Clitoral surgery and sexual outcome in intersex conditions

Current surgery and medical treatment are not necessarily the best solution for a better outcome in intersex women. But any changes in the policy of sex-assignment might overrule the question of the necessity for genital surgery in some groups of individuals born with ambiguous genitalia. In the Sophia Children's Hospital in Rotterdam, sex-assignments in newborn babies with ambiguous genitalia are, since about 1995, usually male, except for girls with congenital adrenal hyperplasia and for undervirilised boys with partial androgen insensitivity syndrome. There is international consensus by the joint ESPE/LWPES working-group on congenital adrenal hyperplasia8 about the policy of genital surgery in affected girls. Although this protocol is clear about the age for surgery (between 2 and 12 months of age, and from adolescence onwards), it is not clear for the degree of virilisation. There is an unclear area between minimal clitoromegaly (no indication) and Prader 5 (indication for a one-stage complete repair with vaginoplasty and clitoral and labial surgery). Formulating criteria for genital surgery is not easy.