The study “Exploring factors associated with decisions about feminizing genitoplasty
in differences of sex development” by Kremen et al aimed to address if Prader stage,
clitoral size, parental uncertainty, anxiety, depression, or dissatisfaction with
genital appearance correlated with surgical decision-making in children under age
2 with a difference of sex development (dsd). Most of the 58 children were diagnosed
with 46 XX congenital adrenal hyperplasia (CAH), and all but 5 underwent surgery before
age 2. Interestingly, there was no significant difference in Prader score or dissatisfaction
with their children's genital appearance for mothers in the surgical vs nonsurgical
groups. The most notable finding was that the urologists were the most dissatisfied
with the appearance of the genitals of the patients who ultimately underwent surgery.
1.
This finding, that genital appearance is rated worse by surgeons compared with parents,
has been reported previously; this might reflect more detailed knowledge of “normal”
anatomy, but it also might reflect bias toward performing surgery.
- Kremen J
- Harris RM
- Aston CE
- et al.
Exploring factors associated with decisions about feminizing genitoplasty in differences
of sex development.
J Pediatr Adolesc Gynecol. 2022; https://doi.org/10.1016/j.jpag.2022.08.004
2.
Although shared decision-making encourages elucidating parental values and biases,
the spotlight rarely focuses on clarifying the biases, values, and assumptions of
surgeons.
3.
- Suorsa-Johnson KI
- Gardner MD
- Brinkman W
- et al.
A survey of healthcare professionals' perceptions of the decisional needs of parents
with an infant born with a disorder/difference of sex development.
J Pediatr Urol. 2022; https://doi.org/10.1016/j.jpurol.2022.09.015
Key Words
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References
- Exploring factors associated with decisions about feminizing genitoplasty in differences of sex development.J Pediatr Adolesc Gynecol. 2022; https://doi.org/10.1016/j.jpag.2022.08.004
- Prospective assessment of cosmesis before and after genital surgery.J Pediatr Urol. 2017; 13 (.e1-28.e6): 28
- A survey of healthcare professionals' perceptions of the decisional needs of parents with an infant born with a disorder/difference of sex development.J Pediatr Urol. 2022; https://doi.org/10.1016/j.jpurol.2022.09.015
- Reference values for the external genitalia of full-term and pre-term female neonates.Arch Dis Child Fetal Neonatal Ed. 2021; 106: 39-44
- Country-based reference values and international comparisons of clitoral size in healthy Nigerian newborn infants.Acta Paediatr. 2015; 104: 1286-1290
- Congenital adrenal hyperplasia: results of medical therapy on appearance of external genitalia.J Pediatr Urol. 2010; 6: 555-559
- Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia.Arch Sex Behav. 2005; 34: 389-397
- Fully Masculinized 46,XX individuals with congenital adrenal Hyperplasia: perspective regarding sex of rearing and surgery.Int J Fertil Steril. 2022; 16: 128-131
Brown A: About 5% of young adults in the U.S. say their gender is different from their sex assigned at birth. Available: https://www.pewresearch.org/fact-tank/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/. Accessed October 20, 2022
- Gender-role behaviour and gender identity in girls with classical congenital adrenal hyperplasia.BMC Pediatr. 2021; 21: 262
- Effects on gender identity of prenatal androgens and genital appearance: evidence from girls with congenital adrenal hyperplasia.J Clin Endocrinol Metab. 2003; 88: 1102-1106
- Sexual function and genital sensitivity following feminizing genitoplasty for congenital adrenal hyperplasia.J Urol. 2008; 179: 634-638
- Long-term results of surgical treatment and patient-reported outcomes in congenital adrenal hyperplasia-a multicenter European registry study.J Clin Med. 2022; 11: 4629
- Urinary continence outcomes following vaginoplasty in patients with congenital adrenal hyperplasia.J Pediatr Urol. 2017; 13: 38.e1-38.e7
- Long-term urinary symptoms in adolescent and adult women with congenital adrenal hyperplasia.J Pediatr Urol. 2018; 14: 240.e1-240.e5
- Lower urinary tract symptoms after feminizing genitoplasty.J Pediatr Urol. 2013; 9: 23-26
- Illness uncertainty longitudinally predicts distress among caregivers of children born with DSD.J Pediatr Psychol. 2020; 45: 1053-1062
- Children with disorders of sex development: a qualitative study of early parental experience.Int J Pediatr Endocrinol. 2011; (10)
- Subjective need for psychological support (PsySupp) in parents of children and adolescents with disorders of sex development (dsd).Eur J Pediatr. 2015; 174: 1287-1297
- Changes in levels of parental distress after their child with atypical genitalia undergoes genitoplasty.J Pediatr Urol. 2017; 13: 32.e1-32.e6
World Health Organization: Female genital mutilation. Available: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation. Accessed October 20, 2022
Bonobo3D: Paediatric surgeon Mika Venhola on INTERSEX. Available: https://www.youtube.com/watch?v=riNtxjntqZE. Accessed October 20, 2022
Article info
Publication history
Published online: November 03, 2022
Accepted:
October 24,
2022
Received:
October 20,
2022
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
