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The latest supplemental issue of BJU International published by the British Association of Urological Surgeons is entirely dedicated to the "management of ambiguous genitalia," or intersex conditions. The issue is based on the 2003 meeting of the European Society of Paediatric Urology that addressed the controversy, and begins with a delightfully titled introduction, "Possible determinants of sexual identity: how to make the least bad choice in children with ambiguous genitalia." We are glad to know that doctors have finally realized that they should pick the least bad among the bad, worse, and worst choices when it comes to the treatment of intersex conditions. Below is the summary of a couple of papers that address the controversy over cosmetic genital surgeries on intersex children.
As always, Sarah Creighton of the University College London Hospitals combines good research and a commitment to child's well-being in her paper, "Long-term outcome of feminization surgery: the London experience." In this paper, she discusses how cosmetic result of vaginoplasty on infants may appear good at the time, but it may not result in satisfactory cosmetic or anatomical outcome when the child is older. "If vaginal surgery were deferred, it would limit the total number of operations for each individual and may reduce the substantial risk of fibrotic introital stenosis." She further states, "it is now unacceptable to claim that clitoral surgery does not affect sexual function," and that the "option of no infant genital surgery must be discussed with the family."
D.F.M. Thomas also addresses the issue of feminizing surgeries on intersex children and considers criticisms from some patient support groups and ethicists against the cosmetic genital surgeries that are performed without the child's consent. "Putting aside the ethical question of the rights of the child vs the parents," he concedes, "there is a growing body of evidence" that long-term consequences of such surgeries may be damaging to the child. "However," he argues, "the experience of most doctors involved in gender assignment indicates that many, if not most, parents would find it extremely difficult to contemplate rearing their child" without cosmetic surgery.
The fact that Thomas recognizes many of the harms of intersex genital surgeries make it all the more insidious that he insists that "the approach advocated by some patient groups, which envisages leaving some girls with an obviously uncorrected male genital phenotype, is likely to prove unacceptable to most parents." Acceptable or not, risky and irreversible surgeries on the child should only be performed in the best interest of the child, not the parents; if the parents are experiencing anxiety or stress because of their child's condition, they should be offered counseling and peer support.
For the index of other papers published in this issue, visit the journal's website.
Source:
Creighton SM (2004). "Long-term outcome of feminization surgery: the London experience." BJU International. 93(s3): 44-46.
Thomas DFM (2004). "Gender assignment: background and current controversies." BJU International. 93(s3): 47-50.
Posted by Emi on Apr 17, 2004