Infants with genital development considered atypical for assigned female sex may undergo
feminizing genitoplasty (clitoroplasty and/or vaginoplasty) in early life. We sought
to identify factors associated with parent/caregiver decisions regarding genitoplasty
for their children with genital virilization.
Longitudinal, observational study
Twelve pediatric centers in the United States with multidisciplinary differences/disorders
of sex development clinics, 2015-2020
Children under 2 years old with genital appearance atypical for female sex of rearing
and their parents/caregivers
Data on the child's diagnosis and anatomic characteristics before surgery were extracted
from the medical record. Parents/caregivers completed questionnaires on psychosocial
distress, experience of uncertainty, cosmetic appearance of their child's genitalia,
and demographic characteristics. Urologists rated cosmetic appearance. For 58 patients
from the study cohort with genital virilization being raised as girls or gender-neutral,
we compared these data across 3 groups based on the child's subsequent surgical intervention:
(i) no surgery (n = 5), (ii) vaginoplasty without clitoroplasty (V-only) (n = 15), and (iii) vaginoplasty and clitoroplasty (V+C) (n = 38).
Fathers’ and urologists’ ratings of genital appearance were more favorable in the
no-surgery group than in the V-only and V+C groups. Clitorophallic length was greater
in the V+C group compared with the V-only group, with substantial overlap between
groups. Mothers’ depressive and anxious symptoms were lower in the no-surgery group
compared with the V-only and V+C groups.
Surgical decisions were associated with fathers’ and urologists’ ratings of genital
appearance, the child's anatomic characteristics, and mothers’ depressive and anxious
symptoms. Further research on surgical decision-making is needed to inform counseling