Feminizing genitoplasty: a synopsis of issues relating to genital surgery in intersex individuals

Abstract

This review of the literature relevant to genitoplasty explores multiple factors that could impact and improve long-term outcomes. In 1998, surgeons began a dialogue that fostered interactive multidisciplinary exchanges regarding necessity, timing, and risks related to genitoplasty. Prior practice had embraced a simplistic approach--make an intersexed child resemble either a typical boy or girl. But surgery was never 'perfect' because function was often sacrificed for form, the goal being to create an aesthetic appearance. Compounding the difficulties of this type of surgery were the demands of the patients and parents for clarity, sure direction, and surgery that looked cosmetically authentic and provided good function. They demanded answers that medical experts could not readily provide regarding long-term outcomes. To increase patient satisfaction, we seek such outcomes and knowledge to better our understanding for optimal patient management and care. A review of current research is provided that might have important implications impacting surgical issues. Knowledge garnered from fields other than surgery is explored for potential applications that could improve surgical outcomes. Surgical technique modifications may be part of the solution to a complex problem, but they are not the sole solution. A multidisciplinary approach is required because to this date, surgical promise is limited at best. Better understanding of the anatomy and physiology, as well as the related hormonal environment and its impact on healing, may be the key toward improvement of outcomes and heightened patient satisfaction.