Disorders of sexual development: Surgical management

Abstract

There is no topic in pediatric urology/surgery that generates as much controversy as surgery for disorders of sexual development (DSD). Birth of a child with DSD is an extraordinarily difficult time for young parents, and they require support. Historically most parents have elected early surgery to “normalize” their child’s ambiguous genitalia, but this has been challenged by advocacy groups and some physicians. We outline the controversies of performing surgery at all and the timing of procedures. We feel strongly that the parent should know of all pros and cons of both having surgery and not having surgery. The parents should also be an integral part of the gender assignment team and participate in all decisions. We discuss the surgical approaches and techniques of feminizing genitoplasty, including clitoroplasty, vaginoplasty – (1) cutback vaginoplasty, (2) flap vaginoplasty, and (3) pull-through vaginoplasty – and labioplasty. Lastly, we discuss the lack of reliable long-term data in this patient population and future direction.