Complete androgen insensitivity: the role of the surgeon

This is a retrospective series of the surgical management of complete androgen insensitivity at a single institution.

The records of 16 patients 4 to 63 years old with complete androgen insensitivity were extracted from an institutionally approved database. We determined whether each patient underwent vaginoplasty, age at vaginoplasty, vaginal depth before vaginoplasty, age at gonadectomy and whether the patient was sexually active. These data were pooled with those from a prior study at our institution to yield a total of 29 patients.

All patients had undergone gonadectomy with no evidence of malignancy in any pathology specimens. Of the 27 patients in whom the date of surgery was known 20 underwent surgery in late adolescence/adulthood, while 7 had the testes removed in childhood. Of the 29 patients 11 (38%) have undergone vaginal reconstruction. Average vaginal depth in postpubertal patients without reconstruction was 6.6 cm (range 1.5 to 10). Preoperative vaginal depth in patients with was between 2 and 4 cm. Ten postpubertal patients have undergone vaginoplasty and 7 (70%) are sexually active. Of the postpubertal patients 15 have not undergone vaginoplasty, of whom 12 (80%) are sexually active.

A delayed approach to gonadectomy and vaginal reconstruction respects patient autonomy and allows a more mature patient to handle the psychological and physical trauma of surgery and rehabilitation. Since we recognize the small number of patients in this series, strict guidelines cannot be proposed.