The adult consequences of feminising genital surgery in infancy. A growing skepticism.

The Role of Surgery Current standard practice in Europe and North America advocates feminising genital surgery for all children with ambiguous genitalia assigned to a female sex of rearing. A standard infant feminising genitoplasty involves removal of some of the clitoris to reduce its size, construction of a vagina or opening the vaginal introitus and sometimes refashioning of the labia. In some European centres removal of the whole clitoris (clitorectomy) is still the procedure of choice for the enlarged clitoris. Proponents of feminising genitoplasty in infancy cite both psychological reasons such as stable gender identity development and a better psychosexual and psychosocial outcome as well as physical reasons such as menstruation and sexual intercourse in later life. It is important for clinicians to know whether all or any of these outcomes are achieved and this information can only be obtained by well designed long-term follow-up studies.