A Case-control Study of Female Genital Measurements in Polycystic Ovary Syndrome and Their Relation to Sexual Function and Genital Perception

Purpose:The objective of this study was to analyze differences in external genital measurements between women with polycystic ovary syndrome (PCOS) and healthy controls, and to evaluate how these anatomical differences relate to sexual function and genital self-image. Methods:A prospective multicenter case-control study was conducted between January and December 2024.The study included 155 women with PCOS and 155 control women with mild male factor infertility or unexplained infertility, all 18-45 years old and evaluated at an infertility clinic.PCOS was diagnosed according to the Rotterdam criteria.Participants with a history of gynecological surgery, hormonal medication use, or endocrine disorders were excluded.External genital measurements, including clitoral size, labial dimensions, vaginal length, and anogenital distance (AGD), were recorded.The female sexual function index (FSFI) and the female genital self-image scale (FGSIS) were administered to assess sexual function and genital self-image.Results: Women with PCOS had a significantly higher body mass index (26.56.2 kg/m vs. 24.64.7 kg/m, p=0.003) and later menarche (12.71.3 years vs. 11.61.1 years, p<0.001) compared to controls.Genital measurements revealed that women with PCOS had a shorter clitoral prepuce length (18.37.02mm vs. 20.74.9 mm, p=0.001), shorter AGD (21.213.3mm vs. 26.17.7 mm, p<0.001), and reduced labia majora length (62.719.8mm vs. 74.28.7 mm, p<0.001).In contrast, clitoral glans width was significantly larger in the PCOS group (6.52.8 mm vs. 5.81.5 mm, p=0.008).Women with PCOS also had higher FSFI subscale scores for arousal (3.81.6 vs. 3.3 1.2, p=0.002) and orgasm (4.11.2 vs. 3.61.8,p=0.003) but lower FGSIS scores (18.23.8 vs. 22.84.1,p<0.001), indicating less positive genital self-image. Conclusion:This study demonstrates marked differences in external genital measurements between women with PCOS and healthy controls, including shorter clitoral prepuce length, shorter AGD, and smaller labia majora in the PCOS group.These results imply that hormonal imbalances in PCOS may lead to distinct genital morphological changes that could influence sexual function and self-image.Despite higher arousal and orgasm scores, women with PCOS reported a lower genital self-image, highlighting a complex relationship between PCOS, body image, and sexual health.These findings provide new insights into the physical and psychological dimensions of PCOS and should inform future research and clinical strategies addressing sexual health in this population.