Sexual Function and Attitudes towards Surgery After Feminizing Genitoplasty

Abstract

Purpose Sexual function was analyzed in females, who had undergone feminizing genitoplasty in childhood. Material and Methods Sexual function and attitudes towards surgery were assessed by a questionnaire in 23 females who had undergone genitoplasty in childhood. 16 females were prenatally exposed to androgens, 15 of them had congenital adrenal hyperplasia. 7 females had 46XY karyotype. Seventeen patients, who had reached adulthood, were compared with 1700 age-matched controls by using the Female Sexual Function Index (FSFI) questionnaire. Results 19 of the 23 patients had undergone clitoral reduction and 21 patients had undergone reconstruction of the vaginal introitus. Sigmoid bowel had been used in vaginal reconstruction in 4 patients. 12 of 23 patients had undergone repeated operations. Sixteen patients considered that the genital operation was performed at a proper age, 3 patients considered it was done too late, and none thought it was performed at a too young age. Two patients regretted the operation: one had undergone clitoral resection without nerve preservation and the other had a sigmoid vagina. The control group had more often and earlier (median age 17 vs 19 years) experiences with sexual intercourse. However, sexual function was similar in the sexually active controls and in the patients. One-fourth of both groups had severe problems in achieving orgasm. Severe pain experiences during penetrative sex was rare in both groups. Conclusions Sexual intercourse activity is decreased in females who have undergone genital reconstruction in childhood. However, early surgery, except vaginal substitution, with nerve preservation is usually preferred by the patients and allows normal sexual function in adulthood. Sexual function was analyzed in females, who had undergone feminizing genitoplasty in childhood. Sexual function and attitudes towards surgery were assessed by a questionnaire in 23 females who had undergone genitoplasty in childhood. 16 females were prenatally exposed to androgens, 15 of them had congenital adrenal hyperplasia. 7 females had 46XY karyotype. Seventeen patients, who had reached adulthood, were compared with 1700 age-matched controls by using the Female Sexual Function Index (FSFI) questionnaire. 19 of the 23 patients had undergone clitoral reduction and 21 patients had undergone reconstruction of the vaginal introitus. Sigmoid bowel had been used in vaginal reconstruction in 4 patients. 12 of 23 patients had undergone repeated operations. Sixteen patients considered that the genital operation was performed at a proper age, 3 patients considered it was done too late, and none thought it was performed at a too young age. Two patients regretted the operation: one had undergone clitoral resection without nerve preservation and the other had a sigmoid vagina. The control group had more often and earlier (median age 17 vs 19 years) experiences with sexual intercourse. However, sexual function was similar in the sexually active controls and in the patients. One-fourth of both groups had severe problems in achieving orgasm. Severe pain experiences during penetrative sex was rare in both groups. Sexual intercourse activity is decreased in females who have undergone genital reconstruction in childhood. However, early surgery, except vaginal substitution, with nerve preservation is usually preferred by the patients and allows normal sexual function in adulthood.