Skip to main content

Advertisement

Log in

Feminizing surgical management of intersex patients

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

The study’s objective was to evaluate the results of surgical modalities for children with ambiguous genitalia. The records of 55 patients who were reared as females between 1985 and 2001 were reviewed regarding diagnosis, age at surgery, operative procedures, and outcome. The mean age at surgery was 3.5 years, and the follow-up period averaged 4.1 years with a range of 2 months–17 years. The types of reconstructive surgical techniques were clitorovaginoplasty in 29, staging clitoral surgery and vaginoplasty in seven, clitoroplasty in five, total urogenital mobilization (TUM) in three, vaginal bowel substitution in two, clitoridectomy in one, and gonadectomy in six, and two are waiting for vaginal substitution surgery after gonadectomy. The main complications were vaginal stenosis in four patients. All of the TUM patients had good appearances of their urethral orifice and vagina, all of them were continent, and none of them had urinary tract infections. With our limited experience with the TUM procedure, we feel that it is possible to obtain a better cosmetic and functional result with an easier technique. Among the 10 patients of postpubertal age, none of them had had sexual experience. Eight of the postpubertal patients asked questions about their reproductive status. Patients with an intersex disorder should be informed about their problems, especially about their reproductivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Alizai NK, Thomas DFM, Lilford RJ, Batchelor AGG, Johnson N (1999) Feminizing genitoplasty for congenital adrenal hyperplasia: what happens at puberty? J Urol 161:1588–1591

    Article  CAS  PubMed  Google Scholar 

  2. Bellinger MF (1993) Subtotal de-epithelialization and partial concealment of glans clitoris: a modification to improve the cosmetic results of feminizing genitoplasty. J Urol 150:651–653

    CAS  PubMed  Google Scholar 

  3. Braz A (1999) Posterior sagittal transanorectal approach in patients with ambiguous genitalia: report of eight cases. Pediatr Surg Int 15:108–110

    Article  CAS  PubMed  Google Scholar 

  4. Castilla EE, Orioli IM, Lugarinho R, Dutra G (1987) Epidemiology of ambiguous genitalia in South America. Am J Med Genet 27:337–343

    CAS  PubMed  Google Scholar 

  5. Donahoe PK, Hendren WH (1984) Perineal reconstruction in ambiguous genitalia infants raised as females. Ann Surg 200:363–371

    CAS  PubMed  Google Scholar 

  6. Donahoe PK, Powell DM, Lee MM (1991) Clinical management of intersex anomalies. Curr Prob Surg 28:519–579

    Article  Google Scholar 

  7. Fortunoff ST, Lattimer JK, Edson M (1964) Vaginoplasty technique for female pseudohermaphrodites. Surg Gynecol Obstet 118:253–259

    Google Scholar 

  8. Gearhart JP (2000) Editorial comment. Br J Urol 86:258–259

    Article  Google Scholar 

  9. Gonzales R, Fernandes ET (1990) Single stage feminization genitoplasty. J Urol 143:776–778

    PubMed  Google Scholar 

  10. Gross RE, Randolph J, Crigler JF Jr. (1966) Clitorectomy for sexual abnormalities: indications and technique. Surgery 59:300–308

    Google Scholar 

  11. Hamza A, Elsafory H, Abdelhay S, Elbehery M (2001) Total urogenital sinus mobilization in the repair of cloacal anomalies and adrenogenital syndrome. Presented at 34th Annual Meeting of Pacific Association of Pediatric Surgeons, Kyoto, Japan, 4–8 April, 2001, p 81

  12. Hendren WH, Crawford JW (1969) Adrenogenital syndrome: the anatomy of the anomaly and its repair. Some new concepts. J Pediatr Surg 4:49–58

    Article  CAS  PubMed  Google Scholar 

  13. Hendren WH (2000) A dissenting viewpoint concerning total urogenital mobilization. Dialogues Pediatr Urol 23:4-5

    Google Scholar 

  14. de Jong TPVM, Boemers TML (1995) Neonatal management of female intersex by clitorovaginoplasty. J Urol 154:830–832

    PubMed  Google Scholar 

  15. Kipnis K, Diamond M (1998) Pediatric ethics and the surgical assignment of sex. J Clin Ethics 9:398–410

    CAS  PubMed  Google Scholar 

  16. Kogan SJ, Smey P, Levitt SB (1983) Subtunical total reduction clitoroplasty: a safe method of existing techniques. J Urol 130:746–748

    CAS  PubMed  Google Scholar 

  17. Krege S, Walz KH, Hauffa BP, Körner I, Rübben H (2000) Long-term follow up of female patients with congenital adrenal hyperplasia from 21-hydroxylase deficiency, with special emphasis on the results of vaginoplasty. Br J Urol 86:253–259

    Article  CAS  Google Scholar 

  18. Krstić Z, Perovic S, Radmanović S, Necić S, Smoljanić Ž, Jevtić P (1995) Surgical treatment of intersex disorders. J Pediatr Surg 30:1273–1281

    PubMed  Google Scholar 

  19. Kumar H, Kiefer JH, Rosenthal IE, Clark SS (1974) Clitoroplasty: experience during a 19 year period. J Urol 111:81–84

    CAS  PubMed  Google Scholar 

  20. Ladee-Levy JV (1984) Ambiguous genitalia as a psychosocial emergency. Z Kinderchir 39:178–181

    CAS  PubMed  Google Scholar 

  21. Lobe TE, Woodall DL, Ruchards GE, Cavallo A, Meyer WJ (1997) The complications of surgery for intersex: changing pattern over two decades. J Pediatr Surg 22:651–652

    Google Scholar 

  22. Parrott TS, Woodard JR (1991) Abdominoperineal approach to management of the high, short vagina in the adrenogenital syndrome. J Urol 146:647–648

    CAS  PubMed  Google Scholar 

  23. Passerini-Glazel G (1989) A new 1-stage procedure for clitorovaginoplasty. In: Severely masculinized female pseudohermaphrodites. J Urol 142:565–568

    CAS  PubMed  Google Scholar 

  24. Peña A (1997) Total urogenital mobilization-an easier way to repair cloacas. J Pediatr Surg 32:263–268

    PubMed  Google Scholar 

  25. Rink RC, Adams MC (1999) Evaluation and surgical management of the child with intersex. Prog Pediatr Urol 2:67–88

    Google Scholar 

  26. Rink RC (2000) Total urogenital mobilization (TUM). Dialogues Pediatr Urol 23: 2–4

    Google Scholar 

  27. Sheldon CA, Gilbert A, Lewis AG (1994) Vaginal reconstruction: critical technical principles. J Urol 152:190–195

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N. Danişmend.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eroğlu, E., Tekant, G., Gündoğdu, G. et al. Feminizing surgical management of intersex patients. Ped Surgery Int 20, 543–547 (2004). https://doi.org/10.1007/s00383-004-1208-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-004-1208-5

Keywords

Navigation