What is Clitoromegaly?

Clitoromegaly is the medical term for an enlargement of the clitoris beyond the size considered normal (glans larger than 10 mm in adult women). It can be congenital (present from birth) or acquired (developed over time). Differential diagnosis is essential — before considering surgery, it is necessary to understand why the clitoris is enlarged.

Definition and reference measurements

The normal size of the clitoral glans in adult women ranges between 3.7 mm and 10 mm. Above this, it is considered clitoromegaly. In newborns and children, there are specific reference tables by age — evaluation in childhood requires an endocrinological protocol.

Causes — differential diagnosis

Congenital causes

• Congenital adrenal hyperplasia (CAH) — 21-hydroxylase deficiency is the classic form; produces excess androgens from fetal life.
• Disorders of sex development — rare syndromes involving chromosomes and gonadal differentiation.
• Maternal exposure to androgens during pregnancy — inadvertent use of androgenic medications.

Acquired causes

• Use of testosterone or anabolics — the most frequent cause of acquired clitoromegaly in clinics today, linked to the increasing use of hormones in gyms.
• PCOS in hyperandrogenic form — mild to moderate clitoromegaly may accompany hirsutism and acne.
• Androgen-producing tumors — ovarian (arrhenoblastoma) or adrenal. Rapid clitoral growth in an adult woman requires immediate investigation.
• Cushing's Syndrome and other endocrinopathies.

How is the clinical investigation performed?

The investigation combines:

• Anamnesis: age of onset, growth rate, hormone use, menstrual cycle, fertility.
• Physical examination: measurement of the clitoral glans, hair assessment (Ferriman-Gallwey scale), acne, body fat distribution.
• Laboratory: total and free testosterone, SHBG, DHEA-S, 17-OH-progesterone, prolactin, TSH, cortisol.
• Imaging: pelvic ultrasound (polycystic ovaries, ovarian tumors); adrenal MRI if DHEA-S is elevated.
• Genetics / karyotype: in congenital cases or with genital ambiguity.

Treatment

1. Treat the cause. Discontinue anabolics, control PCOS, replace cortisol in CAH, resect androgen-producing tumor. Part of the clitoral enlargement may regress.

2. Surgery (clitoroplasty). Indicated when the enlargement persists after treatment of the cause, when the cause is anatomical, or when physical and psychological discomfort is significant. Modern techniques — subcutaneous clitorotomy and clitoropexy — reduce volume while preserving the dorsal neurovascular bundle of the clitoris, maintaining sensitivity.

When to seek evaluation

Recent growth, associated symptoms (menstrual changes, hair, voice, severe acne) or persistent discomfort are clear indications for specialized evaluation. The ideal approach is multidisciplinary — a gynecologist, endocrinologist, and plastic surgeon working together.

Frequently Asked Questions

What is clitoromegaly?

Clitoromegaly is the medical term for an enlarged clitoris — glans larger than 10 mm in adults or disproportionate to development in childhood. It can be congenital or acquired.

What are the main causes of clitoromegaly?

The most common causes are: individual anatomical variation; use of testosterone or anabolics; polycystic ovary syndrome (PCOS); congenital adrenal hyperplasia; androgen-producing tumors (rare); and disorders of sex development.

How is the differential diagnosis made?

It combines physical examination, anamnesis (hormone use, age of onset), hormone measurements (testosterone, DHEA-S, 17-hydroxyprogesterone, SHBG), pelvic ultrasound, and, in selected cases, adrenal MRI or karyotyping.

Can clitoromegaly be cured?

When there is a hormonal cause, treating that cause (discontinuation of anabolic steroids, PCOS control, replacement in adrenal hyperplasia) may partially reduce the clitoris. When the cause is anatomical or the enlargement persists, clitoroplasty offers definitive correction.

Is clitoral reduction surgery safe?

Yes, when performed by a plastic surgeon experienced in intimate surgery. Modern techniques (subcutaneous clitorotomy, clitoropexy) preserve the dorsal neurovascular bundle, maintaining sensitivity and orgasmic capacity.

Consultation in São Paulo

In-person evaluation with Dr. Fernando Amato

Office in Jardim América (Av. Brasil, 2283), São Paulo. Discreet service, with detailed clinical evaluation and individualized surgical plan.

WhatsApp (11) 97646-0655 Clitoral surgeries

Also read: Clitoromegaly treatment · Clitorotomy and clitoropexy · Testosterone and clitoris