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İnsan Fetüslerinde Anogenital Mesafe, Penis ve Klitoris Boyutlarının Morfometrik Olarak İncelenmesi

Yıl 2023, Cilt: 76 Sayı: 3, 252 - 257, 24.10.2023

Öz

Amaç: Çalışmada kız ve erkek fetüslerde anogenital mesafe, penis ve klitoris boyutlarının morfometrik ölçümleri yapılarak, konu ile ilgili antenatal
dönem standartların belirlenmesine katkı sağlanması amaçlanmıştır.

Gereç ve Yöntem: Formalinle fikse edilmiş 55 fetüs değerlendirildi. Anogenital mesafe kızlarda anüs orta hat-posterior fourchette, erkeklerde anüs
orta hat-posterior skrotal raphe arası mesafe olarak ölçüldü. Kız fetüslerde klitoris uzunluğu ve klitoral glansın genişliği ölçüldü. Erkek fetüslerde
penis (glans) genişliği ve penis uzunluğu ölçüldü.

Bulgular: Çalışmaya dahil edilen fetüslerin 29’u kız, 26’sı erkek idi. Erkek fetüslerde hem ikinci hem üçüncü trimesterde kızlara göre anogenital
mesafe değerlerinin anlamlı şekilde fazla olduğu tespit edildi (p=0,031). Anogenital mesafe ile fallus uzunluk değerleri arasında erkek fetüslerde
anlamlı bir ilişki tespit edilirken kız fetüslerde anlamlı bir ilişki tespit edilmedi (p<0,001), (p=0,212). İkinci trimesterde fallus uzunluğunun 5,58
mm’den, fallus genişliğinin 4,55 mm’den küçük değerleri kız cinsiyet ile ilişkilendirilirken, üçüncü trimesterde fallus uzunluğunun 4,79 mm’den,
fallus genişliğinin 5,08 mm’den küçük değerlerinin kız cinsiyet ile ilişkili olduğu görüldü (p<0,0001), (p=0,0003).

Sonuç: Çalışmada fallus boyutları ile ilgili tespit edilen referans değerlerin ve bu değerlerin anogenital mesafe ile olan ilişkisinin, antenatal dönemde
normalden sapma ve cinsiyet tayini konularına katkı sağlayabileceği düşünülmektedir.

Etik Beyan

Araştırmanın yapıldığı Mersin Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu araştırmayı onayladı (2023/195).

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

  • 1. Odeh M, Ophir E, Bornstein J. Hypospadias mimicking female genitalia on early second trimester sonographic examination. J Clin Ultrasound. 2008;36:581-583.
  • 2. Romano-Riquer SP, Hernández-Avila M, Gladen BC, et al. Reliability and determinants of anogenital distance and penis dimensions in male newborns from Chiapas, Mexico. Paediatr Perinat Epidemiol. 2007;21:219-228.
  • 3. İsbir C, Elvan Ö, Taşkınlar H, et al. Assessment of clitoral anatomy in human fetuses. Surg Radiol Anat. 2020;42:453-459.
  • 4. Taşkınlar H, Elvan Ö, İsbir C, et al. Anogenital distance and anal position index in cadaveric human fetuses. Anat Sci Int. 2023;98:155-163.
  • 5. Leihy MW, Shaw G, Wilson JD, et al. Development of the penile urethra in the tammar wallaby. Sex Dev. 2011;5:241-249.
  • 6. Butler CM, Shaw G, Renfree MB. Development of the penis and clitoris in the tammar wallaby, Macropus eugenii. Anat Embryol (Berl). 1999;199:451-457.
  • 7. Zimmer EZ, Blazer S, Blumenfeld Z, et al. Fetal transient clitoromegaly and transient hypertrophy of the labia minora in early and mid pregnancy. J Ultrasound Med. 2012;31:409-415.
  • 8. Efrat Z, Akinfenwa OO, Nicolaides KH. First-trimester determination of fetal gender by ultrasound. Ultrasound Obstet Gynecol. 1999;13:305-307.
  • 9. Thankamony A, Pasterski V, Ong KK, et al. Anogenital distance as a marker of androgen exposure in humans. Andrology. 2016;4:616-625.
  • 10. Hernández-Peñalver AI, Sánchez-Ferrer ML, Mendiola J, et al. Assessment of anogenital distance as a diagnostic tool in polycystic ovary syndrome. Reprod Biomed Online. 2018;37:741-749.
  • 11. Aydin E, Holt R, Chaplin D, et al. Fetal anogenital distance using ultrasound. Prenat Diagn. 2019;39:527-535.
  • 12. Vocel J, Marková H. Význam vrásnĕní plosky a délky nohy pro upresnĕní gestacního vĕku novorozence [Signifivance of sole dermatoglyphics and of foot length in the accurate determination of gestational age in newborn infants]. Cesk Pediatr. 1978;33:618-620.
  • 13. Chitty LS, Altman DG, Henderson A, et al. Charts of fetal size: 4. Femur length. Br J Obstet Gynaecol. 1994;101:132-135.
  • 14. Liu C, Xu X, Huo X. Anogenital distance and its application in environmental health research. Environ Sci Pollut Res Int. 2014;21:5457-5764.
  • 15. Salazar-Martinez E, Romano-Riquer P, Yanez-Marquez E, et al. Anogenital distance in human male and female newborns: a descriptive, cross-sectional study. Environ Health. 2004;3:8.
  • 16. Suryana Y, Makhmudi A. Assessment of the normal anal position index (API) of Indonesian neonates. J Med Sci. 2018;50:431-435.
  • 17. Bowman CJ, Barlow NJ, Turner KJ, et al. Effects of in utero exposure to finasteride on androgen-dependent reproductive development in the malerat. Toxicol Sci. 2003;74:393-406.
  • 18. Swan SH, Main KM, Liu F, et al. Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environ Health Perspect. 2005;113:1056-1061.
  • 19. Kutlu A, Akbiyik F. Clitoral length in female newborns: a new approach to the assessment of clitoromegaly. Turk J Med Sci. 2011;41:495-499.
  • 20. Cheng PK, Chanoine JP. Should the definition of micropenis vary according to ethnicity? Horm Res. 2001;55:278-281.
  • 21. Asafo-Agyei SB, Ameyaw E, Chanoine JP, et al. Clitoral size in term newborns in Kumasi, Ghana. Int J Pediatr Endocrinol. 2017;2017:6.

Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses

Yıl 2023, Cilt: 76 Sayı: 3, 252 - 257, 24.10.2023

Öz

Objectives: In the study, morphometric measurements of anogenital distance, penis and clitoris dimensions were taken in female and male fetuses.
In this way, it is aimed to contribute to the determination of antenatal period standards related to the subject.

Materials and Methods: Fifty-five fetuses were included in the study. The anogenital distance was measured as the anus midline-posterior
fourchette in girls, and the anus midline-posterior scrotal raphe in boys. Clitoris length and clitoral glans width were measured in female fetuses.
Penis (glans) width and penis length were measured in male fetuses.

Results: Of the 55 fetuses, 29 were female, 26 were male. Anogenital distance values were found to be significantly higher in male fetuses in both second and third trimesters compared to female fetuses (p=0.031). While a significant relationship was found between anogenital distance and
phallus length values in male fetuses, no significant relationship was found in female fetuses (p<0.001), (p=0.212). In the second trimester, values of
phallus length less than 5.58 mm and phallus width less than 4.55 mm are associated with female gender. In the third trimester, phallus length less
than 4.79 mm and phallus width less than 5.08 mm were found to be associated with female gender (p<0.0001), (p=0.0003).

Conclusion: It is thought that the reference values determined in the study regarding the phallus dimensions and the relationship of these values
with the anogenital distance may contribute to the issues of deviation from normal and sex determination in the antenatal period.

Etik Beyan

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Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. Odeh M, Ophir E, Bornstein J. Hypospadias mimicking female genitalia on early second trimester sonographic examination. J Clin Ultrasound. 2008;36:581-583.
  • 2. Romano-Riquer SP, Hernández-Avila M, Gladen BC, et al. Reliability and determinants of anogenital distance and penis dimensions in male newborns from Chiapas, Mexico. Paediatr Perinat Epidemiol. 2007;21:219-228.
  • 3. İsbir C, Elvan Ö, Taşkınlar H, et al. Assessment of clitoral anatomy in human fetuses. Surg Radiol Anat. 2020;42:453-459.
  • 4. Taşkınlar H, Elvan Ö, İsbir C, et al. Anogenital distance and anal position index in cadaveric human fetuses. Anat Sci Int. 2023;98:155-163.
  • 5. Leihy MW, Shaw G, Wilson JD, et al. Development of the penile urethra in the tammar wallaby. Sex Dev. 2011;5:241-249.
  • 6. Butler CM, Shaw G, Renfree MB. Development of the penis and clitoris in the tammar wallaby, Macropus eugenii. Anat Embryol (Berl). 1999;199:451-457.
  • 7. Zimmer EZ, Blazer S, Blumenfeld Z, et al. Fetal transient clitoromegaly and transient hypertrophy of the labia minora in early and mid pregnancy. J Ultrasound Med. 2012;31:409-415.
  • 8. Efrat Z, Akinfenwa OO, Nicolaides KH. First-trimester determination of fetal gender by ultrasound. Ultrasound Obstet Gynecol. 1999;13:305-307.
  • 9. Thankamony A, Pasterski V, Ong KK, et al. Anogenital distance as a marker of androgen exposure in humans. Andrology. 2016;4:616-625.
  • 10. Hernández-Peñalver AI, Sánchez-Ferrer ML, Mendiola J, et al. Assessment of anogenital distance as a diagnostic tool in polycystic ovary syndrome. Reprod Biomed Online. 2018;37:741-749.
  • 11. Aydin E, Holt R, Chaplin D, et al. Fetal anogenital distance using ultrasound. Prenat Diagn. 2019;39:527-535.
  • 12. Vocel J, Marková H. Význam vrásnĕní plosky a délky nohy pro upresnĕní gestacního vĕku novorozence [Signifivance of sole dermatoglyphics and of foot length in the accurate determination of gestational age in newborn infants]. Cesk Pediatr. 1978;33:618-620.
  • 13. Chitty LS, Altman DG, Henderson A, et al. Charts of fetal size: 4. Femur length. Br J Obstet Gynaecol. 1994;101:132-135.
  • 14. Liu C, Xu X, Huo X. Anogenital distance and its application in environmental health research. Environ Sci Pollut Res Int. 2014;21:5457-5764.
  • 15. Salazar-Martinez E, Romano-Riquer P, Yanez-Marquez E, et al. Anogenital distance in human male and female newborns: a descriptive, cross-sectional study. Environ Health. 2004;3:8.
  • 16. Suryana Y, Makhmudi A. Assessment of the normal anal position index (API) of Indonesian neonates. J Med Sci. 2018;50:431-435.
  • 17. Bowman CJ, Barlow NJ, Turner KJ, et al. Effects of in utero exposure to finasteride on androgen-dependent reproductive development in the malerat. Toxicol Sci. 2003;74:393-406.
  • 18. Swan SH, Main KM, Liu F, et al. Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environ Health Perspect. 2005;113:1056-1061.
  • 19. Kutlu A, Akbiyik F. Clitoral length in female newborns: a new approach to the assessment of clitoromegaly. Turk J Med Sci. 2011;41:495-499.
  • 20. Cheng PK, Chanoine JP. Should the definition of micropenis vary according to ethnicity? Horm Res. 2001;55:278-281.
  • 21. Asafo-Agyei SB, Ameyaw E, Chanoine JP, et al. Clitoral size in term newborns in Kumasi, Ghana. Int J Pediatr Endocrinol. 2017;2017:6.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Cerrahisi
Bölüm Makaleler
Yazarlar

Caner İsbir 0000-0003-0887-9817

Proje Numarası -
Yayımlanma Tarihi 24 Ekim 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 76 Sayı: 3

Kaynak Göster

APA İsbir, C. (2023). Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 76(3), 252-257. https://doi.org/10.4274/atfm.galenos.2023.47704
AMA İsbir C. Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ekim 2023;76(3):252-257. doi:10.4274/atfm.galenos.2023.47704
Chicago İsbir, Caner. “Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76, sy. 3 (Ekim 2023): 252-57. https://doi.org/10.4274/atfm.galenos.2023.47704.
EndNote İsbir C (01 Ekim 2023) Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76 3 252–257.
IEEE C. İsbir, “Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 76, sy. 3, ss. 252–257, 2023, doi: 10.4274/atfm.galenos.2023.47704.
ISNAD İsbir, Caner. “Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76/3 (Ekim 2023), 252-257. https://doi.org/10.4274/atfm.galenos.2023.47704.
JAMA İsbir C. Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;76:252–257.
MLA İsbir, Caner. “Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 76, sy. 3, 2023, ss. 252-7, doi:10.4274/atfm.galenos.2023.47704.
Vancouver İsbir C. Morphometric Examination of Anogenital Distance, Penis and Clitoris Dimensions in Human Fetuses. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;76(3):252-7.