What causes spontaneous clitoral engorgement?

From the Guidelines

Unstimulated clitoral engorgement is most likely caused by a combination of physiological and medical factors, including hormonal fluctuations, persistent genital arousal disorder (PGAD), certain medications, neurological conditions, and pelvic congestion syndrome. The exact cause of unstimulated clitoral engorgement can vary widely among individuals, but it is essential to consider the potential underlying medical conditions that may be contributing to this symptom. Some possible causes of unstimulated clitoral engorgement include:

• Hormonal fluctuations during the menstrual cycle, which can cause periodic engorgement, particularly during ovulation when estrogen levels peak
• Medical conditions like PGAD, which can cause spontaneous engorgement without sexual stimulation, creating unwanted and distressing arousal
• Certain medications, particularly those affecting blood flow or neurological function, such as antidepressants, antipsychotics, and some blood pressure medications, which may cause this side effect 1
• Neurological conditions affecting pelvic nerves, such as multiple sclerosis or spinal cord injuries, which can disrupt normal arousal regulation
• Pelvic congestion syndrome, characterized by varicose veins in the pelvic region, which may lead to persistent engorgement
• Psychological factors, including stress and anxiety, which can trigger physical arousal responses through the autonomic nervous system It is crucial to note that the clitoris contains erectile tissue similar to penile tissue, which responds to blood flow changes regulated by the parasympathetic nervous system, explaining why various factors affecting circulation or nerve function can cause engorgement even without sexual stimulation. While the provided study 1 focuses on priapism, a condition affecting penile erection, the underlying principles of blood flow and neurological regulation can be applied to understanding clitoral engorgement, highlighting the importance of considering both physiological and medical factors in the diagnosis and treatment of this condition.

From the Research

Causes of Unstimulated Clitoral Engorgement

• Clitoromegaly, which is an abnormal enlargement of the clitoris, can be either congenital or acquired 2
• Acquired clitoromegaly can be caused by hormonal or non-hormonal factors, with hormonal causes being primarily due to an excess of androgens 2, 3
• Polycystic ovarian syndrome (PCOS) is a condition that can be associated with clitoromegaly, as it often involves hyperandrogenism 3, 4
• Other potential causes of clitoromegaly include endocrinopathies, masculinizing tumors, self-injection of synthetic androgens, and neurofibromatosis 2, 5
• The role of androgens in clitorophallus development suggests that testosterone plays a crucial role in the growth and development of the clitoris, particularly during puberty 6

Hormonal Influences

• Androgen excess is a primary contributing factor to clitoral enlargement, with conditions such as PCOS and non-polycystic ovarian hypertenstosteronism being associated with hyperandrogenism 2, 3
• Testosterone levels have been shown to be elevated in women with PCOS, which can contribute to clitoromegaly 3, 4
• The use of exogenous testosterone can stimulate clitorophallus enlargement, particularly in the context of gender-affirming care 6

Non-Hormonal Factors

• Non-hormonal causes of clitoromegaly are less common, but can include conditions such as neurofibromatosis 2, 5
• Other potential non-hormonal factors may include the presence of sebaceous cysts or other anatomical abnormalities 2