Whether or not to surgically correct ambiguous genitalia to be more female- or male-typical with genitoplasty is an area of pediatric medicine that is highly controversial. Suboptimal outcomes such as poor post-surgical cosmesis and sexual dysfunction following outdated surgical procedures have driven intense controversy in the medical community over how, or if, genitoplasty should be used in the treatment of young children with ambiguous genitalia. To resolve this debate, a prospective study of outcomes of current genitoplasty procedures, including complication rates associated with these procedures, is needed of individuals who receive masculinizing or feminizing surgery during early childhood. Additionally, studies of parents who decide to proceed, or not, with genitoplasty for their young child are necessary to understand how these controversial decisions impact parents'reactions to surgical outcomes for their child. The overall goal of this proposal is to assess the outcomes of modern genitoplasty techniques with a consideration of the psychological outcome of parents who make the decisions to proceed with genital surgery for their child. This information is crucial for physicians to provide guidance to parents regarding the optimal approach for the management of ambiguous genitalia in young children, including the possibility that no surgery is best. The interdisciplinary group of clinicians and researchers included in the proposed studies spans the fields of psychology, statistics, pediatric endocrinology, and pediatric urology. The collective experience of our group optimizes our ability to translate findings from the proposed studies to a clinical setting in a timely manner.
Information about the benefits and risks of modern approaches to genitoplasty in children with ambiguous genitalia due to Disorders of Sex Development (DSD) is lacking. We propose to prospectively study short-term cosmetic and urinary function outcomes of children following feminizing or masculinizing surgeries. Additionally, studies of how parents make decisions about if and when to have genitoplasty for their child, as well as the incidence of decisional regret after the fact, will be conducted.