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Clitoromegaly or macroclitoris [1] is an abnormal enlargement of the clitoris that is mostly congenital or acquired, though deliberately induced clitoris enlargement as a form of female genital body modification is achieved through various uses of anabolic steroids, including testosterone , and may also be referred to as clitoromegaly. The different grade of genital ambiguity is commonly measured by the Prader classification , [6] which ranges, in ascending order of masculinisation, from 1 : female external genitalia with clitoromegaly through 5 : pseudo-phallus looking like normal male external genitalia. Clitoromegaly is a rare condition and can be either present by birth or acquired later in life. If present at birth, congenital adrenal hyperplasia can be one of the causes, since in this condition the adrenal gland of the female fetus produces additional androgens and the newborn baby has ambiguous genitalia which are not clearly male or female. In pregnant women who received norethisterone during pregnancy, masculinization of the fetus occurs, resulting in hypertrophy of the clitoris; [8] however, this is rarely seen nowadays due to use of safer progestogens. It can also be caused by the autosomal recessive congenital disorder known as Fraser syndrome.

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Large clitoral leiomyoma in a forty-two years old premenopausal woman.

The main etiology behind the acquired type is hormonal imbalance affecting mainly adult women. This type is seen mostly in association with polycystic ovarian syndrome, hyperthecosis, ovarian tumors, and clitoral cysts or it can be drug-induced. Clitoral leiomyoma is a rare benign tumor of female genitalia and is an uncommon cause of clitromegaly. After detailed laboratory investigations, she had normal karyotyping. Hormonal assay for testosterone, dehydroepiandrosterone sulphate, and follicle stimulating hormone, luteinizing hormone, parathormone, and prolactin levels revealed values within the normal range.
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