Association between anogenital distance as a noninvasive index in the diagnosis and prognosis of reproductive disorder: A systematic review

Zamani P, Parisa Zamani, Zeinab Hemati, Hemati Z, Roya Kelishadi, Kelishadi R, Kolahdozan S, Sakineh Kolahdozan, Mostafa Dianatinasab, Dianatinasab M, Mojtaba Keikha
International journal of reproductive biomedicine · 2023 · vol. 21(8) , pp. 599–618 · doi:10.18502/ijrm.v21i8.14016 · PMID:37885976 · PMC10598470 · W4386874435
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⚙ AI-generated summary by claude@2026-07, 2026-07-09 ⓘ

This systematic review of 47 studies found associations between anogenital distance and conditions including endometriosis, hypospadias, prostate cancer, polycystic ovary syndrome, and fertility parameters.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This PRISMA-guided systematic review searched PubMed, Scopus, and Web of Knowledge (to July 30, 2021) to evaluate whether anogenital distance (AGD), measured as an easily obtained anthropometric proxy for prenatal androgen-related hormonal disruption, is associated with diagnosis and prognosis across multiple disorders. Forty-seven quantitative observational studies (22 high-quality, 12 medium-quality) were included, and due to heterogeneity the authors did not perform a quantitative meta-analysis. Across included outcomes, the review reports an overall negative association between AGD and endometriosis (including shorter AGD measurements, particularly AGD_AF/AGD_AC, in several studies), and it also describes directionally opposite associations for other conditions such as PCOS and prostate cancer. The paper specifically notes limited evidence in women and a small number of AGD studies for some outcomes, which contributes to heterogeneity and constrains pooled inference. This paper is centrally about endometriosis and AGD — it systematically synthesizes evidence that shorter AGD is significantly associated with endometriosis in women.

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Abstract

BACKGROUND: There are 2 measures of anogenital distance (AGD) in men and women. AGD has been used as an indicator of fetal androgen dysfunction and an adverse outcome in adulthood. Some studies have shown the association of AGD as a predictor in the diagnosis and prognosis of diseases and disorders. OBJECTIVE: To systematically summarize the latest evidence for presenting AGD as a new approach for prognosis and early diagnosis of diseases. MATERIALS AND METHODS: A systematic review of the available literature was performed using Medline via PubMed, Scopus, and ISI Web of Knowledge up to July 2021, using search terms "anogenital distance" OR "anogenital index" OR "ano genital distance" OR "ano genital index". Language restrictions were not imposed. RESULTS: After reviewing the retrieved articles, 47 unique studies were included in this systematic review. Different outcomes, including endometriosis, prostate cancer, polycystic ovary syndrome, pelvic organ prolapse, hypospadias, cryptorchidism, fertility and semen parameters, maternal and birth development, and ovarian and gynecological-related disorders, have been studied in the included evidence. A negative association was observed between AGD and endometriosis and hypospadias and a positive association between AGD and prostate cancer, polycystic ovary syndrome, male fetal gender, and fertility parameters. CONCLUSION: Using quantitative indicators such as AGD may be a useful clinical tool for the diagnosis of diseases. Although many studies have shown an association between AGD and diseases, some factors, including different measurement methods, different measurement tools, age, and different definitions of AGD, can be involved in the variation of AGD.
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We declare that this manuscript is original, has not been previously published or submitted elsewhere for publication, and is not under consideration by another journal.

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The authors declare that there is no conflict of interest.

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endometriosis

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