Genital reconstruction in an adult female patient with idiopathic clitoromegaly: A case report

INTRODUCTION: 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. PRESENTATION OF CASE: 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. DISCUSSION: 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. CONCLUSION: 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.