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Anogenital distance is related to ovarian follicular number in young Spanish women: a cross-sectional study

Jaime Mendiola12*, Manuela Roca12, Lidia Mínguez-Alarcón1, Maria-Pilar Mira-Escolano1, José J López-Espín3, Emily S Barrett4, Shanna H Swan5 and Alberto M Torres-Cantero16

Author Affiliations

1 Division of Preventive Medicine and Public Health, Department of Health and Social Sciences, University of Murcia School of Medicine, Espinardo Campus, Espinardo (Murcia), 30100, Spain

2 Fertilidad Roca, Gestión Clínica Avanzada SLU, Avenida Ronda Sur 20, Murcia, 30010, Spain

3 Center of Operations Research, Miguel Hernandez University, Elche Campus, Elche, 03202, Spain

4 Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Rochester (NY), 14624, USA

5 Department of Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York (NY), 10029, USA

6 Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Avenida Teniente Flomesta 5, Murcia, 30003, Spain

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Environmental Health 2012, 11:90  doi:10.1186/1476-069X-11-90

Published: 8 December 2012



In animals, anogenital distance (AGD) at birth reflects androgen levels during pregnancy and predicts adult AGD. Little is known about AGD in relation to female reproductive characteristics in humans, a question this study was designed to explore.


We used multiple linear and logistic regression analyses to model the relationships between adult female reproductive system characteristics (e.g. ovarian morphology, menstrual cycle) and two measures of AGD [anus-fourchette (AGDAF) and anus-clitoris (AGDAC)] in 100 college-age volunteers in Spain. Ovarian morphology was classified as having < 6 or ≥ 6 follicles per ovary.


Both AGD measures were positively associated with ovarian follicle number, with AGDAF being more strongly associated. Women in the upper tertile of the AGDAF and AGDAC distributions were more likely to have ≥ 6 ovarian follicles [OR: 6.0 (95% CI 2.0, 17.6) and 3.0 (95% CI 1.1, 8.6), respectively] compared to women in the lowest tertile.


Increased follicular recruitment has been related to excess androgen exposure in utero in toxicological studies. Our results suggest that the androgenic environment during early fetal life may influence reproductive system development, including AGD, in human females.

Androgens; Anogenital distance; Increased follicular recruitment; Ovarian morphology