Genitoplasty for congenital adrenal hyperplasia: anatomy and technical review

There is variable virilisation in female pseudohermaphrodities with congenital adrenal hyperplasia, but they always have normal ovaries, uterus and upper part of the vagina. The various anatomical stages of virilisation are outlined and a historical review is given. For psychological and practical reasons it is generally accepted that the operation should be performed when the patient is between 6 and 18 months of age. The aim is to reduce the size of the clitoris and to expose the vagina so that it opens onto the perineum. Operative procedures are described. The child is reviewed at intervals to determine the size and shape of the vagina and clitoris. Adjustments can be made around the time of puberty but are rarely necessary.