Endocrine Abstracts

Feminizing genitoplasty has been historically performed to reduce the size of the clitoris, to separate the urethra from the vagina, and/or to increase the diameter and length of the vagina in those with variations in sex characteristics. These procedures are often performed in infancy and childhood by pediatric surgical subspecialists and may involve clitoroplasty, labioplasty, urogenital sinus mobilization, and/or vaginoplasty. Surgical outcomes research is most commonly focused on short term complications; patients are rarely followed long enough postoperatively to robustly assess sexual function and complications in adolescence and adulthood. Long term outcomes studies are commonly limited due to absence of non-operative control groups, low numbers of participants, heterogeneity in surgical techniques, and lack of phenotype, genotype, and gender identity subtype analyses. Adults who have undergone feminizing genital surgery experience significant rates of impaired sexual function and satisfaction. Long term complications of clitoral surgery include altered clitoral sensation and anorgasmia. Vaginoplasty complications include introital and proximal stensosis, bothersome hair growth, and abnormal discharge and lubrication. Difficulties with penetrative sexual activity and dyspareunia are common. Early vaginoplasty is associated with high rates of additional surgery later in life to address functional or aesthetic concerns. Individuals may experience medicalization of their genitals, which may result in avoidance of sexual intimacy and fear of sex. Mangement of these complications is challenging. In conclusion, patients and parents should be counseled about the risk of sexual dysfunction and the limitiations of long term outcomes data following feminizing genital surgery. Additionally, providers who care for patients with variations in sex characteristics need to know how to assess and manage complications of surgical interventions in adolescence and adulthood.