Quigley scale
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TheQuigley scaleis a descriptive, visual system ofphenotypicgrading that defines seven classes between "fully masculinized" and "fully feminized" genitalia. It was proposed by pediatricendocrinologistCharmian A. Quigley et al. in 1995.[1]It is similar in function to thePrader scaleand is used to describe genitalia in cases ofandrogen insensitivity syndrome,includingcomplete androgen insensitivity syndrome,partial androgen insensitivity syndromeandmild androgen insensitivity syndrome.[2][3]
Schematic representation
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Staging
[edit]The first six grades of the scale, grades 1 through 6, are differentiated by the degree ofgenital masculinization.Quigley describes the scale as depicting "severity" or "defective masculinization". Grade 1 is indicated when the external genitalia is fully masculinized, and corresponds tomild androgen insensitivity syndrome.Grades 6 and 7 are indicated when the external genitalia is fully feminized, corresponding tocomplete androgen insensitivity syndrome.[1]
Grades 2 through 5 quantify four degrees of decreasingly masculinized genitalia that lie in the interim.[1]Grades 2 through 5 of the Quigley scale quantify four degrees of increasingly feminized genitalia that correspond to partial androgen insensitivity syndrome.[citation needed]
Grade 7 is indistinguishable from grade 6 until puberty, and is thereafter differentiated by the presence ofsecondaryterminal hair.Grade 6 is indicated when secondary terminal hair is present, whereas grade 7 is indicated when it is absent.[1]
Controversy
[edit]While the scale has been defined as a grading system for feminized or undermasculinized genitalia, the concept that atypical genitals are necessarily abnormal is contested. An opinion paper by the Swiss National Advisory Centre for Biomedical Ethics advises that "not infrequently" variations from sex norms may not be pathological or require medical treatment.[4]Similarly, an Australian Senate Committee report on involuntary sterilization determined that research "regarding 'adequate' or 'normal' genitals, particularly for women, raises some disturbing questions", including preferences influenced by doctors' specialism and gender.[5]In a 2015 issue paper onHuman rights and intersex people,the Commissioner for Human Rights of theCouncil of Europerecommended a review of medical classification that pathologise variations in sex characteristics.[6]
Related concepts
[edit]Numerous clinical scales and measurement systems exist to define genitals as normal male or female, or "abnormal", including theorchidometer,Prader scaleand the satiricalPhall-O-Meter.[citation needed]
See also
[edit]References
[edit]- ^abcdQuigley CA, De Bellis A, Marschke KB, el-Awady MK, Wilson EM, French FS (June 1995). "Androgen receptor defects: historical, clinical, and molecular perspectives".Endocr. Rev.16(3): 271–321.doi:10.1210/edrv-16-3-271.PMID7671849.
- ^Galani A, Kitsiou-Tzeli S, Sofokleous C, Kanavakis E, Kalpini-Mavrou A (2008)."Androgen insensitivity syndrome: clinical features and molecular defects".Hormones (Athens).7(3): 217–29.doi:10.14310/horm.2002.1201.PMID18694860.
- ^Sultan C, Paris F, Terouanne B, Balaguer P, Georget V, Poujol N, Jeandel C, Lumbroso S, Nicolas JC (2001)."Disorders linked to insufficient androgen action in male children".Hum. Reprod. Update.7(3): 314–22.doi:10.1093/humupd/7.3.314.PMID11392378.
- ^Swiss National Advisory Commission on Biomedical Ethics NEK-CNE (November 2012).On the management of differences of sex development. Ethical issues relating to "intersexuality".Opinion No. 20/2012(PDF).Berne. Archived fromthe original(PDF)on 2015-04-23.
{{cite book}}:CS1 maint: location missing publisher (link) - ^Australia (2013).Involuntary or coerced sterilisation of intersex people in Australia.Canberra: Community Affairs References Committee.ISBN9781742299174.
- ^Council of Europe;Commissioner for Human Rights (April 2015)."Human rights and intersex people, Issue Paper"(PDF).
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