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Surgical treatment of disorders of sexual development
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rafael V. Pieretti, Patricia K. Donahoe
All 46,XX DSD newborns should be assigned to the female gender, regardless of the extent of masculinization, and should undergo surgical reconstruction concordant with the female gender assignment. Similar repairs can be used for selected patients who are not severely masculinized because of 46,XY DSD, MGD, or ovotesticular DSD. The key steps in a feminizing genitoplasty are clitoroplasty, labioplasty, or labioscrotal reduction and vaginoplasty, or mobilization and exteriorization. Surgical procedures must preserve clitoral sensation and excretion and result in normal-looking external genitalia, with a well-lubricated vagina, which will allow satisfactory and painless sexual intercourse. Due to some concerns regarding the benefits of clitoroplasty, it should be undertaken only after extensive discussions with the family, because another option is for deferral until the patient is capable of making her own decision.
Disorders of sexual development
Published in Prem Puri, Newborn Surgery, 2017
The outcome in undermasculinized males with a phallus depends on the degree of hypospadias and the amount of erectile tissue (Figure 109.16). Feminizing genitoplasty as opposed to masculinizing genitoplasty requires less surgery to achieve an acceptable outcome and results in fewer urologic difficulties. Long-term data regarding sexual function and quality of life among those assigned female as well as male show great variability. There are no controlled clinical trials of the efficacy of early (12 months of age) versus late (adolescence and adulthood) surgery or of the efficacy of different techniques.
Pediatric Urogynecology
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Angela M. Arlen, Howard M. Snyder, Andrew J. Kirsch
in >90%). This AutosomAl-recessive disorder is Among the most common heritAble metAbolic disorders [37]. The Absence of 21-hydroxylAse leAds to the overproduction of Androgens And results in A wide spectrum of genitAl AbnormAlities, rAnging from mild mAsculinizAtion of the clitoris (clitoromegAly) to complete mAsculinizAtion. The lAbioscrotAl folds Are often rugAted And hyperpigmented, giving the physicAl AppeArAnce of severe hypospAdiAs with cryptorchidism. In virtuAlly All cAses, however, the internAl femAle AnAtomy is normAl. After the diAgnosis is estAblished, surgicAl treAtment is individuAlly tAilored; feminizing genitoplAsty entAils reduction clitoroplAsty, vAginoplAsty, And urogenitAl mobilizAtion [38,39]. These pAtients generAlly require lifelong glucocorticoid (hydrocortisone) And minerAlocorticoid (9-AlphA-fludrocortisone) supplementAtion [40].
Outcome measures reported following feminizing genital gender affirmation surgery for transgender women and gender diverse individuals: A systematic review
Published in International Journal of Transgender Health, 2023
Thomas E. Pidgeon, Thomas Franchi, Andre C. Q. Lo, Ginimol Mathew, Heer V. Shah, Despoina Iakovou, Mimi R. Borrelli, Catrin Sohrabi, Tina Rashid
The search strategy was developed with the assistance of an information search specialist. An electronic literature search was conducted using free text search terms: Vaginoplasty, vaginoplast*, vulvoplasty, clitoroplasty, labiaplasty, neovagin*, neo-vagin*, genital reconstructive surgery, feminising genitoplasty, feminizing genitoplasty; combined with applicable Boolean logical operators (Supplementary Appendix 1, for the full search strategy). The databases that were searched using the above strategy included: PubMed, Medline, EMBASE (all using Ovid), The Cochrane Central Register of Controlled Trials (CENTRAL), Clinicaltrials.gov, CINAHL (using EBSCO), AMED (Allied and Complementary Medicine), PsycINFO (using HDAS), and the International Standard Randomized Control Trial Number (ISRCTN) database. Where possible, the search strategies excluded the above irrelevant study designs (case reports, review articles). There were no date limits. The searches took place between 4th and 18th November 2020.
Ovotestis at 18 years: an accidental discovery in an internally displaced persons’ camp in North-Eastern Nigeria
Published in Journal of Obstetrics and Gynaecology, 2019
Hadiza Abdullahi Usman, Bala Mohammed Audu, Mohammed Bukar, Ahmed A. Mayun
The therapeutic goals in the management of DSD are centred on ensuring an individual with a sound psychosocial and sexual fulfilment in life. The patient and her parents had counselling and psychosocial support by experts, including religious clerics. This is an important goal in the care of DSD to minimise the risk of creating a social outcast (Nthumba et al. 2008). This patient had dominant clinical and functional feminine features and therefore had genitoplasty with the resection of the right ovotesticular tissue, which is discordant with her sex of rearing. The gonadectomy would reduce the risk of a gonadal malignancy (Liu et al. 2014). The option of the Modified Randolph–Hung reduction clitoroplasty offered to this patient would ensure that the orgasmic function and the erectile sensation of the clitoris are maintained. This is superior to a clitoridectomy, as it preserves the glans and its neurovascular bundle. The management of OT-DSD in the adolescent and the adult is quite challenging and associated with psychological trauma. The need for a thorough examination of the external genitalia of new-borns and the appropriate referral of those with ambiguous genitalia early in life will minimise the psychological trauma associated with the management of these cases later in life. This patient benefited from the volunteer service scheme of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), which extended its services to the IDP camp.
Intersex or Diverse Sex Development: Critical Review of Psychosocial Health Care Research and Indications for Practice
Published in The Journal of Sex Research, 2019
More recently, this group of researchers published findings from an analysis of parental distress six months after genitoplasty compared with before any surgery took place. The researchers found no significant change according to measures of anxious and depressive symptoms and QOL measures (Wolfe-Christensen et al., 2017). The researchers concluded that the data suggest “that for some parents, neither time nor genitoplasty for their child, is sufficient in ameliorating their distress, underscoring the need for interventions aimed at helping parents to cope with their child’s diagnosis” (p. 32e4).