Great controversy exists in regard to the timing and technical alternatives to perform feminizing genitoplasty in children. Opponents to an early approach argue that the reconstruction can be risky in terms of clitoral/vaginal function therefore surgery should be postponed until the patient herself can sign an informed consent and be aware of potential risks as well as confirms the desire to undergo the procedures. Such negative feelings in regard to early reconstruction are based on published long-term follow-up in patients who underwent outdated surgical procedures, mostly done in centers with various surgeons performing different procedures. The surgical approach for feminizing genitoplasty has evolved significantly over the years. Modern techniques aim to spare the nerves involved in the clitoral sensitivity. In addition there were significant learning in how to improve the approach to these structures in order to minimize injuries to the vagina. In this lecture we present the historical evolution of surgical techniques for feminizing genitoplasty, emphasizing the main points that will likely improve future outcomes. It will be also emphasized that, regardless of conservative or surgical approach, it is essential to have these patients closely followed and monitored by a multidisciplinary team that should include individuals with adequate psych-social training to deal with this population.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology