Cosmetic and anatomical outcomes following feminising childhood surgery for intersex conditions

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.