Around 1 in 2000 births result in intersex conditions--abnormal development of the reproductive system--which is often characterised by ambiguous genitalia in infancy and early childhood. For infants with intersex conditions and ambiguous genitalia being raised female (a conventional approach in western countries), clitoral surgery is often undertaken in early childhood to remove any incongruent gonadal tissue and to feminise the appearance of the genitalia-usually through the removal of parts of the clitoris or phallus to reduce its size. This surgery is done because it is thought to result in better psychological outcomes for the child than leaving the genitalia unaltered.
Catherine Minto from University College London, UK, and colleagues assessed the effects of surgery on later sexual outcome of 39 adults with intersex conditions who had been brought up female. 28 women had been sexually active and all had sexual difficulties. The 18 women who had undergone clitoral surgery had higher rates of non-sensuality (78%) and of inability to achieve orgasm (39%) than those who had not had surgery (20% and 0%, respectively).
Catherine Minto comments: "Sexual function could be compromised by clitoral surgery. Ethical debate on the use of this surgery in children should be promoted and further multicentre research is needed to ensure representative samples and comprehensive outcome assessment. Meanwhile, parents and patients who consent to clitoral surgery should be fully informed of the potential risks to sexual function."
In an accompanying Commentary (p 1236), Froukje Slijper from Erasmus Medical Centre, Rotterdam, The Netherlands, comments that this study 'fills an important information need for learning how to cope with ambiguous genitalia. The subsamples are small…but such limitations do not alter the fact that the study still provides important information.'
Contact: Dr Catherine Minto, Academic Department of Obstetrics and Gynaecology, University College London, 86-96 Chenies Mews, London WC1E 6AU;
T) 44-774-894-7721;
F) 44-207-383-7429;
E) c.minto@ucl.ac.uk
Dr Froukje M E Slijper, Gender Team, Erasmus MC/Sophia Children's Hospital, 3000 DR Rotterdam, Netherlands;
T) 31-10-463-4551;
F) 31-10-463-6803;
E) slijper@dds.nl
Journal
The Lancet