Long term sexual function in intersex conditions with ambiguous genitalia

Abstract

BACKGROUND: Current management for intersex conditions includes clitoral reduction surgery for those patients with ambiguous genitalia who are being raised female. Evaluation of this management is difficult due to the scarcity of long term outcome data looking at sexual function and other outcomes.METHODS: This was a questionnaire study combined with a retrospective hospital notes review. The questionnaire comprised detail on diagnosis and treatment along with a modified sexual function inventory (GRISS) which provided scores encompassing seven areas of female sexual function. All hospital notes were collected and analyzed for diagnosis and surgical detail. All respondents were invited for clinical examination.RESULTS: 37 intersex women, over 18 years old, all with ambiguous genitalia at birth or in childhood, completed the questionnaire. 11 were patients, 26 were recruited through the UK AISSG (Androgen Insensitivity Syndrome Support Group). 16/37 (43%) attended for a clinical examination. 10/37 (29%) had had clitoral surgery deferred and so had currently not undergone clitoral surgery, of which 1/10 (10%) had never been sexually active. Of the 27/37 (73%) who had undergone clitoral surgery, 9/27 (33%) had never been sexually active, leaving sexual function data on 18 subjects who had undergone clitoral surgery and 9 subjects who have virilised female genitalia and have not undergone clitoral surgery. Mean global sexual function scores were worse in the group with clitoral surgery. On looking at orgasm scores alone, the group with clitoral surgery had scores significantly abnormal for difficulty with orgasm, with 5/18 (28%) having complete anorgasmia.CONCLUSIONS: This study shows that clitoral surgery can damage adult sexual function.