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Clitoral hypertrophy or clitoromegaly is also known as a macroclitoris: an atypically large clitoris.
Note: This article does not discuss deliberately modified clitorises, such as those found with female genital body modification using anabolic steroids and testosterone.
Causes of clitoromegaly
There are several reasons why the clitoris hypertrophies or enlarges. Some of the most common reasons include hormonal interruptions caused by chromosomal differences.2 These include:
- Complete, partial or mild androgen insensitivity syndrome (CAIS, PAIS, MAIS)
- Congenital adrenal hyperplasia (CAH)3
- Swyer syndrome
All of these conditions are loosely grouped under the umbrella of Difference in Sexual Development (DSD). Other causes of clitoromegaly include the use of certain drugs or tumours.
It is estimated that around one in 10,000 babies is born with CAH, one of the most common causes of a large clitoris (clitoromegaly).4
A typical clitoral glans looks something like this
The usual size of a clitoris is less than 5mm wide and less than 16mm long, with anything over 35mm indicating clitorial hypertrophy.1
An enlarged clitoris might look like this
There are many variations on clitoromegaly, and everyone will be a bit different.
Treatment for clitoromegaly
There is usually no medical reason to treat clitoromegaly; however, treatment can be discussed for aesthetic reasons.5
Some people don’t like the appearance of a large clitoris. One option is to partially or fully remove (amputate) the tissue. New techniques aim to retain sexual function and the ability to orgasm in most people.
Those considering surgery will be counselled by their surgeon to carefully weigh up the possible risks of a reduction in sexual satisfaction with aesthetics. A clitorectomy usually results in a typical-looking vulva and satisfaction from the patient; however, while it is generally considered a very safe procedure, it can result in excessive bleeding or, worse, permanent nerve damage. 6
Other treatments include hormone therapy, but each person must be evaluated individually since the cause must be established – treatment for each person will be different.
The pseudo-penis in animals and humans
A pseudo-penis looks like a penis, but is usually a clitoris. Pseudo-penis is the term used to describe the appendage found in many mammals, not just humans, and is understood to be an enlarged clitoris (clitoromegaly).7 Those with CAH may have this clitoral appearance.
The pseudo-penis occurs in several other mammals besides humans (the spotted hyena, squirrel monkeys, lemurs and baby fossa, among others).
The penis-like protrusion may disappear as the animal grows, but not always. Other animals (besides humans) that also have elongated labia include the spider monkey, and the os clitoridis (a bone) is found in most mammals.
References
- 1.Fahmy MAB. Female Genital Anomalies, Clitoris. Rare Congenital Genitourinary Anomalies. Published online September 20, 2014:133-144. doi:10.1007/978-3-662-43680-6_8
- 2.Ivanov NV, Serebryakova IP, Khudyakova NV, Fedorova AI. Clitoromegaly: principles of diagnostics and treatment. Akušerstvo, ginekologiâ i reprodukciâ. Published online September 5, 2023:462-475. doi:10.17749/2313-7347/ob.gyn.rep.2023.400
- 3.Szymanski KM, Kokorowski P, Braga LH, Frady H, Whittam B, Hensel DJ. Growing up with clitoromegaly: experiences of North American women with congenital adrenal hyperplasia. Journal of Pediatric Urology. Published online December 2022:775-783. doi:10.1016/j.jpurol.2022.05.016
- 4.Iezzi ML, Lasorella S, Varriale G, Zagaroli L, Ambrosi M, Verrotti A. Clitoromegaly in Childhood and Adolescence: Behind One Clinical Sign, a Clinical Sea. Sex Dev. Published online 2018:163-174. doi:10.1159/000489385
- 5.Stoyanov S, Ivanova K, Koleva I. Operative Treatment of Idiopathic Isolated Clitoromegaly – A Clinical Case. Acta Medica Bulgarica. Published online March 1, 2024:58-61. doi:10.2478/amb-2024-0009
- 6.Kaefer M, Rink RC. Treatment of the Enlarged Clitoris. Front Pediatr. Published online August 28, 2017. doi:10.3389/fped.2017.00125
- 7.Tjalma WAA. Assembling a Functional Clitoris and Vulva from a Pseudo-Penis: A Surgical Technique for an Adult Woman with Congenital Adrenal Hyperplasia. Journal of Pediatric and Adolescent Gynecology. Published online June 2017:425-428. doi:10.1016/j.jpag.2016.11.011
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