Surgical management of neonates and children with ambiguous genitalia

Abstract

Gender assignment is a neonatal surgical emergency. Early evaluation and treatment of intersexuality must be done as a team approach with a genetist, a paediatric endocrinologist and a paediatric surgeon/urologist taking part in it. Change of gender after 2 years of confusion of gender identity often results in social disaster. Over a period of 20 years the authors managed a total of 27 patients with ambiguous genitalia. They favour early reconstruction of most anomalies at about 3 years of age, which seems to be optimal in terms of surgical feasibility and avoidance of the obvious emotional problems caused by delayed intervention. A detailed description of policy and techniques is given for surgical intervention in the patient to be raised as a female or as a male. They changed the gender in three patients, twice in neonates and once before two years of age.