Exploring Factors Associated with Decisions about Feminizing Genitoplasty in Differences of Sex Development - 22/11/22
, Rebecca M. Harris, MD, PhD, MA 1, #, Christopher E. Aston, PhD 2, Meghan Perez, PhD MBA 3, Paul F. Austin, MD 4, Laurence Baskin, MD 5, Earl Y. Cheng, MD 6, Allyson Fried, MSN, CPNP 7, Thomas Kolon, MD 8, Bradley Kropp, MD 3, 9, Yegappan Lakshmanan, MD 10, Natalie J. Nokoff, MD, MSCS 11, Blake Palmer, MD ⋆, 12, Alethea Paradis, MTS 13, Dix Poppas, MD 14, Kristy J. Scott Reyes 12, Cortney Wolfe-Christensen, PhD 12, David A. Diamond, MD 15, Amy C. Tishelman, PhD 16, Larry L. Mullins, PhD 3, Amy B. Wisniewski, PhD 2, Yee-Ming Chan, MD, PhD 1ABSTRACT |
Study Objective |
Infants with genital development considered atypical for assigned female sex may undergo feminizing genitoplasty (clitoroplasty and/or vaginoplasty) in early life. We sought to identify factors associated with parent/caregiver decisions regarding genitoplasty for their children with genital virilization.
Design |
Longitudinal, observational study
Setting |
Twelve pediatric centers in the United States with multidisciplinary differences/disorders of sex development clinics, 2015-2020
Participants |
Children under 2 years old with genital appearance atypical for female sex of rearing and their parents/caregivers
Interventions/Outcome Measures |
Data on the child's diagnosis and anatomic characteristics before surgery were extracted from the medical record. Parents/caregivers completed questionnaires on psychosocial distress, experience of uncertainty, cosmetic appearance of their child's genitalia, and demographic characteristics. Urologists rated cosmetic appearance. For 58 patients from the study cohort with genital virilization being raised as girls or gender-neutral, we compared these data across 3 groups based on the child's subsequent surgical intervention: (i) no surgery (n = 5), (ii) vaginoplasty without clitoroplasty (V-only) (n = 15), and (iii) vaginoplasty and clitoroplasty (V+C) (n = 38).
Results |
Fathers’ and urologists’ ratings of genital appearance were more favorable in the no-surgery group than in the V-only and V+C groups. Clitorophallic length was greater in the V+C group compared with the V-only group, with substantial overlap between groups. Mothers’ depressive and anxious symptoms were lower in the no-surgery group compared with the V-only and V+C groups.
Conclusions |
Surgical decisions were associated with fathers’ and urologists’ ratings of genital appearance, the child's anatomic characteristics, and mothers’ depressive and anxious symptoms. Further research on surgical decision-making is needed to inform counseling practices.
Le texte complet de cet article est disponible en PDF.Key Words : Intersex persons, Disorders of sex development, Congenital adrenal hyperplasia
Abbreviations : DSDs, V+C, V-only
Plan
Vol 35 - N° 6
P. 638-646 - décembre 2022 Retour au numéro
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