clitoral hypertrophy can also be caused by mechanical stimuli. Permanent rubbing of the clitoris can cause inflammation. Enlargement of the prepuce and labia minora may suggest pseudo-clitoral hypertrophy.
Symptoms, complaints, and signs
The typical sign of megaloclitoris represents the excessive enlargement of the clitoris. This can be pronounced to the point that the clitoris looks like a small penis. It is possible that other androgenic features such as a strong male pattern of hairiness may appear. In addition to the enlarged clitoris, changes in the external genitalia may also occur. If patients suffer from very pronounced masculinization, clitoral hypertrophy may result in the appearance of testicular labia and obstruction of the vagina or urogenital canal. If other causes underlie the enlargement of the clitoris, the symptoms of the underlying condition may also occur.
Diagnosis and course of the disease
A gynecologist can determine whether an anatomical malformation of the female genitalia is present by performing a gynecologic examination. First, this involves taking a medical history. With regard to the clinical picture, special attention is paid to the use of medication. This excludes the possibility of exposure to androgens, for example through doping. A smear is then taken and a microscopic examination of the vaginal and cervical secretions is performed. The cell structures provide information about the hormone balance. Further examinations may be necessary. To confirm the diagnosis of clitoral hypertrophy, a comprehensive hormone test is performed. For this purpose, a blood sample must be taken. By means of an ultrasound examination, the gynecologist can further determine whether a tumor is present on the ovaries.Magnetic resonance imaging or magnetic resonance therapy of the adrenal gland may be required. Since significant postnatal enlargement of the clitoris often results from significant hormonal stimulation, the presence of other androgen-producing tumors must also be excluded. If no malignant neoplasms are present, affected individuals must be evaluated for other conditions with androgenic effects, such as Cushing or Fraser syndrome.
Complications
In most cases, clitoral hypertrophy does not result in any particular health complaints or complications. This condition can either be congenital or occur during life. If clitoral hypertrophy occurs for no particular reason, affected individuals usually suffer from another underlying condition. In most cases, clitoral hypertrophy leads primarily to psychological discomfort. Patients do not feel comfortable in their bodies and not infrequently suffer from inferiority complexes and lowered self-esteem. Furthermore, depression and other psychological upsets may also occur due to the disease. Sexual life is also severely limited by clitoral hypertrophy, as women are usually ashamed of the complaint. Likewise, there is a lot of body hair, which can be perceived as unpleasant. The quality of life is significantly reduced by clitoral hypertrophy. If the reason for this condition is a tumor, it must be removed. In some cases, this can also lead to a negative course of the disease, if the cancer has already spread to other regions of the body. However, the symptoms can be corrected by surgical intervention. It is generally impossible to predict whether there will be a reduced life expectancy for the patient.
When should you see a doctor?
For the most part, clitoral hypertrophy does not cause serious symptoms. A visit to the doctor is recommended if the malformation causes emotional problems or is generally considered unpleasant. Parents who notice a change in their child’s behavior or other abnormalities should determine the cause. Since the condition is often concealed by those affected, a visit to the gynecologist may be suggested if the condition is suspected. If physical complaints arise as a result of the malformation, medical advice is also required. Inflammation or pain in the intimate area must be medically clarified and treated. If further symptoms occur, clitoral hypertrophy may be the cause of a serious condition that needs to be diagnosed. Affected girls and women should see a gynecologist. The actual treatment is usually done in the hospital and the surgery is performed by a surgeon. After the surgery, close consultation should be made with the doctors in charge. If the cause is hormonal, an endocrinologist or a hormone and metabolism center should be consulted.
Treatment and therapy
When a malformation of the clitoris is diagnosed, it must be clarified whether the condition should be considered in isolation or as part of a symptom complex or syndrome. The actual cause of clitoromegaly must therefore be explicitly identified. Clitoral hypertrophy can ultimately be corrected by surgical intervention. Plastic surgery techniques can ensure both subsequent sexual stimulation and a later inconspicuous appearance. Since a pathological change of the genitals can be very stressful for the affected girls, a later psychotherapeutic treatment should be considered. If hormone-producing tumors are the cause, they usually have to be surgically removed. In some cases, combinatorial procedures such as chemotherapy and radiation may be necessary. If certain enzyme defects are responsible for the malformation, hormone therapy is indicated. This therapy has an inhibitory effect on the production of androgens in the ovaries as well as adrenal glands.
Outlook and prognosis
The prognosis of clitoral hypertrophy is tied to the causative disorder. In most cases, the outlook for recovery is favorable. If a malformation of the clitoris is present, it can be corrected by surgical intervention. It is irrelevant whether the malformation is congenital or developed due to an accident.Correction is equally possible in both cases and is performed successfully in almost all cases. Like any operation, it is associated with various risks and side effects. Nevertheless, they are comparatively low and manageable. Some patients may experience problems with wound healing, which can lead to a prolongation of the healing process. If the procedure runs without further complications, the patient can be discharged from the treatment as recovered within a short time. Recurrence of clitoral hypertrophy in the course of life is considered unlikely in these cases. If clitoral hypertrophy is based on tumor disease, the prognosis worsens considerably. Depending on the stage of the cancer, chemotherapy or radiation will take place. Ultimately, the tumor must be removed for relief to occur. In the case of an unfavorable course of the disease, the patient is threatened with premature death, as the cancer can spread to his organism. In addition, cancer therapy is associated with numerous side effects and impairment of quality of life.
Prevention
The development of clitoral hypertrophy cannot be averted preventively. The congenital malformation can only be diagnosed immediately after birth during the initial examination. In order to minimize the psychological stress caused by a reduction in the size of the clitoris, early recognition, diagnosis and adequate treatment are of utmost importance. Therefore, it is imperative that parents attend routine checkups for their children.
Follow-up
In most cases, clitoral hypertrophy no longer requires direct follow-up, as the condition does not always need to be treated and thus is not always treated. Only in severe cases or when there is a severe decrease in aesthetics should clitoral hypertrophy be treated. In many cases, the disease itself can be treated relatively well by surgical intervention. After such a procedure, the affected person should rest and take care of her body. Effort or other physical and stressful activities should be avoided so that the body is not put under unnecessary strain. If the clitoral hypertrophy occurred due to a tumor, regular examinations by a doctor should still be performed. This will allow other possible tumors to be detected and treated at an early stage so that the tumors do not spread throughout the woman’s body. Likewise, in many cases, intensive psychological treatment is necessary to prevent depression or other psychological upsets. In this context, loving and intensive conversations with one’s own family are particularly useful. As a rule, clitoral hypertrophy does not reduce the patient’s life expectancy in the process.
What you can do yourself
Dealing with clitoral hypertrophy in everyday life depends primarily on the underlying cause and the extent to which it is treated. For the most part, the treatment and management of the underlying condition, if any, is the primary focus. Irrespective of this, in many cases the affected girls suffer above all from psychological discomfort and feelings of shame due to the malformation of the genitals. It is important to strengthen self-esteem and self-confidence, to alleviate fears and, if necessary, to accept psychotherapeutic help. There are no self-help remedies for clitoral hypertrophy itself, but the quality of life of the affected person in everyday life can be improved by the measures mentioned. Depending on the severity and cause of clitoral hypertrophy, it is also advisable for both affected individuals and the parents of affected girls to inform themselves about the various options for treatment and therapy. There are also now self-help groups in some cities, internet forums and various social networks through which those affected or parents of affected girls can exchange information with each other.
