Sexual function and attitudes toward surgery after feminizing genitoplasty

Sexual function and attitudes toward surgery were evaluated in females who had undergone feminizing genitoplasty in childhood.

Sexual function and attitudes toward surgery were assessed by a questionnaire in 24 females who had undergone genitoplasty in childhood. Of 16 females who were prenatally exposed to androgens 15 had congenital adrenal hyperplasia and 8 had androgen insensitivity. A total of 18 patients who had reached adulthood were compared with 900 age matched normal controls by using the Female Sexual Function Index questionnaire.

Of the 24 patients 19 had undergone clitoral reduction and 21 had undergone reconstruction of the vaginal introitus. Sigmoid bowel had been used in vaginal reconstruction in 5 patients. There were 17 patients who believed that the genital operation was performed at a proper age, 3 who thought it was done too late while none thought it was performed at too young an age. Two patients regretted the operation, 1 of whom 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. Overall sexual function was similar in the sexually active controls and patients. Decreased sexual desire and problems in achieving orgasm were common but severe pain experiences during penetrative sex were rare in both groups.

Sexual intercoital relationships started later in females who underwent genital reconstruction in childhood. Early surgery is preferred by the patients and satisfactory sex life is possible in adulthood.