Clitoral hypertrophy is understood in medicine to be an abnormal enlargement of the clitoris. Women suffer from a clitoris, which is similar in part to 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 various reasons.

What is a clitoral hypertrophy?

The typical sign of a megaloclitoris is the excessive enlargement of the clitoris. This can be so pronounced that the clitoris looks like a small penis.
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Clitoral hypertrophy is also referred to as megaloclitoris or clitoromegaly. The malformation is divided into four classes:

  • a hormonal clitoral hypertrophy
  • non-hormonal clitoral hypertrophy
  • a pseudo-clitoromegaly
  • idiopathic clitoromegaly

The reasons for the development of clitoral hypertrophy are manifold. The most common cause of this malformation of the female genital is a hormonal disorder. This occurs very often in younger girls. In most cases there is a defect of the enzyme CYP21. This enzyme affects 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 formation of androgens causes a masculinization of female persons.

causes

Common causes include pseudohermaphroditism, which results from an adrenogenital syndrome or adrenocortical hyperplasia. The development often occurs in early pregnancy. If the female fetus suffers from an enzyme defect, there is a disproportionate abundance of male hormones.

If this disorder occurs before the 14th week of pregnancy, pronounced hermaphroditism may result. Basically, the severity of the later clitoral hypertrophy depends on the time, intensity and duration of the influence of the androgens.

An enlargement of the clitoris can still be triggered by tumors with androgenic effect. The malignant neoplasms are found not only in the ovaries such as the hilum cell tumor and the Leydig cell tumors.

Also, adrenal cancers, gonadal tumors producing steroids and carcinosarcomas in the bladder can have masculinizing effects. In addition, Cushing's syndrome, Fraser syndrome, gonadal dysgenesis, Turner's syndrome and neurofibromatosis are among the diseases that can cause clitoromegaly.

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 & signs

The typical sign of a megaloclitoris is the excessive enlargement of the clitoris. This can be so pronounced that the clitoris looks like a small penis. It is possible that other androgenic features such as strong male hair growth may occur. In addition to the enlarged clitoris, changes in the external genitalia can also occur.

Patients with a severe degree of masculinization may experience testicular labia and occlusion of the vagina or urogenital canal in patients with clitoral hypertrophy. If enlargement of the clitoris is due to other causes, the symptoms of the underlying disease may also be present.

Diagnosis & disease course

A gynecologist can determine if an anatomical malformation of the female genitals is present. First of all, a survey of the anamnesis is carried out. With regard to the clinical picture, special attention is paid to the intake of medicines. This excludes whether there is an exposure to androgens by, for example, doping.

After a smear, a microscopic examination of the vaginal and cervical secretions is performed. The cell structures provide information about the hormone balance. Further investigations may be necessary. To ensure the diagnosis of clitoral hypertrophy, a comprehensive hormone examination is performed. For this, a blood sample must be taken. An ultrasound exam can help the gynecologist to determine if a tumor is present on the ovaries.

Magnetic resonance imaging or magnetic resonance therapy of the adrenal glands may be required. Since significant postnatal enlargement of the clitoris is often due to significant hormonal stimulation, the presence of other androgen producing tumors must also be excluded. If there are no malignant neoplasms, those affected must be screened for other androgenic disorders such as Cushing or Fraser syndrome.

complications

In most cases, clitoral hypertrophy does not result in any particular health ailments or complications. This disease can either be congenital or occur in the course of life. If it comes to clitoral hypertrophy without any special reason, sufferers usually suffer from another underlying disease.

In most cases, clitoral hypertrophy primarily causes mental health problems. The patients do not feel well in their bodies and often suffer from inferiority complexes and reduced self-esteem. Furthermore, depression and other mental disorders may also occur due to the disease.

The sexual life is severely limited by the clitoris hypertrophy, as the women are usually ashamed of the complaint. Likewise, it comes to a strong body hair, which can be perceived as unpleasant. The quality of life is considerably limited by the clitoris hypertrophy. If the cause of this disease 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. By surgery, the complaints can be corrected, however. In general, it can not be predicted whether the life expectancy of the patient will be reduced.

When should you go to the doctor?

For the most part, clitoral hypertrophy does not cause any serious discomfort. A doctor's visit is recommended if the malformation causes mental problems or is generally perceived as unpleasant. Parents who notice a change in behavior or other abnormalities in their child should determine the cause. Since the disease is often concealed by those affected, a visit to the gynecologist can be proposed in case of suspicion. Should physical problems develop due to the malformation, medical advice is also required.

Inflammation or pain in the genital area must be medically clarified and treated. If there are more symptoms, clitoral hypertrophy may be due to a serious condition that needs to be diagnosed. Affected girls and women should visit a gynecologist. The actual treatment usually takes place in the hospital and the surgery is performed by a surgeon. After the procedure, close consultation with the responsible physicians should be maintained. For hormonal causes an endocrinologist or a hormone and metabolic center should be visited.

Treatment & Therapy

In the case of a diagnosed malformation of the clitoris, it must be clarified whether the disease should be isolated or considered as part of a symptom complex or a syndrome. The actual cause of clitoromegaly must therefore be explicitly recognized. Clitoral hypertrophy can ultimately be corrected by surgery.

The plastic-surgical surgical techniques can ensure both subsequent sexual stimulation and a later unobtrusive 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 part, combinatorial procedures such as chemotherapy and radiation may be necessary. If certain enzyme defects are responsible for the malformation, hormone treatment is indicated. This therapy inhibits the production of androgens in the ovaries and adrenal glands.

Outlook & Forecast

The prognosis of clitoral hypertrophy is linked to the causative disorder. In most cases, the prospect of a cure is favorable. If there is a malformation of the clitoris, this can be corrected by surgery. It is irrelevant whether the deformity is innate or has developed as a result of an accident. A correction is equally possible in both cases and is carried out successfully in almost all cases.

Like any surgery, this is associated with various risks and side effects. Nevertheless, they are comparatively small and manageable. Some sufferers may experience wound healing problems that prolong the healing process. If the procedure is without further complications, the patient can be released from the treatment within a short time as recovering. Recurrence of clitoral hypertrophy over the course of life is unlikely in these cases.

If clitoral hypertrophy is based on a tumor disease, the prognosis deteriorates considerably. Depending on the stage of the cancer, chemotherapy or radiation takes place. The tumor must ultimately be removed, so that a relief of the symptoms can occur. In an unfavorable course of the disease threatens the patient's premature death, as the cancer can spread to his organism. In addition, cancer therapy is associated with numerous side effects and impairments of quality of life.

prevention

The development of clitoral hypertrophy can not be averted preventively. The congenital malformation can only be diagnosed immediately after birth as part of the initial examination. In order to be able to minimize the psychological stress caused by a reduction of the clitoris, early recognition, diagnosis and adequate treatment are of the utmost importance. Parents should therefore necessarily take the routine check-ups of their children.

aftercare

In most cases, clitoral hypertrophy does not require direct follow-up, because the disease does not always have to be treated and therefore is not always treated. Clitoral hypertrophy should only be treated in severe cases or when the aesthetic aspect is greatly reduced.

In many cases, the disease itself can be treated relatively well again by surgery. After such an intervention, the person should rest and spare their body. Efforts or other physical and stressful activities should be avoided, so that the body is not unnecessarily burdened. If clitoral hypertrophy has occurred due to a tumor, regular medical examinations should be performed.

As a result, other possible tumors can be detected and treated at an early stage, so that the tumors do not spread in the body of the woman. Likewise, in many cases, intensive psychological treatment is needed to prevent depression or other mental upsets. Above all, loving and intensive conversations with one's own family are the right thing to do. As a rule, the clitoris hypertrophy does not reduce the life expectancy of the patient.

You can do that yourself

The handling of a clitoral hypertrophy in everyday life depends primarily on what the cause is based on and how it is treated. In most cases, the treatment and the handling of the underlying underlying disease, if any, is in the foreground.

Regardless of this, the affected girls in many cases suffer mainly from mental complaints and feelings of shame due to the malformation of the genitals. It is important to strengthen the self-esteem and consciousness, to take fears and if necessary also to accept psychotherapeutic help. For the clitoris hypertrophy itself, there are no means of self-help, but the quality of life of those affected in everyday life by the measures mentioned can be improved.

Depending on the severity and cause of the clitoral hypertrophy, it is also advisable for both affected and the parents of affected girls to find out about the various options for treatment and therapy. In addition, in some cities, internet forums and various social networks, there are now self-help groups through which those affected or parents of affected girls can talk to each other.

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