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BACKGROUND: Current management for intersex conditions includes clitoral reduction surgery for
those patients with ambiguous genitalia who are being raised female. Evaluation of
this management is difficult due to the scarcity of long term outcome data looking
at sexual function and other outcomes.
METHODS: This was a questionnaire study combined with a retrospective hospital notes review.
The questionnaire comprised detail on diagnosis and treatment along with a modified
sexual function inventory (GRISS) which provided scores encompassing seven areas of
female sexual function. All hospital notes were collected and analyzed for diagnosis
and surgical detail. All respondents were invited for clinical examination.
RESULTS: 37 intersex women, over 18 years old, all with ambiguous genitalia at birth or in
childhood, completed the questionnaire. 11 were patients, 26 were recruited through
the UK AISSG (Androgen Insensitivity Syndrome Support Group). 16/37 (43%) attended
for a clinical examination. 10/37 (29%) had had clitoral surgery deferred and so had
currently not undergone clitoral surgery, of which 1/10 (10%) had never been sexually
active. Of the 27/37 (73%) who had undergone clitoral surgery, 9/27 (33%) had never
been sexually active, leaving sexual function data on 18 subjects who had undergone
clitoral surgery and 9 subjects who have virilised female genitalia and have not undergone
clitoral surgery. Mean global sexual function scores were worse in the group with
clitoral surgery. On looking at orgasm scores alone, the group with clitoral surgery
had scores significantly abnormal for difficulty with orgasm, with 5/18 (28%) having
CONCLUSIONS: This study shows that clitoral surgery can damage adult sexual function.
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