Clitoral surgery and sexual outcome in intersex conditions

Abstract

See page 1252 Parents who are confronted with a newborn baby with ambiguous genitalia are overwhelmed because they have probably never before heard of such a condition. They need good information about surgical procedures and the effect of the operation on body image, self-concept, and gender identity of their daughter during childhood and her sexual life in adolescence and adulthood. Professionals treating these patients also lack this essential information. There are not many studies about the sexual outcome of genital surgery in women born with ambiguous genitalia. 1–3 Patients are not motivated to participate in research because of fear of stigmatisation and often refuse physical examinations because of previous traumatic experiences and shame. In this week’s Lancet, Catherine Minto and colleagues report on sexual outcome after clitoral surgery in individuals with intersex conditions and ambiguous genitalia. The subsamples are small and only 44 of the 81 patients returned the questionnaires, but the study still provides important information. The 18 women who had had clitoral surgery had higher rates of non-sensuality and of failure to achieve orgasm than did the ten who had not had surgery. Minto and colleagues conclude that sexual function can be compromised by clitoral surgery, but are hesitant to advise against such surgery—they advocate an ethical debate about the use of such surgery and stress the need for good information about the potential risks on sexual functioning. Sexual functioning can also be compromised by other factors, such as sexual shyness due to a negative genital body-image. Mureau and colleagues 4