Surgery for Female Ambiguous Genitalia

Historically, in female pseudohermaphrodites a staged procedure with early clitoral reduction and delayed vaginoplasty was often the treatment of choice. In recent years several authors have described 1-stage genitoplasty that is performed in the first year of life. The 1stage procedure for clitoroplasty and vaginal exteriorization is preferable for an optimal functional and cosmetic result. Because of emotional aspects of the family in intersex cases, neonatal reconstruction offers advantages to the child and parents. Furthermore, the perinatal genital hyperstimulation by maternal and placental estrogens that persists into the first 3 to 4 weeks of life produces vaginal enlargement by mucous secretion and vaginal wall hypertrophy, facilitating identification of the cleavage planes and vaginal pull-through. These arguments have led us to treat these patients by neonatal 1 stage clitorovaginoplasty. Cosmetic and functional results in 5 consecutive cases have been excellent without serious complications.