Quigley scale
{{short description|Rating scale for morphology of human genitalia}}
{{Intersex sidebar|rights}}
The Quigley scale is a descriptive, visual system of phenotypic grading that defines seven classes between "fully masculinized" and "fully feminized" genitalia. It was proposed by pediatric endocrinologist Charmian A. Quigley et al. in 1995. It is similar in function to the Prader scale and is used to describe genitalia in cases of androgen insensitivity syndrome, including complete androgen insensitivity syndrome, partial androgen insensitivity syndrome and mild androgen insensitivity syndrome.{{cite journal |vauthors=Galani A, Kitsiou-Tzeli S, Sofokleous C, Kanavakis E, Kalpini-Mavrou A | title = Androgen insensitivity syndrome: clinical features and molecular defects | journal = Hormones (Athens) | volume = 7 | issue = 3 | pages = 217–29 | year = 2008 | pmid = 18694860 | doi = 10.14310/horm.2002.1201| doi-access = free }}{{cite journal |vauthors=Sultan C, Paris F, Terouanne B, Balaguer P, Georget V, Poujol N, Jeandel C, Lumbroso S, Nicolas JC | title = Disorders linked to insufficient androgen action in male children | journal = Hum. Reprod. Update | volume = 7 | issue = 3 | pages = 314–22 | year = 2001 | pmid = 11392378 | doi = 10.1093/humupd/7.3.314 | doi-access = free }}
Schematic representation
Staging
The first six grades of the scale, grades 1 through 6, are differentiated by the degree of genital masculinization. Quigley describes the scale as depicting "severity" or "defective masculinization". Grade 1 is indicated when the external genitalia is fully masculinized, and corresponds to mild androgen insensitivity syndrome. Grades 6 and 7 are indicated when the external genitalia is fully feminized, corresponding to complete androgen insensitivity syndrome.
Grades 2 through 5 quantify four degrees of decreasingly masculinized genitalia that lie in the interim.{{cite journal |vauthors=Quigley CA, De Bellis A, Marschke KB, el-Awady MK, Wilson EM, French FS | title = Androgen receptor defects: historical, clinical, and molecular perspectives | journal = Endocr. Rev. | volume = 16 | issue = 3 | pages = 271–321 |date=June 1995 | pmid = 7671849 | doi = 10.1210/edrv-16-3-271}} Grades 2 through 5 of the Quigley scale quantify four degrees of increasingly feminized genitalia that correspond to partial androgen insensitivity syndrome.{{cn|date=February 2022}}
Grade 7 is indistinguishable from grade 6 until puberty, and is thereafter differentiated by the presence of secondary terminal hair. Grade 6 is indicated when secondary terminal hair is present, whereas grade 7 is indicated when it is absent.
Controversy
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.{{Cite book
|last = Swiss National Advisory Commission on Biomedical Ethics NEK-CNE
|title = On the management of differences of sex development. Ethical issues relating to "intersexuality".Opinion No. 20/2012
|location = Berne
|date = November 2012
|url = http://www.nek-cne.ch/fileadmin/nek-cne-dateien/Themen/Stellungnahmen/en/NEK_Intersexualitaet_En.pdf
|url-status = dead
|archive-url = https://web.archive.org/web/20150423213245/http://www.nek-cne.ch/fileadmin/nek-cne-dateien/Themen/Stellungnahmen/en/NEK_Intersexualitaet_En.pdf
|archive-date = 2015-04-23
}} 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.{{Cite book
| publisher = Community Affairs References Committee
| isbn = 9781742299174
| last = Australia
| title = Involuntary or coerced sterilisation of intersex people in Australia
| location = Canberra
| date = 2013
| url = http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index
}} In a 2015 issue paper on Human rights and intersex people, the Commissioner for Human Rights of the Council of Europe recommended a review of medical classification that pathologise variations in sex characteristics.{{cite web | last1 = Council of Europe| last2 = Commissioner for Human Rights| title = Human rights and intersex people, Issue Paper| date = April 2015| url = https://wcd.coe.int/ViewDoc.jsp?Ref=CommDH/IssuePaper(2015)1&Language=lanEnglish&Ver=original |format=PDF| author1-link = Council of Europe}}
Related concepts
Numerous clinical scales and measurement systems exist to define genitals as normal male or female, or "abnormal", including the orchidometer, Prader scale and the satirical Phall-O-Meter.{{citation needed|date=September 2020}}
See also
References
{{Reflist}}
{{Intersex}}
{{Congenital malformations of genital organs}}
Category:Male genital procedures