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The Association between Surgeon Dissatisfaction with Infant Genital Appearance and Surgical Decision-Making Surrounding Clitoroplasty

  • Anne-Marie Amies Oelschlager
    Correspondence
    Address correspondence to: Anne-Marie Amies Oelschlager, MD, Professor of Obstetrics and Gynecology, Pediatric and Adolescent Gynecology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195; Phone (206) 987-3005 ; Fax (206) 987-3959.
    Affiliations
    Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
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Published:November 03, 2022DOI:https://doi.org/10.1016/j.jpag.2022.10.010
      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.
      • Kremen J
      • Harris RM
      • Aston CE
      • et al.
      Exploring factors associated with decisions about feminizing genitoplasty in differences of sex development.
      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.
      • Nokoff NJ
      • Palmer B
      • Mullins AJ
      • et al.
      Prospective assessment of cosmesis before and after genital surgery.
      Although shared decision-making encourages elucidating parental values and biases, the spotlight rarely focuses on clarifying the biases, values, and assumptions of surgeons.
      • 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.

      Key Words

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