Study Objective

Infants with genital development considered atypical for assigned female sex may undergo feminizing genitoplasty (clitoroplasty and/or vaginoplasty) in early life. We sought to identify factors associated with parent/caregiver decisions regarding genitoplasty for their children with genital virilization.

Design

Longitudinal, observational study

Setting

Twelve pediatric centers in the United States with multidisciplinary differences/disorders of sex development clinics, 2015-2020

Participants

Children under 2 years old with genital appearance atypical for female sex of rearing and their parents/caregivers

Interventions/Outcome Measures

Data on the child's diagnosis and anatomic characteristics before surgery were extracted from the medical record. Parents/caregivers completed questionnaires on psychosocial distress, experience of uncertainty, cosmetic appearance of their child's genitalia, and demographic characteristics. Urologists rated cosmetic appearance. For 58 patients from the study cohort with genital virilization being raised as girls or gender-neutral, we compared these data across 3 groups based on the child's subsequent surgical intervention: (i) no surgery (n = 5), (ii) vaginoplasty without clitoroplasty (V-only) (n = 15), and (iii) vaginoplasty and clitoroplasty (V+C) (n = 38).

Results

Fathers’ and urologists’ ratings of genital appearance were more favorable in the no-surgery group than in the V-only and V+C groups. Clitorophallic length was greater in the V+C group compared with the V-only group, with substantial overlap between groups. Mothers’ depressive and anxious symptoms were lower in the no-surgery group compared with the V-only and V+C groups.

Conclusions

Surgical decisions were associated with fathers’ and urologists’ ratings of genital appearance, the child's anatomic characteristics, and mothers’ depressive and anxious symptoms. Further research on surgical decision-making is needed to inform counseling practices.

中文翻译：

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探索性别发育差异中女性化生殖整形术决策的相关因素

 学习目的

生殖器发育被认为不典型的女性婴儿可能在生命早期接受女性化生殖器成形术（阴蒂成形术和/或阴道成形术）。我们试图找出与父母/照顾者为生殖器男性化的孩子进行生殖器成形术的决定相关的因素。

 设计

纵向观察研究

 环境

2015-2020 年美国 12 个具有多学科差异/性发育障碍诊所的儿科中心

 参加者

2 岁以下的儿童，其生殖器外观对于女性抚养者及其父母/照顾者来说不典型

干预措施/结果措施

从病历中提取了孩子手术前的诊断和解剖特征的数据。父母/照顾者完成了关于心理社会困扰、不确定性经历、孩子生殖器外观和人口特征的调查问卷。泌尿科医生对外观进行评价。对于研究队列中 58 名生殖器男性化被视为女孩或中性的患者，我们根据孩子随后的手术干预比较了 3 组的数据：(i) 没有手术（ n = 5），(ii)没有进行阴道成形术阴蒂成形术（仅 V）（ n = 15），以及（iii）阴道成形术和阴蒂成形术（V+C）（ n = 38）。

 结果

父亲和泌尿科医生对未手术组生殖器外观的评价比仅 V 组和 V+C 组更有利。与仅 V 组相比，V+C 组的阴蒂阴茎长度更长，组间有很大的重叠。与仅 V 组和 V+C 组相比，未手术组母亲的抑郁和焦虑症状较低。

 结论

手术决定与父亲和泌尿科医生对生殖器外观的评分、孩子的解剖特征以及母亲的抑郁和焦虑症状有关。需要对手术决策进行进一步研究，为咨询实践提供信息。