Long-term Outcomes of Feminizing Genitoplasty in DSD: Genital Morphology, Sensitivity, Sexual Function, and Satisfaction.

Abstract

Context: Understanding long-term outcomes and patient satisfaction with feminizing genitoplasty (FG) in patients with differences of sexual development (DSD) is crucial for optimizing treatment protocols.

Objective: To evaluate long-term morphological and functional results and patients' satisfaction in a cohort of DSD patients submitted to FG.

Design: Cross-sectional and retrospective cohort study conducted from 1965 to 2016 with follow-up assessments.

Setting: Tertiary care center.

Patients or other participants: Sixty DSD female patients, including 36 with congenital adrenal hyperplasia (CAH) and 24 with non-CAH DSD etiology, who underwent FG.

Interventions: FG procedures were performed, and results were analyzed based on age at surgery and surgical techniques used.

Main outcome measures: Surgical results, genital sensitivity, sexual function, and patient satisfaction.

Results: Ninety-one percent of patients had normal clitoral size, and 85% had separated perineal orifices. Three patients with persistent urogenital sinus did not report symptoms. Genital sensitivity to mechanical and vibratory stimuli was similar to control groups. No CAH patients experienced overall sexual dysfunction, while 3 non-CAH patients and 4 control women reported reduced sexual desire and arousal. Eighty-nine percent of patients preferred surgery during childhood, and 97% were satisfied with their surgical outcomes.

Conclusion: FG outcomes in this cohort were satisfactory, with no significant impact on genital sensitivity or sexual function. Most patients preferred early surgery and reported high satisfaction with the results. Further studies are needed to confirm these findings in broader populations.