Sexual Function and Genital Sensitivity Following Feminizing Genitoplasty for Congenital Adrenal Hyperplasia

Abstract

Genital sensitivity is impaired in areas where feminizing genital surgery had been done and impairment to sensitivity are linearly related to difficulties in sexual function. The new information may help inform clinicians and parents making difficult decisions about genital surgery for infants with ambiguous genitalia.

Disorders of sex development: advances in genetic diagnosis and challenges in management

“…44 Damage of the neuronal network is reported to be highly likely in clitoral reduction, despite improvement in surgical technique, thus affecting sexual function in adult life. [66][67][68][69] The cosmetic result in adulthood is also influenced by changes during puberty, including pubic hair and labial fat development. In the case of CAH, steroid replacement may induce reduction of the clitoris after a few months of treatment.…”

Labial surgery for well women: a review of the literature

“…However, the nature of these complaints has not been investigated, rendering it difficult to determine how best to evaluate the impact of surgery. Surgery may damage the nerve supply and is associated with impaired sensitivity when objectively assessed, 44 and with impaired sexual function. 45 Sensitivity and long-term sexual function constitute an important focus for future research.…”

Prenatal diagnosis of congenital adrenal hyperplasia owing to 21-hydroxylase deficiency

“…In our clinic's experience from 1978 to 2011, the average Prader score of 63 affected female newborns prenatally treated with dexamethasone was 1.7 compared with the average Prader score of 3.73 in the 11 untreated affected females [7]. Long-term studies of women who underwent cosmetic genitoplasty in infancy or early childhood disclose impaired genital sensitivity, sexual difficulties, decreased intercourse frequency and stress urinary leakage [28,29]. There are reports of complications resulting from genitoplasty such as strictures, fistulas, urinary infection, fibrosis and scarring, which have caused stress and depression in patients, especially with regard to their sexual relationships [30] The complications that may be associated with genitoplasty along with impaired fertility may result in non-disclosure, and distress in patients who require repeated surgery and genital examinations that reinforce their disorder [30].…”