Timing of feminising surgery in disorders of sex development

The role of feminising surgery in disorders of sex development (DSD) has been a topic of intense discussion for many years. The controversy mainly focuses on the timing of surgery: early (in childhood) or delayed (in adolescence), with clinicians divided in opinion. This conflict between proponents of either treatment approach remains unresolved, and will continue to do so until long-term outcome data from prospective studies become available. A significant recommendation of the Chicago Consensus Statement in 2005 was the need for individuals with DSD to be cared for exclusively in specialised centres within a multidisciplinary setting. Whilst this appears to be widely adopted, it remains to be seen whether other recommendations regarding limiting feminising surgery only to girls with a significant degree of virilisation have been similarly embraced. To reflect the current situation, we will summarise the main arguments in favour of either of the two treatment modalities, i.e. early or late feminising surgery, and conclude with a management proposal.