Endocrine Abstracts (2006) 11 S79

Surgical management of ambiguous genitalia in the infant

CN Fékété, S Lortat-Jacob & H Lottmann

Pediatric Surgery – Hospital “Enfants Malades”, Paris, France.

The Intersex Society of North America stated in 1993 that “Intersex Genital Surgery in Infancy is a form of child sexual abuse”. This peremptory statement based on outcome data judged from outdated medical and surgical procedures, leaded to an even more accurate surgical management of the intersex baby.

An etiological precise diagnosis of the condition and of the FURTHER post-pubertal sexual abilities of the patient, is mandatory before surgery. The choice of sex of rearing weighs heavily on the surgeon since he performs irreversible acts. This choice depends on:

1. mostly the etiology

2. the age at diagnosis: in the case of a late referred child with unappropriate sex of rearing, surgery ought to be postponed.

3. the anatomy of the genitalia, but in somes cases, the anatomy will not be concordant with the post pubertal genital abilities.

4. completed, repeated, patient information of the parents (and the child) about the condition and its unavoidable sequellae.

Our experience of post pubertal results is based on our survey performed in 2001 of 270 genitoplasties; we conclude that early ONESTAGE genitoplasty leads to good results in 70% of cases. In this series, there was no close correlation between the anatomical results and the achievement of a “normal” sexual life.

This surgery has to be performed with a comprehensive knowledge of the embryological development and is only one of the therapeutic actions concerning the intersex child (thorough appropriate information, endocrinological and psychological managements are mandatory).

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