Feminizing genitoplasty for congenital adrenal hyperplasia: what happens at puberty?
OBJECTIVE
We document the postpubertal outcome of feminizing genitoplasty.


METHODS
A total of 14 girls, mean age 13.1 years, with congenital adrenal hyperplasia were assessed under anesthesia by a pediatric urologist, plastic/reconstructive surgeon and gynecologist. Of these patients 13 had previously undergone feminizing genitoplasty in early childhood at 4 different specialist centers in the United Kingdom.


RESULTS
The outcome of clitoral surgery was unsatisfactory (clitoral atrophy or prominent glans) in 6 girls, including 3 whose genitoplasty had been performed by 3 different specialist pediatric urologists. Additional vaginal surgery was necessary for normal comfortable intercourse in 13 patients. Fibrosis and scarring were most evident in those who had undergone aggressive attempts at vaginal reconstruction in infancy.


CONCLUSIONS
These disappointing results, even in the hands of specialists, highlight the importance of late followup and challenge the prevailing assumption that total correction can be achieved with a single stage operation in infancy. Although simple exteriorization of a low vagina can reasonably be combined with cosmetic correction of virilized external genitalia in infancy, we now believe that in some cases it may be best to defer definitive reconstruction of the intermediate or high vagina until after puberty. The psychological issues surrounding sexuality in these patients are inadequately researched and poorly understood.
Alizai
N K
NK
Department of Paediatric Urology, St. James's University Hospital and General Infirmary, Leeds, United Kingdom.
Thomas
D F
DF
Lilford
R J
RJ
Batchelor
A G
AG
Johnson
N
N
D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005836:Genitalia, Female / Q000601:surgery*; D006801:Humans; D011627:Puberty