F1000 Commentary: Long term psychological and sexual outcomes of severe penile hypospadias repair / What is clitoromegaly?

“Clitoromegaly” is a medical term meaning that the clitoris has grown larger than is typical in girls. Sometimes clitoromegaly happens during fetal development because of a DSD, so that a girl is born with a large clitoris. Sometimes clitoromegaly occurs during puberty, or even later in life, because of an underlying hormonal shift that is atypical.

Clitorises naturally vary in size, just like breasts and penises also do. There is nothing dangerous about a large clitoris, although it might signal an underlying medical problem (like a hormonal imbalance) that needs medical attention. In cases of clitoromegaly, it is important to work with a medical specialist who can figure out whether there are any underlying hormonal problems that require medical attention to keep the patient healthy.

The clitoris is what’s called the “homologue” to the penis. That means that, during fetal development, the clitoris and penis grow from the same set of cells. So the organ that in males typically develops in utero into a penis, in females typically develops into a clitoris. Sometimes a girl is born with clitoromegaly because, during the time her genitals were forming in the womb, her body was exposed to more “masculinizing” hormones than is typical. Sometimes a girl experiences clitoromegaly during puberty because her body is either making or being exposed to higher-than-typical levels of “masculinizing” hormones.

When we are talking about “clitoromegaly,” we are speaking about the size of the part of the clitoris that is visible outside the body. This part is sometimes called the external clitoris. Much of the clitoris is actually contained inside the body, extending inward from the external clitoris.

The clitoris is a sexual organ and is the chief organ responsible for orgasm in women. Even in the relatively uncommon situation when a woman reaches orgasm via penetration of the vagina without external clitoral stimulation, that is often because her internal clitoris is being stimulated through pressure conveyed through the vaginal wall. When a woman is sexually excited (consciously or unconsciously), her clitoris will typically become engorged with blood, so that it will become warmer and larger. It is normal for clitorises to become flaccid and erect (temporarily smaller and larger), like penises.

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