title: Results from a pediatric surgical centre justify early intervention in disorders of sex development.
abstract: BACKGROUND
  Controversy persists surrounding early management of disorders of sex development. We assessed genital appearance, gender identity, and quality of life in prepubertal children who have had early surgical intervention.
  
  
  METHODS
  Children treated for disorders of sex development who were 5 to 10 years of age were eligible (n = 54). Children were scored (modified Creighton scale) for anatomical and cosmetic outcome, and both patients and parents completed PedsQL quality-of-life and gender identity questionnaires, with ethics approval.
  
  
  RESULTS
  Of 54 patients, 41 presented for review. Treatment began at 13.2 (1.8-250.1) months (median; range) and were reviewed at 7.5 +/- 2.1 (mean +/- SD) years of age. Nineteen were raised as girls and 22 as boys. Girls had good (85%) or satisfactory (15%) anatomical/cosmetic outcome, whereas 52% boys had good, 38% satisfactory, and 10% poor cosmetic outcomes. On gender identity questionnaire, boys scored 3.9 +/- 0.4 (mean +/- SD) and girls 3.6 +/- 0.5; 1 of 19 boys and 3 of 19 girls had lower scores, suggesting risk of gender identity disorder. Quality-of-life scores were 80+ for physical and 65 to 80 for psychosocial scores.
  
  
  CONCLUSIONS
  Early intervention is generally associated with positive outcomes for patients and parents. Girls had better anatomical outcomes than boys, and gender dysphoria risks were low in both sexes.
authors.affiliation: School of Medicine, University of Melbourne, Parkville, Victoria 3052, Australia. j.crawford6@ugrad.unimelb.edu.au
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Crawford
authors.forename: Garry
authors.initials: G
authors.lastname: Warne
authors.forename: Sonia
authors.initials: S
authors.lastname: Grover
authors.forename: Bridget R
authors.initials: BR
authors.lastname: Southwell
authors.forename: John M
authors.initials: JM
authors.lastname: Hutson
mesh_terms: D002648:Child; D002675:Child, Preschool; D012734:Disorders of Sex Development / Q000601:surgery*; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D011788:Quality of Life; D013997:Time Factors