title: Timing and Outcome Concerns regarding Feminizing Genitoplasty from the Perspective of Egyptian Families of Girls with Virilized External Genitalia.
abstract: BACKGROUND
  Congenital adrenal hyperplasia in females leads to virilization of external genitalia and persistent urogenital sinus. There are controversies regarding the timing and outcomes of surgery. Deferring surgeries beyond childhood is difficult to implement in conservative societies, and may result in stigmatization and distress to individuals with disorders of sexual differentiation and their families.
  
  
  METHODS
  Thirty girls with virilization due to congenital adrenal hyperplasia were admitted for single-stage feminizing genitoplasty, between 2011 and 2014. We prospectively studied the concerns and input of the families represented by the mothers. After comprehensive counselling, the mothers completed a questionnaire to clarify their priorities and concerns related to surgery.
  
  
  RESULTS
  Surgeries were performed at a mean age of 22 months. Most cases ranged between Prader's degrees III and IV. Egyptian families believe that early surgical reconstruction is in the best interest of their girls. They are marginally more concerned about functional outcomes and future child bearing than external appearance and cosmetic outcomes.
  
  
  CONCLUSIONS
  Social difficulties noticeably add challenges to the management plan within conservative societies. Early genital reconstructive surgery, when reasonably indicated, needs to remain a viable option. Comprehensive psychosocial support within a multidisciplinary approach is needed to defer feminizing genitoplasty in selected cases to adolescence.
authors.affiliation: Department of Pediatric Surgery, Endocrinology and Metabolism Pediatric Unit (DEMPU), Cairo University, Cairo, Egypt.
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: Marei
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Fares
authors.forename: Noha
authors.initials: N
authors.lastname: Musa
authors.forename: Ayman H
authors.initials: AH
authors.lastname: Abdelsattar
authors.forename: Amal
authors.initials: A
authors.lastname: Sharaf
authors.forename: Mona M
authors.initials: MM
authors.lastname: Hassan
authors.forename: Montasser
authors.initials: M
authors.lastname: Elkotby
authors.forename: Gamal
authors.initials: G
authors.lastname: Eltagy
authors.forename: Mona
authors.initials: M
authors.lastname: Hafez
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Elbarbary
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000601:surgery*; D000312:Adrenal Hyperplasia, Congenital / Q000601:surgery*; D002675:Child, Preschool; D004534:Egypt; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019651:Plastic Surgery Procedures; D014770:Virilism / Q000601:surgery*