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At least 235 records · Page 13Linked to original sources
PubMed1998

Androgens and masculinization of genitalia in the spotted hyaena (Crocuta crocuta). 2. Effects of prenatal anti-androgens.

Pregnant spotted hyaenas were treated with anti-androgens to interfere with the unusually masculine 'phallic' development that characterizes females of this species. The effects on genital morphology and plasma androgen concentrations of infants were studied during the first 6 months of life. Although there were consistent 'feminizing' effects of prenatal anti-androgen treatment on genital morphology in both sexes, such exposure did not produce males with extreme hypospadia, as it does in other species, nor did it produce females with a 'typical' mammalian clitoris and external vagina. 'Feminization' of males resulted in a penis with the morphological features of the hyaena clitoris, and 'feminization' of females exaggerated the sex differences that are typical of this species. The effects of treatment were present at birth and persisted for at least 6 months. Treatment of pregnant females with flutamide and finasteride also markedly reduced circulating concentrations of testosterone and dihydrotestosterone in maternal plasma during pregnancy. Plasma delta 4-androstenedione was reduced in the female, but not the male, infants of treated mothers, consistent with an epigenetic hypothesis previously advanced to explain hormonal 'masculinization' of females. The present 'feminizing' effects of prenatal anti-androgen treatment are consistent with contemporary understanding of sexual differentiation, which accounts for morphological variation between the sexes in terms of steroids. However, current theory does not account for the basic genital structure of females and the present data suggest that development of the male penis and scrotum, and the female clitoris and pseudoscrotum, in spotted hyaenas may involve both androgen-dependent and androgen-independent components.

5-alpha Reductase Inhibitors↗
PubMed1983

Plastic surgical postero-lateral redirection extension vulvo-vaginoplasty.

This paper offers a report of a vulvo-vaginoplasty, that rotates the vaginal axis away from alignment with the internal genitalia and bladder to treat refractory coitally connected recurrent cystitis and deep internal genital and bladder dyspareunia, by lessening coital trauma to the bladder and the internal genitalia. This rotation also aligns the vagina with the clitoris and the upper inner labia, which increases the mechanical efficiency of indirect coital clitoral manipulation via the inner labia and adds direct coital clitoral manipulation. The intensity of coital sexual response is thereby equated with the intensity of clitoral response. Standard reconstructive surgical procedures are utilized to rotate the axis of the vagina, which shorten the long axis of the vagina, requiring the concomitant construction from the labia majora of an extension of the vagina and a new introitus, both of an appropriate diameter. This extends the vagina to the clitoris and the indications for the operation to treatment of iatrogenic or congenital stricture and shortening of the vagina; and childbirth enlargement. The clitoris is not moved. It is circumcised to increase clitoral response. A preliminary report of results is included herein.

Dyspareunia↗
PubMed1989

Genitoplasty for congenital adrenal hyperplasia: anatomy and technical review.

There is variable virilisation in female pseudohermaphrodities with congenital adrenal hyperplasia, but they always have normal ovaries, uterus and upper part of the vagina. The various anatomical stages of virilisation are outlined and a historical review is given. For psychological and practical reasons it is generally accepted that the operation should be performed when the patient is between 6 and 18 months of age. The aim is to reduce the size of the clitoris and to expose the vagina so that it opens onto the perineum. Operative procedures are described. The child is reviewed at intervals to determine the size and shape of the vagina and clitoris. Adjustments can be made around the time of puberty but are rarely necessary.

Adrenal Hyperplasia, Congenital↗
PubMed1997

Assessment of the reliability of cerebral potentials evoked by electrical stimulation of the anal canal.

The aim of this study was to assess the reliability of cortical evoked potentials after electrical stimulation of the anal canal. Cortical evoked potentials were recorded on 243 patients presenting with perineal pain (28 patients), impotence (55 patients), anal incontinence (52 patients), urinary continence (30 patients), constipation (49 patients), and on 29 neurological patients, by stimulating the external anal sphincter and penis (or clitoris). The inter- and intra-observer reproducibility was studied by coding recordings interpreted by three different observers on two separate occasions. The influence of recording characteristics and clinical data were assessed. To study operator dependence, five operators investigated the patients. Only one of them was well trained in this technique. The interpretation of the coded curves by the observers was poorly reproducible in about 15% of cases, depending on time between the two readings and the quality of recordings. The interpretation of cerebral responses after anal stimulation were observer-dependent and influenced by the knowledge of clinical data. This was also observed with cortical evoked potentials after electrical stimulation of the penis or clitoris, but to a lesser extent. The cerebral evoked potentials method was also operator-dependent, mainly after anal stimulation. When a study of cortical evoked potentials by perineal stimulation is needed in clinical practice, it seems logical to prefer cortical evoked potentials by penile or clitoral stimulation as they seem easier to obtain than those evoked by anal stimulation if the investigators are not well trained for the performance of electrophysiological studies as the former are much less operator- and observer-dependent.

Adult↗
PubMed1985

Value of prognostic parameters in squamous cell carcinoma of the vulva.

In a series of 137 patients with cancer of the vulva who had undergone radical surgery we investigated, by means of a Cox regression model, which combination of clinical variables and clinical as well as histopathological variables afforded the best prediction of survival/death from cancer and survival/death from other causes. Among clinical variables the best prediction was afforded by a combination of tumor site in the clitoris/not clitoris, tumor size greater or smaller than 40 mm, obesity/not obesity, and age. Among clinical and histopathological variables the best prediction was by a combination of groin node metastases/not groin node metastases, tumor site in the clitoris/not clitoris, degree of differentiation high/moderate + low, and age. The combination of clinical and histopathological variables had a significantly better predictive power than clinical variables alone. The best prognostic group in both combinations had a 5-year-survival for cancer of 98%, while the poorest prognostic group in the two combinations showed a 5-year survival for cancer of 19 and 9%. The best predictors of death from causes other than cancer were age and a poor general health. It is concluded that the poorest prognostic group is definitely under treated and that the best prognostic group is presumably over treated. Patients in poor general health and with a good cancer prognosis should receive a more conservative treatment.

Adult↗
PubMed2005

Virilization of the external genitalia and severe mental retardation in a girl with an unbalanced translocation 1;18.

A female infant with dysmorphic facial features, psychomotor retardation, and clitoris hypertrophy is described. Molecular cytogenetic analyses revealed a de novo unbalanced translocation, causing partial monosomy 1p36 and partial trisomy 18q22. Monosomy 1p was confirmed by FISH, and trisomy of the distal part of chromosome 18q was demonstrated by microFISH. Gene copy number changes in these chromosomal regions were determined by array-CGH. The absence of a number of facial dysmorphic signs, and the presence of clitoris hypertrophy indicate that the combination of a del(1p36->pter) with a dup(18q22->qter) may lead to a unique phenotypic constellation. The findings at birth and at age 12 years in our patient are compared with genotype-phenotype correlations discussed in the literature.

Abnormalities, Multiple↗
PubMed1980

Correction of congenital abnormalities of the vagina and perineum.

Techniques used for vaginoplasty in patients with congenital anomalies are described. They include simple cutback, inlay of a perineal flap, perineal pullthrough, abdominal-perineal pullthrough, and the use of a free skin graft. When the clitoris is enlarged, clitoroplasty should be performed instead of clitoridectomy. The technique should vary according to the size of the phallus. Labia minora can be constructed from excess skin of the clitoris. Labioscrotal tissue can be advanced posteriorly to provide a more normal appearing vulva. These various reconstructive procedures can be performed either simultaneously or in stages depending on the complexity of the case and the age of the patient.

Adrenal Hyperplasia, Congenital↗
PubMed1987

Anogenital ratio: measure of fetal virilization in premature and full-term newborn infants.

To provide normative data, we measured anogenital distances in 115 infants of 25 to 42 weeks gestational age and 10 pregnant women, including anus to fourchette (AF), anus to base of the clitoris (AC), and fourchette to base of the clitoris (FC). All infant measurements showed positive and significant correlations with body surface area, weight, length, and gestational age (P less than 0.001). However, the anogenital ratio (AF/AC) followed a normal distribution and did not correlate with any of the anthropometric variables or age. Mean (+/- SD) value in infants was 0.37 +/- 0.07, and in adults, 0.36 +/- 0.07. An anogenital ratio greater than 0.50 falls outside the 95% confidence limits, suggests labioscrotal fusion, and indicates a need for further evaluation. Because it is independent of body size and gestational age, the anogenital ratio should be useful in diagnosing androgen-induced labioscrotal fusion in both premature and full-term female infants.

Adult↗
PubMed2002

Diabetes induced alteration of clitoral hemodynamics and structure in the rabbit.

PURPOSE: We investigated the effect of diabetes on clitoral hemodynamics and structures in the rabbit. MATERIALS AND METHODS: A total of 25 New Zealand White female rabbits weighing 3 to 3.5 kg. were divided into 2 groups, including 5 in the control and 20 in the experimental group. Experimental animals received intravenous injection of alloxan hydrochloride (Sigma Chemical Co., St. Louis, Missouri) (100 mg./kg.). The development of diabetes was verified by measuring body weight and blood glucose levels. After 12 weeks clitoral cavernous blood flow in ml. per minute per 100 gm. tissue was measured with a laser Doppler flowmeter. Cross sections of the clitoris were used for histochemistry and histomorphometric image analysis. RESULTS: After 12 weeks 5 animals were included in the diabetes group. Mean baseline flaccid and peak clitoral cavernous blood flow plus or minus standard deviation significantly decreased in the diabetic group compared with the control group (3.9 +/- 1.6 and 5.8 +/- 2.2 versus 7.2 +/- 2.5 and 12.9 +/- 5.8 ml. per minute per 100 gm. tissue, respectively, p <0.05). Histology revealed diffuse clitoral fibrosis in the diabetic group. On histomorphometry the mean proportion of clitoral cavernous smooth muscle in the diabetic group was significantly decreased compared with the control group (51.9% +/- 4.9% versus 62.3% +/- 3.1%, p < 0.05). CONCLUSIONS: These results show that diabetes mellitus produces significant adverse effects on the hemodynamic mechanism of clitoral engorgement and leads to diffuse clitoral cavernous fibrosis. It implies that decreased sexual arousal in diabetic women may result from structural changes in the clitoris.

Animals↗
PubMed2003

The long term outcome of feminizing genital surgery for congenital adrenal hyperplasia: anatomical, functional and cosmetic outcomes, psychosexual development, and satisfaction in adult female patients.

BACKGROUND: There are only a few reports analyzing the long term outcome of feminizing surgery in females with congenital adrenal hyperplasia (CAH). Such analysis is crucial to evaluate the treatment and to make necessary adjustments. STUDY OBJECTIVES: To evaluate the adult outcome after feminizing surgery in adult females with salt wasting CAH. DESIGN: Retrospective observational followup investigation. SETTING: Outpatient clinic of a University Medical Center, in 2002. PARTICIPANTS: Eight patients (born 1973-1983) who underwent feminizing surgery in infancy by the same procedure and the same pediatric surgeon in our center, and 19 healthy female controls (for visual analog scales). METHODS: (a) Study of patients' records (n=8); (b) Systematic evaluation of the current situation (n=6): uroflowmetry, a written questionnaire to screen for psychopathology (Youth Adult Self Report, YASR), structured gynecologic examination and a structured psychosexual interview, including scoring on visual analog scales. RESULTS: (a) The first surgery (age 0.1-3.7 yr) consisted of clitoris reduction and vaginoplasty (single-stage) in 7 patients and clitoris reduction only in one patient. The latter patient had vaginoplasty in puberty. In puberty, 6 of the 7 patients with an initial single-stage procedure required re-vaginoplasty. All 6 patients who participated in this systematic evaluation had undergone (re-) vaginoplasty in puberty; (b) 2 of the 6 patients experienced some urinary incontinence, and in one of them, the uroflowmetry result was abnormal. The YASR showed no psychopathology, except for 1 patient with a slightly elevated externalizing score. Gynecologic examination (n=5) revealed vaginal strictures in 3 patients (1 severe, 2 mild). The 2 patients without vaginal strictures had coitus regularly. In the interview, 2 patients called themselves bisexual, the other 4 heterosexual. None of the patients had homosexual contacts. Sexual developmental milestones (romantic interest, falling in love, kissing and petting, coitus) had been reached by all, except for 1 patient who did not have coitus yet. In the patient group, satisfaction with height, body hair, and external genitalia and sexual fantasies and interest, measured with visual analog scales, was not different compared to the control group, except for satisfaction with total body appearance, which was significantly lower in the patients. CONCLUSION: Despite the poor outcome of the initial single-stage surgery in infancy and the inevitable re-operation in puberty, the adult outcome in our study population seems more positive than the findings in the few previous reports, especially with respect to sexual development and activity.

Adrenal Hyperplasia, Congenital↗
PubMed2000

Atherosclerosis-induced chronic arterial insufficiency causes clitoral cavernosal fibrosis in the rabbit.

In our previous studies we found that aging-associated fibrosis of clitoral cavernosal tissue correlated with the prevalence of cardiovascular disease in elderly women. The aim of this study was to determine specifically, arterial insufficiency-related structural changes of clitoral cavernosal tissue in a rabbit model. New Zealand white female rabbits were divided into clitoral cavernosal ischemia (CCI, n = 5) and control (n = 5) groups. The CCI group underwent balloon endothelial injury of the iliac arteries and received 0.5% cholesterol diet. The control group received a regular diet. After 16 weeks, arteriography was performed then the animals were sacrificed. The iliac arteries and the entire clitoris were removed. Cross-sections of the iliac arteries and clitoris were processed for histologic evaluation The percentage of smooth muscle and connective tissue in trichrome stained sections of clitoral cavernosal tissue was determined by computer-assisted histomorphometry. Arteriography revealed diffused occlusive disease in the common iliac, internal iliac and pudendal arteries in the CCI group. Histology showed that arterial occlusive disease spreads from the site of balloon injury to the smaller branches involving the clitoral cavernosal arteries. Diffuse fibrosis was observed in the clitoral cross-sections of the CCI group. The percentage of clitoral cavernosal smooth muscle (mean +/- standard error) in the CCI group (53% +/- 0.9%) was significantly decreased compared with the control group (62% +/- 0.8%) (P = 0.0001). Chronic clitoral cavernosal ischemia causes significant fibrosis and loss of smooth muscle in the clitoral cavernosal tissue. These findings suggest that chronic clitoral cavernosal arterial insufficiency may play a role in the pathophysiology of female sexual arousal disorders.

Angiography↗
PubMed1999

Nefazodone-induced clitoral priapism.

A case is presented of painful priapism of the clitoris lasting 3 days, with a strong temporal association with the administration of nefazodone hydrochloride. Priapism has been described as a rare side-effect of drugs with high alpha1-adrenergic blocking potential. However, the alpha1-adrenergic blocking potential of nefazodone is moderate. Drug-induced clitoral priapism has been described for citalopram, bromocriptine, fluoxetine and trazodone combined with fluoxetine. To our knowledge, this is the first report in the literature about priapism of the clitoris associated with nefazodone.

Antidepressive Agents, Second-Generation↗
PubMed1996

Metaidoioplasty: an alternative phalloplasty technique in transsexuals.

The various techniques for phalloplasty in female-to-male transsexuals produce results that are more or less acceptable, both aesthetically and functionally. However, all these techniques will lead to extensive scarring of the donor area. Metaidoioplasty uses the clitoris, overdeveloped by hormonal treatment, to construct a microphallus in a way comparable to the correction of chordae and lengthening of urethra in male pseudohermaphrodites and in cases of severe hypospadias. It will not leave any scars outside the genital area. My experience in 32 female-to-male transsexuals is presented. At best, metaidoioplasty will provide a small phallus hardly, if at all, capable of sexual penetration. Still, I consider it to be a method of choice in cases where the clitoris seems large enough to provide a phallus that will satisfy the patient.

Adult↗
PubMed2003

Magnetic resonance imaging anatomy of the female genitalia in premenopausal and postmenopausal women.

PURPOSE: We used contrast enhanced magnetic resonance imaging (MRI) of the female genital organs to describe normal anatomy and differences between premenopausal and postmenopausal women. MATERIALS AND METHODS: A total of 12 healthy premenopausal and 9 healthy postmenopausal women underwent MRI. A 1.5 Tesla system with phased array coils anterior and posterior to the pelvis was used to produce T1-weighted images before and after intravenous administration of MS-325 (Epix Medical, Cambridge, Massachusetts), a new gadolinium based blood pool contrast agent. Select structural dimensions were measured for reference. RESULTS: The clitoris and vestibular bulbs were well delineated on T1-weighted post-contrast images. The clitoral unit formed a brightly enhancing, wishbone-shaped structure lying just anterior to the inverted V of the bulbs, which surrounded the urethra and vagina. The urethral complex had a target-like appearance with layers that were discernible on T1 post-contrast images. The urethra, vagina and rectum formed a distinct complex within uniformly enhancing soft tissue. The vagina was well visualized in premenopausal subjects but without distinguishable mucosal rugae or clearly separate layers in postmenopausal subjects. Postmenopausal subjects were also observed to have smaller labia minora width, vestibular bulb width, vaginal width and wall thickness, and cervical diameter. Pelvic and genital structures were not well visualized on T1 noncontrast images. CONCLUSIONS: To our knowledge we describe detailed female genital anatomy for the first time using MRI with MS-325 contrast medium. The clitoris, vestibular bulbs, labia majora and minora, urethra, vagina, cervix and rectum are well visualized on T1 post-contrast images. The observed genital anatomy on MRI was consistent with descriptions in current anatomical texts. Differences in the female genitalia between premenopausal and postmenopausal women were discernible on MRI. These data are important for future studies using MRI for evaluating anatomical anomalies, postoperative changes and female sexual function.

Adult↗
PubMed2004

Neuroanatomy of the human female lower urogenital tract.

PURPOSE: The neuroanatomy of the female lower urogenital tract remains controversial. We defined the topographical anatomy and differential immunohistochemical characteristics of the dorsal nerve of the clitoris, the cavernous nerve and the nerves innervating the female urethral sphincter complex. MATERIALS AND METHODS: A total of 16 normal female human pelvic specimens at 14 to 34 weeks of gestation were studied by immunohistochemical techniques. Serial sections were stained with antibodies raised against the neuronal markers S-100 and neuronal nitric oxide synthase (nNOS), vesicular acetylcholine transporter, calcitonin gene-related peptide and substance P. The serial sections were computer reconstructed into 3-dimensional images. RESULTS: Under the pubic arch at the hilum of the clitoral bodies the branches of the cavernous nerves joined the clitoral dorsal nerve to transform its immunoreactivity to nNOS positive. The cavernous nerves originated from the vaginal nervous plexus occupying the 2 and 10 o'clock positions on the anterolateral vagina and they traveled at the 5 and 7 o'clock positions along the urethra. The urethral sphincter complex was innervated by nNOS immunoreactive and nonimmunoreactive nerve fibers arising from the vaginal nervous plexus and pudendal nerve, respectively. CONCLUSIONS: The dorsal nerve of the clitoris receives nNOS positive branches from the cavernous nerve as a possible redundant mechanism for clitoral erectile function. The urethral sphincter complex has dual innervation, which pierces into the urethral sphincter complex at different locations. The study of the neuroanatomy of the female lower urogenital tract is germane to the strategic design of female reconstructive surgery.

Clitoris↗
PubMed1981

Clitoroplasty in intersex: a new technique.

A new technique of reduction clitoroplasty is presented. The procedure consists of a subtotal resection of the shaft of the clitoris with preservation of the dorsal neurovascular bundle of the glans. The purpose is to preserve erogenous glans clitoris and the erection of the crura. The anatomical results in 8 patients were excellent; partial necrosis occurred in a 12-year-old patient. The functional result remains unknown since the children are still young. This technique of clitoroplasty is, as far as we know, the most conservative procedure to date.

Child↗
PubMed1983

Direct and reflex responses in perineal muscles on electrical stimulation.

Responses in the external anal and urethral sphincters as well as in the bulbocavernosus muscle have been evoked by supramaximal electrical stimulation of the penis (or clitoris), perineum and the peri-anal region and recorded electromyographically in 82 male subjects 5 to 73 years old and in nine female subjects 18 to 55 years old, who had no systemic diseases or demonstrable sacral nervous system lesion. On perineal stimulation (including the penis or clitoris) reflex responses with a typical latency of 33 ms and which exhibit no habituation were obtained in all muscles examined. Stimulation of the peri-anal region gave habituating reflex responses with a typical latency of 55 ms in all muscles examined. On perineal, and sometimes also peri-anal stimulation, stable short latency responses with typical latencies of 5 and 13 ms were recorded; both were considered to be direct responses. The different evoked muscle responses obtained by stimulation in the perineal and peri-anal region have to be distinguished when the bulbocavernosus and anal reflexes are recorded for evaluation of sacral nervous system lesions.

Adolescent↗
PubMed2002

Female genitalia: dynamic MR imaging with use of MS-325 initial experiences evaluating female sexual response.

PURPOSE: To determine whether magnetic resonance (MR) imaging with MS-325, a recently developed blood pool contrast agent, can depict sexual arousal response in healthy women. MATERIALS AND METHODS: Serial MR imaging of the external genitalia was performed in 12 healthy sexually functional women before and after administration of MS-325. MR images were obtained every 3 minutes during a 45-minute examination. During the examination, the subjects viewed neutral and erotic video material while they were in the magnet bore. MR image analysis at each interval consisted of vaginal wall, vaginal mucosa, and clitoris assessments; femoral vein signal intensity measurements; relative regional blood volume (rRBV) calculations; and clitoral volume measurements. Statistical analysis of the results was performed with a t test. RESULTS: On subjective questionnaires, all subjects in the test group reported being sexually aroused. MS-325-enhanced MR images showed strong contrast enhancement of the external genitalia. The rRBV in the glans clitoris of seven of 10 subjects and in the clitoral body of eight of these subjects increased significantly (P <.05) during erotic visual stimulation. All 10 subjects had a significant (P <.05) increase in clitoral size. There were no significant differences in any measures between the pre- and postmenopausal study groups. CONCLUSION: The sexual arousal response in healthy women can be monitored at serial MR imaging with MS-325. This examination holds promise for future studies of sexual arousal dysfunction in women.

Adult↗