A RARE genetic condition caused a woman’s vaginal opening to gradually close – then triggered the growth of what looked like a micropenis.
The 23-year-old went to hospital aged 22 with a history of “enlargement of the clitoris”, or clitoromegaly, since birth.
This was initially small but slowly increased to measure 1.8in (4.5cm) by 0.4in (1cm) – 10 times the average.
The woman also complained of a “gradual narrowing of the vaginal orifice”, which she had noticed over the previous two years.
It was about 0.2in (5mm) “because of the formed scrotum covering the vagina”.
She had increased facial hair that required cosmetic removal every two to three days for the past four years, and reported that she only started her period that year.
The patient, who was 4ft 6in (137cm), 6st 6lbs (41kg) and “thinly built”, also had little breast tissue and “secondary sexual characteristics” that were typical of men.
Writing in the journal Cureus, doctors from Shalinitai Meghe Hospital in Nagpur, India, said: “On local examination of the genitalia, the clitoris was enlarged, resembling a penis.”
The “micropenis” measured 2.4in by 0.8in by 0.4in (6cm by 2cm by 1cm) when aroused, and 1.8in by 0.8in by 0.4in (4.5cm by 2cm by 1cm) without being stretched.
“It had retractable preputial skin and a hooded prepuce,” medics added.
Her labia majora were fused at the fourchette – a thin fold of skin at the back of the vulva – and the skin was wrinkly.
The urethral opening – the hole that allows urine out of the body – was normal, as were her uterus and ovaries.
Doctors performed “feminising” genitoplasty, which included a clitoroplasty to reduce the size of the clitoris, a labiaplasty to adjust the labia, or lips, and a vaginoplasty to remove the fused, scrotalised skin.
The woman, who is unmarried, was discharged from hospital after five days and there were no further complications.
“After one month, the sensation was normal, and the patient was delighted, happy, and extremely satisfied with the aesthetic, functional, and sexual arousal results,” doctors said.
“She also regained her self-esteem and has significantly improved her mental health.”
Clitoromegaly, also called macroclitoris, is a rare disorder that causes external genitals to develop abnormally, often resembling male organs.
Said to affect an estimated one in 100,000 women worldwide, it is thought to be caused by a genetic mutation that imbalances sex hormones.
“Irrespective of the cause of clitoromegaly, the condition has severe and detrimental effects on mental health,” doctors said.
“It is a cause of poor self-esteem, anxiety, and gender self-perception, and it negatively affects social, romantic, and emotional domains.
“There is an overall alteration of body self-image with short stature, increased weight, and hirsutism.
“This leads to social withdrawal, especially in team sports and medical examinations involving nudity.
“They avoid romantic and sexual relationships, although there is no net effect on pleasurable sexual activity.”
Clitoromegaly is defined by a hood length exceeding 1.1in (27.4cm) and a width of 0.3in (8cm).
