EARLY FEMINIZING GENITOPLASTY: SEXUAL FUNCTION IN ADULT LIFE

AbstractA major complication of feminizing genitoplasty in children is the loss of clitoral sensation with serious impact at adult life. We suggest a new method to evaluate the surgical results during childhood based on the bulbocavernosus or clitoro-perineal reflex (CPR). The afferent pathway of CPR implies the intact sensory receptors on the clitoral glans. Girls with congenital adrenal hyperplasia who were followed-up medically without surgery or who underwent feminizing genitoplasty with or without clitoroplasty were included (2002–2018). All clitoroplasties were standardized reduction clitoroplasty with preservation of neurovascular bundles associated with vaginoplasty and vestibuloplasty. Standardized examinations were prospectively performed including the CPR starting at one year postoperatively. The reflex was triggered by gentle touch of the glans by a cotton swab. Contraction of the perineal muscles was considered positive. Thirty-two children were operated at a median age of 8.6 months (5.8–12.1). Median follow-up (FU) was 3.9 years (1.3–6.4). Twenty-four patients had clitoroplasties: 17 were tested for CPR at one-year FU, and all had a positive test. Eight girls had genitoplasty without clitoral surgery, two of them were tested and were positive. Ten patients were managed without surgery, two of them were tested for the CPR and were positive. The reflex was always triggered easily and repeated at least twice during the FU. The clitoro-perineal reflex is a simple, non-invasive and reproducible test in early childhood and may serve as an early evaluation tool of clitoral innervation after feminizing genitoplasty. These results need to be confirmed at long term and completed at adult life.

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The Effect of Child Sexual Abuse on Social, Interpersonal and Sexual Function in Adult Life

The British Journal of Psychiatry ◽

10.1192/bjp.165.1.35 ◽

1994 ◽

Vol 165 (1) ◽

pp. 35-47 ◽

Cited By ~ 161

Author(s):

P. E. Mullen ◽

J. L. Martin ◽

J. C. Anderson ◽

S. E. Romans ◽

G. P. Herbison

Keyword(s):

Socioeconomic Status ◽

Sexual Abuse ◽

Child Sexual Abuse ◽

Sexual Function ◽

Random Sample ◽

Intimate Relationships ◽

Emotional Abuse ◽

Adult Life ◽

Sexual Problems ◽

Apparent Association

BackgroundThe association was examined between reporting child sexual abuse (CSA) and a range of social, interpersonal and sexual difficulties in adult life.MethodA random sample of 2250 women were posted a questionnaire exploring a range of abuse experiences. All 248 reporting CSA were invited for interview, together with an equal number of controls. At interview a detailed inquiry was made into the CSA and into current interpersonal, social and sexual function.ResultsSignificant associations emerged between reporting CSA and a decline in socioeconomic status, increased sexual problems, and the disruption of intimate relationships by difficulties with trust as well as a propensity to perceive their partners as uncaring and overcontrolling. CSA was more common in those from disturbed and disrupted families and in those who also reported physical and emotional abuse. This explained part, but not all, of the apparent association between CSA and negative outcomes.ConclusionsThose reporting CSA are more likely to suffer social, interpersonal and sexual difficulties in adult life.

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