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TheQuigley scale is a descriptive, visual system ofphenotypic grading that defines seven classes between "fully masculinized" and "fully feminized" genitalia. It was proposed by pediatricendocrinologist Charmian A. Quigley et al. in 1995.[1] It is similar in function to thePrader scale and is used to describe genitalia in cases ofandrogen insensitivity syndrome, includingcomplete androgen insensitivity syndrome,partial androgen insensitivity syndrome andmild androgen insensitivity syndrome.[2][3]
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]
While the scale has been defined as a grading system for feminized or undermasculinized genitalia, the concept that atypical genitals are necessarily pathological 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 Europe recommended a review of medical classification that pathologise variations in sex characteristics.[6]
Numerous clinical scales and measurement systems exist to define genitals as normal male or female, or "abnormal", including theorchidometer,Prader scale and the satiricalPhall-O-Meter.[citation needed]
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