UroToday - A study by Crouch, et al. from the United Kingdom is the first study to evaluate genital sensitivity and sexual function in women with a history of congenital adrenal hyperplasia. The affects of feminizing genitoplasty on genital sensitivity have never been objectively evaluated until this study was performed.

The study had a total of 38 women. Of these 38 women, 28 had congenital adrenal hyperplasia and 10 were normal controls. The details of the surgery for these 28 women were obtained from a retrospective review of medical records. Sexual function was assessed using a standardized questionnaire measure. Utilizing a Genito-Sensory Analyzer, the sensitivity thresholds for the clitoris and upper vagina were measured.

The group found that of the 28 women with congenital adrenal hyperplasia, 24 had undergone a feminizing genitoplasty. These women who underwent this surgery had a significant impairment to sensitivity in the clitoris as compared to the 10 controls. There was no difference observed for the sensitivity threshold in the upper vagina where surgery had not been done on any of the women in either group. Interestingly the sensitivity thresholds in the 4 women with congenital adrenal hypoplasia who had no feminizing genitoplasty were similar to the 10 controls. Sexual dysfunction seemed to be more severe in the women who underwent feminizing genitoplasty. This was especially evident for vaginal penetration difficulties as well as decrease in intercourse frequency.

The group concluded that genital sensitivity is impaired in areas where feminizing genitoplasty was performed. They also found that impairment to sensitivity is linearly related to difficulties in sexual function. This study sheds a whole new light on feminizing genitoplasty, and will make us more cognizant of the future ramifications of this surgery in order to properly inform parents who are making a very difficult decision for their baby girl.

Crouch NS, Liao LM, Woodhouse CR, Conway GS, Creighton SM

J Urol. 2008 Feb;179(2):634-8
doi: 10.1016/j.juro.2007.09.079

Reported by UroToday Medical Editor Pasquale Casale, MD Assistant Professor, University of Pennsylvania University of Pennsylvania, Children's Hospital of Philadelphia

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