Clitoromegaly Size

Clitoromegaly is called as macroclitoris. It is basically enlargement of clitoris, may be acquired or congenital. Clitoromegaly in newborn, this feature is recognizable in girls. Easily detectable at birth. Neonatal Clitoromegaly is usually due to androgen stimulation or in utero androgen stimulation. The initial diagnosis in neonates is based upon clinical investigation. This Clinical investigation can lead to over diagnosis and stress for parents. Clitoris is a part of external genitalia. External genitalia abnormalities in first 2 days of neonate’s life considered as endocrine or genetic disorder.

Fetal clitoromegaly is usually due to maternal or fetal hormonal imbalance or due to treatment. If the fetus still show clitoromegaly in prenatal sonographic finding, then most probably there will be clitoromegaly chances in neonate.

The mechanism of clitoromegaly is exactly not known but some theories are there that some how relate the clitoromegaly, one theory is that vulva fat is not present that makes the clitoris appearance large, second theory is that high levels of androgen's lead to clitoromegaly. High androgen level may be due to high leutinizing hormone and re-programming of the ovary. One more reason of high androgens level is prolong synthesis and release of kisspeptin from the brain or placenta contribute in increasing gonadotropin hormone. But in childhood if clitoromegaly continues, these theories do not explain the reason.

In neonates, clitoris measurement is performed by using a digital campus having measurement sensitivity of 0.01cm. Firstly the genital part is measured that either the clitoris is covered by labia majora or not. Then baby is placed into the frog-leg position, and the length of the clitoris was measured. During the measurement procedure, the legs are secured by the assisting
nurse, physician separated the labia majora by using the thumb and second finger of
the left hand and then take the measurement.

Clitoris is known to be prominent in the newborn. Studies shows that the clitoris length should be less than 5 mm when it appeared to be covered by the labia majora. Clitoromegaly is clearly diagnosed when clitoris length is more than 1cm even if it is covered by labia majora. Newer studies showed that if clitoris length is more that 8mm then it should be carefully monitor, and if clitoris length is more than 10mm then we considered it as a pathological condition.

Study shows that the serum steroid profile should be done during the clitoromegaly period. 16-hydroxysteroid and 3β-hydroxy-5-enesteroid metabolites levels are increase. These changes may be due to immaturity in the adrenal gland of neonate. Sudden changes in the fetal clitoris may be parallel to the hormonal changes in the  immature adrenal gland. An association is shown between clitoromegaly and cloacal anomaly in many cases. Some cases of citoromegaly was shown in 15 to 16 week of gestation period but clitoromegaly was disappeared at 22 to 26 week of gestation period.
Treatment is surgical removal of the unnecessary part of clitoris or to wait till the adrenal gland matures in neonate.
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