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This letter to the editor is in response to the article "Congenital adrenal hyperplasia," published in the New England Journal of Medicine. Source: Speiser PW, White PC. Congenital adrenal hyperplasia. N Engl J Med 2003;349(8):776-88.
To the Editor:
As an intersex patient-advocate, I appreciate the fact that Phyllis Speiser and Perrin White acknowledged (in Aug. 21 issue) the role that the patient advocacy movement has played in improving the medical treatment of children with congenital adrenal hyperplasia. Regarding the controversy over the surgical correction of genital ambiguity, authors point out that "both the cosmetic and functional outcomes of genital surgery procedures as formerly practiced were often unsatisfactory," while "improvements in the surgical correction of genital anomalies over the past two decades have led to earlier use of single-stage surgery" despite the fact "the long-term outcomes of the newer surgical procedures have yet to be evaluated." Curiously, there is no mention of any reason that "ambiguous genitalia" should to be considered pathological or surgically treated anywhere in this article, leading readers to wonder: if the old surgery was so horrible and the new surgery hasn't been established yet, why are we rushing into the widespread use of the newer technique?
Emi Koyama
Director, Intersex Initiative
http://www.intersexinitiative.org/