Wahyudi Irfan, Islianti Putri Iradita, Situmorang Gerhard Reinaldi, Rodjani Arry
Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Int J Surg Case Rep. 2020;76:545-548. doi: 10.1016/j.ijscr.2020.10.078. Epub 2020 Oct 22.
Clitoromegaly is an abnormality condition commonly related to congenital adrenal hyperplasia; it is rare due to idiopathic. Until now, there is no report about idiopathic clitoromegaly who reach adulthood and evaluation of their sexual life after reconstructive surgery.
We presented an adult female patient with chief complain of enlarged clitoris since birth. The phenotypic appearance of ambiguous external genitalia resembling severe hypospadias with scrotal bifid. Other female secondary sexual characteristics were normal. The karyotype test result was 46 XX. We did genitalia reconstruction with nerve-sparing clitoroplasty, oral mucosal graft vaginoplasty, and labioplasty.
Many factors contribute to clitoromegaly which emerge transiently during the intrauterine period. Our case was unique due to clitoromegaly persistence until adulthood and can not be explained by any hypotheses. Adult females with clitoromegaly and urogenital sinus (UGS) bring a specific problem, especially to their sexual life. The reconstructive surgery should consider the phenotype of genital anatomy, preservation of clitoral neurovascular bundles, and adequate dimension of the vagina. Oral mucosal graft is an option as substitutive materials that can be used for vaginal augmentation.
This is a case report of adult female idiopathic clitoromegaly patient. Scrutinized evaluation is needed to confirm the diagnosis. Many aspects should be considered to perform feminizing genitoplasty. The surgery did not reduce the sensitivity of clitoris and allow the patient to do sexual activity after marriage during a one-year follow up.
阴蒂肥大是一种常与先天性肾上腺皮质增生相关的异常情况；特发性阴蒂肥大较为罕见。迄今为止，尚无关于成年特发性阴蒂肥大患者及其重建手术后性生活评估的报道。
我们报告了一名成年女性患者，其主要诉求为自出生以来阴蒂增大。外生殖器表现模糊，类似严重尿道下裂伴阴囊分裂。其他女性第二性征正常。染色体核型检测结果为46，XX。我们进行了保留神经的阴蒂成形术、口腔黏膜移植阴道成形术和阴唇成形术。
许多因素导致阴蒂肥大，其在子宫内时期短暂出现。我们的病例独特之处在于阴蒂肥大持续至成年，且无法用任何假说来解释。成年阴蒂肥大和泌尿生殖窦（UGS）的女性带来了一个特殊问题，尤其是对她们的性生活而言。重建手术应考虑生殖器官解剖结构的表型、阴蒂神经血管束的保留以及阴道的足够尺寸。口腔黏膜移植是可用于阴道增大的替代材料选择之一。
这是一例成年女性特发性阴蒂肥大患者的病例报告。需要仔细评估以确诊。进行女性化生殖器成形术时应考虑多个方面。手术并未降低阴蒂的敏感性，且在一年的随访期间，患者婚后能够进行性活动。
