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Exploring Factors Associated with Decisions about Feminizing Genitoplasty in Differences of Sex Development
Jessica Kremen1, Rebecca M Harris1, Christopher E Aston2
1Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Journal of Pediatric and Adolescent Gynecology
|August 10, 2022
Summary
Parental decisions about feminizing genitoplasty for infants with atypical genitalia are linked to appearance ratings and maternal mental health. These factors influence surgical choices for children with genital virilization.
Area of Science:
- Pediatric endocrinology
- Genitourinary surgery
- Disorders of Sex Development (DSD)
Background:
- Infants with atypical genitalia may undergo feminizing genitoplasty.
- Parental decisions regarding these surgeries are complex and influenced by multiple factors.
Purpose of the Study:
- To identify factors associated with parent/caregiver decisions on feminizing genitoplasty for infants with genital virilization.
- To compare surgical intervention groups based on diagnosis, anatomy, and psychosocial factors.
Main Methods:
- Longitudinal, observational study across 12 US pediatric centers (2015-2020).
- Included infants (<2 years) with atypical genitalia and their parents/caregivers.
- Compared data across no surgery, vaginoplasty-only, and vaginoplasty+clitoroplasty groups.
Main Results:
- Favorable genital appearance ratings (fathers, urologists) were associated with no surgery.
- Mothers' depressive and anxious symptoms were lower in the no-surgery group.
- Clitorophallic length differed between surgical groups, with overlap.
Conclusions:
- Surgical decisions for feminizing genitoplasty are influenced by genital appearance, child's anatomy, and maternal mental health.
- Further research is needed to improve counseling for these complex decisions.
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