The patients were 14 to 38 years of age at follow-up. The managing physician recorded anatomical and functional results and data on self-reported satisfaction at the last routine follow-up visit.

Their data showed that a total of 38 patients were raised female and 25 were raised male. Primary reconstruction for external genital was initiated shortly after birth, when gender was assigned. There was a negative correlation with the type of primary surgery performed, but not with any secondary surgeries. It seems to correlate to a change in staged verses non-staged procedures. A secondary surgical procedure was typically required. Most patients with gonadal dysgenesis were raised as females and menstruated under treatment but breast development was abnormal in 30%. Spontaneous puberty was observed in true hermaphrodites raised as either sex. In females with partial androgen insensitivity, the main problem was a short vagina. Amenorrhea and infertility often led to transient distress. In males, results were poor due to intractable micropenis and minimal virilization. The patients with a 5?-reductase deficiency seemed to have good results.

The group concluded that their results with intersex surgery have clearly improved with time, and no patient expressed dissatisfaction with sex of rearing except for one patient with 5?-reductase deficiency. This patient underwent a successful sex change procedure. They recognize that there was a lacking of an in-depth psychological survey. Their conclusions, although bright can only be valid only in their patient population. Sexual identity is far too complex even with the assistance of a dedicated and knowledgeable team. It is without a doubt that surgery is easier in the first few years of life, but I believe that despite our best efforts, the patient will make the ultimate decision and it seems intuitive that they be part of that decision making process when the time is right.

Journal of Urology 175(5): 1878-1884, May 2006.

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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