Skip to main content

Advertisement

SpringerLink
Log in

Clitoral length and anogenital ratio in Indian newborn girls

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns.

Design

Cross-sectional study.

Setting

Neonatal unit of a tertiary care teaching hospital in Kolkata.

Participants

378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities.

Interventions

Measurements were recorded using a digital vernier caliper between 24–72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured.

Main outcome measures

Gestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios.

Results

Mean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance.

Conclusions

The normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Oberfield SE, Mondok A, Shahrivar F, Klein JF, Levine LS. Clitoral size in full term infants. Am J Perinatol. 1989;6:453–5.

    Article  CAS  PubMed  Google Scholar 

  2. Phillip M, De Boer C, Pilpel D, Karplus M, Sofer S. Clitoral and penile sizes in full term newborns in two different ethnic groups. J Pediatr Endocrinol Metab. 1996;9:175–9.

    Article  CAS  PubMed  Google Scholar 

  3. Riley WJ, Rosenbloom AC. Clitoral size in infancy. J Pediatr. 1980;96:918–9.

    Article  CAS  PubMed  Google Scholar 

  4. McIntyre BS, Barlow NJ, Foster PM. Male rats exposed to linuron in utero exhibit permanent changes in anogenital distance, nipple retention, and epididymal malformations that result in subsequent testicular atrophy. Toxicol Sci. 2002;65:62–70.

    Article  CAS  PubMed  Google Scholar 

  5. Mylchreest E, Wallace DG, Cattley RC, Foster PM. Dosedependent alterations in androgen-regulated male reproductive development in rats exposed to di (n-butyl) phthalate during late gestation. Toxicol Sci. 2000;55:143–51.

    Article  CAS  PubMed  Google Scholar 

  6. Thankamony A, Ong KK, Dunger DB, Acerini CL, Hughes IA. Anogenital distance from birth to 2 years: a population study. Environ Health Perspect. 2009;117:1786–90.

    PubMed  PubMed Central  Google Scholar 

  7. Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM. Female genital appearance: “normality” unfolds. Br J Obstet Gynaecol. 2005;112:643–6.

    Article  Google Scholar 

  8. Salazar-Martinez E, Romano-Riquer P, Yanez-Marquez E, Longnecker MP, Hernandez-Avila M. Anogenital distance in human male and female newborns: A descriptive, crosssectional study. Environ Health. 2004;3:8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991;119:417–23.

    Article  CAS  PubMed  Google Scholar 

  10. Donovan EF, Tyson JE, Ehrenkranz RA, Verter J, Wright LL, Korones SB, et al. Inaccuracy of Ballard scores before 28 weeks’ gestation. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1999;135:147–52.

    CAS  PubMed  Google Scholar 

  11. Witchel SF, Lee PA. Ambiguous genitalia. In: Sperling MA, ed. Pediatric Endocrinology. 3rd ed. Philadelphia: W. B. Saunders; 2002. P. 111–34.

  12. Kutlu HA, Akbiyik F. Clitoral length in female newborns: A new approach to the assessment of clitoromegaly. Turk J Med Sci. 2011;41:495–9.

    Google Scholar 

  13. Callegari C, Everett S, Ross M, Brasel JA. Anogenital ratio: measure of fetal virilization in premature and fullterm newborn infants. J Pediatr. 1987;111:240–3.

    Article  CAS  PubMed  Google Scholar 

  14. Arbuckle TE, Hauser R, Swan SH, Mao CS, Longnecker MP, Main KM, et al. Meeting report: measuring endocrine-sensitive endpoints within the first years of life. Environ Health Perspect. 2008;116:948–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jarrett OO, Ayoola OO, Ritzen M. Clitoral and penile sizes in healthy newborn babies in Ibadan, Nigeria. Endocrine Abstracts. 2010;24:P15. Available from: http://www.endocrine-abstracts.org/ea/0024/ea0024p15.htm. Accessed May 15, 2015.

    Google Scholar 

  16. Litwin A, Aitkin I, Merlob P. Clitoris length assessment in newborn infants of 30-41 weeks gestational age. Eur J Obstet Gynecol Reprod Biol. 1991;38:209–12.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Medicine, Medical College, 88 college street, Kolkata, 700 073, West Bengal, India

    Rakesh Mondal, Kaushani Chatterjee, Moumita Samanta, Tapas Kumar Sabui, Dibyendu Roychowdhury & Rupa Biswas

  2. Department of Neonatology, Medical College, Kolkata, India

    Avijit Hazra

  3. Department of Pharmacology, Institute of Postgraduate Medical Education & Research (IPGME&R), Kolkata, West Bengal, India

    Somosri Ray

  4. RK Rural Hospital, Kolkata, West Bengal, India

    Basanta Banerjee

  5. Department of Pediatric Medicine, BC Roy PGIPS, Kolkata, West Bengal, India

    Suman Das

Authors
  1. Rakesh Mondal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaushani Chatterjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moumita Samanta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Avijit Hazra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Somosri Ray
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tapas Kumar Sabui
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Basanta Banerjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Suman Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dibyendu Roychowdhury
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Rupa Biswas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rakesh Mondal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mondal, R., Chatterjee, K., Samanta, M. et al. Clitoral length and anogenital ratio in Indian newborn girls. Indian Pediatr 53, 299–303 (2016). https://doi.org/10.1007/s13312-016-0840-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-016-0840-1

Keywords

Search

Navigation