Exploring Factors Associated with Decisions about Feminizing Genitoplasty in Differences of Sex Development.
Academic Article
Overview
abstract
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: 12 pediatric centers in the United States with multi-disciplinary DSD clinics, 2015-2020 PARTICIPANTS: Children <2 years with genital appearance atypical for female sex of rearing and their parents/caregivers. INTERVENTIONS/OUTCOME MEASURES: Data were extracted from the medical record on the child's diagnosis and anatomic characteristics pre-surgery. Parents/caregivers completed questionnaires on psychosocial distress, experience of uncertainty, cosmetic appearance of their child's genitalia, and demographics. 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 three 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 to the V-only group, with substantial overlap between groups. Mothers' depressive and anxious symptoms were lower in the no-surgery group compared to 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.
