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Abstract
BACKGROUND: The immediate aim of feminizing genitoplasty in the management of ambiguous genitalia
is to make the cosmetic appearance look as female as possible. In the long term the
vagina must also be adequate for menstruation and intercourse. There is increasing
awareness amongst patients and clinicians that the outcome of this surgery may be
unsatisfactory. This study evaluates the cosmetic and anatomical outcome of feminising
genital surgery.
METHODS: 45 girls were examined under anaesthetic. All had undergone reconstructive genital
surgery in childhood for intersex conditions. The external cosmetic appearance was
evaluated and a recommendation made as to further intervention. In all cases previous
surgical notes were reviewed.
RESULTS: The age range was 7.5-19.5 years (mean 15 years). The cosmetic result was good or
satisfactory in 62% of patients. However in 98% of patients further intervention was
deemed necessary. Of these, 23% required dilators and 77% surgery. 60% had undergone
one previous procedure. The rest had two or more prior genital operations and one
child had undergone six prior genital procedures. All patients who had undergone prior
vaginoplasty required further treatment to the vagina.
CONCLUSION: Most children undergoing feminizing surgery require further treatment in puberty
and this must be made clear to the parents. Vaginal surgery should be deferred until
puberty unless there is a risk of haematocolpos. The requirement for clitoral surgery
should be carefully considered on an individual basis.
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Copyright
© 2001 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
