Enlarged Clitoris: 6 Possible Causes (& How to Treat)

An enlarged clitoris is also called clitoromegaly, and it means the clitoris is larger than expected for age and body development. It can be present from birth or develop later due to hormone changes, tumors, genetic conditions, or local tissue growth.

In many cases, an enlarged clitoris is linked to high androgen levels, which are hormones that can cause more masculine physical changes. These changes may include irregular periods, acne, excess hair growth, hair loss on the scalp, voice deepening, or changes in body shape.

Treatment depends on the cause of the enlarged clitoris and may involve hormone therapy, surgery, or care from several specialists. Medical assessment is important when clitoral enlargement is new, progressive, present in a newborn, or happens with other signs of virilization.

What causes an enlarged clitoris?

The main causes of enlarged clitoris are congenital adrenal hyperplasia, polycystic ovary syndrome, androgen-secreting ovarian tumors, neurofibromatosis type 1, and Fraser syndrome.

1. Congenital adrenal hyperplasia

Congenital adrenal hyperplasia, or CAH, is a genetic condition that affects how the adrenal glands make hormones. In many cases, the body produces too many androgens because of an enzyme deficiency that affects cortisol and aldosterone production. CAH is one of the most common causes of clitoromegaly, especially when an enlarged clitoris is seen at birth.

Female newborns with CAH may have ambiguous genitalia, which can include an enlarged clitoris, fused labioscrotal folds, and a urogenital sinus. In adolescence or adulthood, CAH may cause severe acne, excess body hair, scalp hair loss, irregular periods, or absence of periods. These symptoms are related to the effects of high androgen levels.

How to treat: Treatment usually involves hormone replacement therapy to help balance cortisol and aldosterone levels and reduce excess androgen production. Surgery, such as clitoroplasty, may be considered in some cases to reduce clitoral size while trying to preserve sensation and function. Some people may also need surgery to enlarge the vaginal opening and improve quality of life.

2. Polyendocrine metabolic ovarian syndrome

Polyendocrine metabolic ovarian syndrome, or PMOS (formerly polycystic ovary syndrome, or PCOS) is a hormone and metabolic condition that can cause high androgen levels. Clitoral enlargement can occur in PMOS, although it is considered uncommon in everyday clinical practice.

Other signs of PMOS may include delayed first period, irregular periods, absent periods, acne, and excess hair growth. Some cases may involve very high testosterone levels and noticeable clitoral enlargement. Symptoms can vary widely from one person to another.

How to treat: Treatment focuses on controlling the underlying hormone imbalance and lowering androgen effects. Hormonal treatment may help improve irregular periods, acne, excess hair growth, and other androgen-related symptoms. If the enlarged clitoris is significant and causes distress, surgery may be considered after hormones are stable.

3. Sertoli-Leydig cell tumor

A Sertoli-Leydig cell tumor is a rare ovarian tumor that can produce androgens. These tumors come from sex cord-stromal cells and can cause progressive masculinizing changes. An enlarged clitoris may appear along with other signs of virilization.

Symptoms may start with anovulation, irregular periods, absent periods, or loss of typically female physical features. Other possible signs include excess hair growth, deepening of the voice, acne, hair thinning at the temples, increased muscle mass, and high testosterone levels. The changes may progress if the tumor is not treated.

How to treat: Treatment usually involves surgery to remove the tumor. In some cases, this may include removal of the ovary and fallopian tube, especially if the tumor is difficult to detect or there is concern about spread. Early diagnosis and surgery can help stop further virilization.

4. Other androgen-secreting ovarian tumors

Other androgen-secreting ovarian tumors can also cause an enlarged clitoris. These include Leydig cell tumors and steroid cell tumors, which are rare ovarian tumors that produce high levels of androgens. Some of these tumors can be very small and may not be easy to see on imaging tests.

In addition to clitoral enlargement, these tumors may cause hirsutism, severe scalp hair loss, voice deepening, acne, and other signs of virilization. Symptoms may be more noticeable when androgen levels rise quickly. In some cases, the ovaries may appear normal in size even when a tumor is present.

How to treat: Treatment usually involves surgical removal of the affected ovary after other causes of high androgen levels have been ruled out. In postmenopausal women, complete surgical removal may be recommended even when the ovaries look normal. The goal is to remove the source of excess androgen production.

5. Neurofibromatosis type 1

Neurofibromatosis type 1, or NF-1, is a genetic condition that can cause growths called neurofibromas to form on nerves and soft tissues. Clitoral involvement is rare, but when it happens, an enlarged clitoris may be the first noticeable sign. The enlargement may happen because of a neurofibroma or soft tissue overgrowth in the clitoral area.

This type of clitoral enlargement is often painless and may be present from birth. It can sometimes look similar to a small phallus and may occur with other NF-1 signs, such as café-au-lait spots, plexiform neurofibromas, and freckles in the armpits. Hormone tests and pelvic imaging are often normal in these cases.

How to treat: Treatment is usually surgical when the enlargement causes functional, cosmetic, or diagnostic concerns. Clitoroplasty may be performed with care to preserve the glans and important nerves and blood vessels. Biopsy is generally reserved for cases in which cancer is suspected.

6. Fraser syndrome

Fraser syndrome is a rare inherited condition that can affect several parts of the body. Ambiguous genitalia, including an enlarged clitoris, is one of the major diagnostic features of this syndrome. Diagnosis is based on a combination of major and minor physical findings.

Other major features can include fused eyelids, fused fingers or toes, urinary tract abnormalities, voice box or windpipe problems, and a family history of the condition. Minor features may include anorectal defects, abnormal ears, skull bone changes, umbilical abnormalities, and nasal changes. Because Fraser syndrome affects multiple body systems, symptoms can vary significantly.

How to treat: Treatment requires care from a multidisciplinary medical team. Management focuses on the organs and body systems affected in each case. Surgery may be needed to correct genital changes or other structural abnormalities.

Other considerations

An enlarged clitoris can have several causes, and not all are related to hormone levels. Some causes are present from birth, while others develop later due to ovarian tumors or other hormone-related conditions.

Medical evaluation may include a physical exam, hormone tests, imaging, and assessment for genetic or syndromic features. This helps identify whether the enlarged clitoris is caused by excess androgens, local tissue growth, or a broader congenital condition.

New, sudden, or progressive clitoral enlargement should be assessed by a doctor, especially when it happens with voice deepening, severe acne, excess body hair, scalp hair loss, irregular periods, or absent periods. Newborns with ambiguous genitalia or suspected CAH should be evaluated promptly.