title: Virilized external genitalia in young girls: clinical characteristics and management challenges in a low-resource setting.
abstract: OBJECTIVE
  Virilization of the external genitalia in young girls (VEG) manifests mostly as ambiguity of the genitalia and elicits concerns and uncertainties especially in settings with poor awareness. This study evaluates the profile and challenges of VEG in southeast Nigeria.
  
  
  METHODS
  We analyzed 23 children with VEG managed in 2 referral centers in southeast Nigeria from June 2005 to January 2013.
  
  
  RESULTS
  They presented at median age of 13.3 months (interquartile range [IQR] 3 months-3 years). The cases included 3 (13%) of Prader type 1, 6 (26%) of type 2, 11 (48%) of type 3, and 3 (13%) of type 4. Five of the Prader type 3 and all 3 cases of Prader type 4 were reared as male prior to presentation. Following evaluation, all the cases were assigned female gender at a mean age of 2.7 years (range 2 months-10.5 years). Appropriate feminizing genitoplasty was undertaken in all the cases and after a follow-up period of 3 months to 5 years (mean 2 years), 2 patients developed vaginal stenosis, and 3 cases had surgical wound infection. Poor awareness, delayed presentation, inadequate facilities, and lack of trained manpower were the challenges in the management of the cases.
  
  
  CONCLUSIONS
  VEG in our setting is associated with delayed management. Focused health education and public awareness programs, and improved healthcare funding may improve outcome and minimize the need for gender reassignment.
authors: Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria. Electronic address: sebekenze@gmail.com.
authors: S O
authors: SO
authors: Ekenze
authors: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors: C O
authors: CO
authors: Adiri
authors: Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors: I O
authors: IO
authors: Igwilo
authors: Plastic Surgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors: O O
authors: OO
authors: Onumaegbu
mesh_terms: D002675:Child, Preschool; D002987:Clitoris / Q000601:surgery; D057210:Delayed Diagnosis; D003906:Developing Countries; D005260:Female; D005836:Genitalia, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D009549:Nigeria; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D014621:Vagina / Q000601:surgery; D014770:Virilism / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D014844:Vulva / Q000601:surgery
keywords: Challenges; Developing country; Girls; Intersex; Virilized genitalia